Details
Stereochemistry | ACHIRAL |
Molecular Formula | C25H29I2NO3 |
Molecular Weight | 645.3116 |
Optical Activity | NONE |
Defined Stereocenters | 0 / 0 |
E/Z Centers | 0 |
Charge | 0 |
SHOW SMILES / InChI
SMILES
CCCCC1=C(C(=O)C2=CC(I)=C(OCCN(CC)CC)C(I)=C2)C3=C(O1)C=CC=C3
InChI
InChIKey=IYIKLHRQXLHMJQ-UHFFFAOYSA-N
InChI=1S/C25H29I2NO3/c1-4-7-11-22-23(18-10-8-9-12-21(18)31-22)24(29)17-15-19(26)25(20(27)16-17)30-14-13-28(5-2)6-3/h8-10,12,15-16H,4-7,11,13-14H2,1-3H3
DescriptionCurator's Comment: description was created based on several sources, including:
https://www.drugs.com/pro/amiodarone.html | DOI: 10.1007/978-1-4613-2827-8_26
Curator's Comment: description was created based on several sources, including:
https://www.drugs.com/pro/amiodarone.html | DOI: 10.1007/978-1-4613-2827-8_26
Amiodarone is an antiarrhythmic with mainly class III properties, but it possesses electrophysiologic characteristics of all four Vaughan Williams classes. Like class I drugs, amiodarone blocks sodium channels at rapid pacing frequencies, and like class II drugs, amiodarone exerts a noncompetitive antisympathetic action. In addition to blocking sodium channels, amiodarone blocks myocardial potassium channels, which contributes to slowing of conduction and prolongation of refractoriness. It is indicated for initiation of treatment and prophylaxis of frequently recurring ventricular fibrillation and hemodynamically unstable ventricular tachycardia in patients refractory to other therapy. The most common adverse reactions (1-2%) leading to discontinuation of intravenous amiodarone therapy are hypotension, asystole/cardiac arrest/pulseless electrical activity, VT, and cardiogenic shock. Other important adverse reactions are, torsade de pointes (TdP), congestive heart failure, and liver function test abnormalities. Fluoroquinolones, macrolide antibiotics, and azoles are known to cause QTc prolongation. There have been reports of QTc prolongation, with or without TdP, in patients taking amiodarone when fluoroquinolones, macrolide antibiotics, or azoles were administered concomitantly. Since amiodarone is a substrate for CYP3A and CYP2C8, drugs/substances that inhibit these isoenzymes may decrease the metabolism and increase serum concentration of amiodarone.
CNS Activity
Sources: https://www.ncbi.nlm.nih.gov/pubmed/4096733
Curator's Comment: The penetration of amiodarone into brain is poor.
Originator
Approval Year
Targets
Primary Target | Pharmacology | Condition | Potency |
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Target ID: CHEMBL2094118 |
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Target ID: CHEMBL240 |
9.8 µM [IC50] | ||
Target ID: Voltage-gated T-type calcium channel (guinea pig) Sources: https://www.ncbi.nlm.nih.gov/pubmed/1281221 |
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Target ID: Voltage-gated L-type calcium channel (guinea pig) Sources: https://www.ncbi.nlm.nih.gov/pubmed/1281221 |
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Target ID: CHEMBL2364675 |
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Target ID: CHEMBL3721 |
Conditions
Condition | Modality | Targets | Highest Phase | Product |
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Primary | PACERONE Approved UseAmiodarone injection is indicated for initiation of treatment and prophylaxis of frequently recurring ventricular fibrillation (VF) and hemodynamically unstable ventricular tachycardia (VT) in patients refractory to other therapy. Amiodarone also can be used to treat patients with VT/VF for whom oral amiodarone is indicated, but who are unable to take oral medication. During or after treatment with amiodarone, patients may be transferred to oral amiodarone therapy. Launch Date1998 |
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Primary | PACERONE Approved UseAmiodarone injection is indicated for initiation of treatment and prophylaxis of frequently recurring ventricular fibrillation (VF) and hemodynamically unstable ventricular tachycardia (VT) in patients refractory to other therapy. Amiodarone also can be used to treat patients with VT/VF for whom oral amiodarone is indicated, but who are unable to take oral medication. During or after treatment with amiodarone, patients may be transferred to oral amiodarone therapy [ see Dosage and Administration (2) Launch Date1998 |
Cmax
Value | Dose | Co-administered | Analyte | Population |
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23.8 ng/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/21052689/ |
2.5 mg/kg single, intravenous dose: 2.5 mg/kg route of administration: Intravenous experiment type: SINGLE co-administered: |
DESETHYLAMIODARONE serum | Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: UNKNOWN |
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13660 ng/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/21052689/ |
5 mg/kg single, intravenous dose: 5 mg/kg route of administration: Intravenous experiment type: SINGLE co-administered: |
AMIODARONE serum | Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: UNKNOWN |
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2920 ng/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/21052689/ |
1.25 mg/kg single, intravenous dose: 1.25 mg/kg route of administration: Intravenous experiment type: SINGLE co-administered: |
AMIODARONE serum | Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: UNKNOWN |
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7140 ng/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/21052689/ |
2.5 mg/kg single, intravenous dose: 2.5 mg/kg route of administration: Intravenous experiment type: SINGLE co-administered: |
AMIODARONE serum | Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: UNKNOWN |
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41.2 ng/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/21052689/ |
5 mg/kg single, intravenous dose: 5 mg/kg route of administration: Intravenous experiment type: SINGLE co-administered: |
DESETHYLAMIODARONE serum | Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: UNKNOWN |
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9 ng/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/21052689/ |
1.25 mg/kg single, intravenous dose: 1.25 mg/kg route of administration: Intravenous experiment type: SINGLE co-administered: |
DESETHYLAMIODARONE serum | Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: UNKNOWN |
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1.7 mg/L EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/6851030/ |
800 mg single, oral dose: 800 mg route of administration: Oral experiment type: SINGLE co-administered: |
AMIODARONE serum | Homo sapiens population: UNKNOWN age: UNKNOWN sex: UNKNOWN food status: UNKNOWN |
AUC
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
16600 ng × h/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/21052689/ |
5 mg/kg single, intravenous dose: 5 mg/kg route of administration: Intravenous experiment type: SINGLE co-administered: |
AMIODARONE serum | Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: UNKNOWN |
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3600 ng × h/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/21052689/ |
1.25 mg/kg single, intravenous dose: 1.25 mg/kg route of administration: Intravenous experiment type: SINGLE co-administered: |
AMIODARONE serum | Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: UNKNOWN |
|
8100 ng × h/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/21052689/ |
2.5 mg/kg single, intravenous dose: 2.5 mg/kg route of administration: Intravenous experiment type: SINGLE co-administered: |
AMIODARONE serum | Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: UNKNOWN |
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16900 ng × h/mL EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/21052689/ |
5 mg/kg single, intravenous dose: 5 mg/kg route of administration: Intravenous experiment type: SINGLE co-administered: |
DESETHYLAMIODARONE serum | Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: UNKNOWN |
T1/2
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
14.6 day EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/21052689/ |
5 mg/kg single, intravenous dose: 5 mg/kg route of administration: Intravenous experiment type: SINGLE co-administered: |
AMIODARONE serum | Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: UNKNOWN |
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14.2 day EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/21052689/ |
5 mg/kg single, intravenous dose: 5 mg/kg route of administration: Intravenous experiment type: SINGLE co-administered: |
DESETHYLAMIODARONE serum | Homo sapiens population: HEALTHY age: ADULT sex: MALE food status: UNKNOWN |
|
4.62 h EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/6851030/ |
800 mg single, oral dose: 800 mg route of administration: Oral experiment type: SINGLE co-administered: |
AMIODARONE serum | Homo sapiens population: UNKNOWN age: UNKNOWN sex: UNKNOWN food status: UNKNOWN |
Funbound
Value | Dose | Co-administered | Analyte | Population |
---|---|---|---|---|
0.023% EXPERIMENT https://pubmed.ncbi.nlm.nih.gov/3242577/ |
200 mg 1 times / day multiple, oral dose: 200 mg route of administration: Oral experiment type: MULTIPLE co-administered: |
AMIODARONE plasma | Homo sapiens population: UNHEALTHY age: ADULT sex: FEMALE / MALE food status: UNKNOWN |
Overview
CYP3A4 | CYP2C9 | CYP2D6 | hERG |
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OverviewOther
Other Inhibitor | Other Substrate | Other Inducer |
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Drug as perpetrator
Target | Modality | Activity | Metabolite | Clinical evidence |
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yes [IC50 15 uM] | yes (co-administration study) Comment: reversible inhibition; The area under the plasma concentration-time curve (AUC) of metoprolol increased from 767 before to 1,387 ug * hours/L after the amiodarone loading dose |
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yes [IC50 5.48 uM] | ||||
yes [IC50 >50 uM] | yes (co-administration study) Comment: reversible inhibition; After treatment with 3 g amiodarone (phase I), this parameter (AUC of lidocaine) increased to 135.3 ± 34.6 (p = 0.016), whereas the AUC of MEGEX decreased from 19.2 ± 6.5 to 15.8 ± 8.3 μg/min/ml (p = 0.04). |
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yes [IC50 >50 uM] | yes (co-administration study) Comment: reversible inhibition; The mean warfarin AUC during the amiodarone regimen increased to 200% of the control value of anticoagulant alone, from 624 ± 59 Rg/ml-hr to 1249 ± 115 p,g/ml-hr, a significant difference |
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yes [IC50 >50 uM] | yes (co-administration study) Comment: reversible inhibition; The mean warfarin AUC during the amiodarone regimen increased to 200% of the control value of anticoagulant alone, from 624 ± 59 Rg/ml-hr to 1249 ± 115 p,g/ml-hr, a significant difference |
Drug as victim
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
yes | likely (co-administration study) Comment: CYP450 inhibitors: grapefruit juice, certain fluoroquinolone and macrolide antibiotics, azole antifungals, cimetidine, certain protease inhibitors: increased exposure of amiodarone. Avoid concomitant use. CYP450 inducers (St. John's Wort): reduced amiodarone serum levels Sources: https://pubmed.ncbi.nlm.nih.gov/11038157/ |
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yes | likely (co-administration study) Comment: CYP450 inhibitors: grapefruit juice, certain fluoroquinolone and macrolide antibiotics, azole antifungals, cimetidine, certain protease inhibitors: increased exposure of amiodarone. Avoid concomitant use. CYP450 inducers (St. John's Wort): reduced amiodarone serum levels Sources: https://pubmed.ncbi.nlm.nih.gov/11038157/ |
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yes | likely (co-administration study) Comment: CYP450 inhibitors: grapefruit juice, certain fluoroquinolone and macrolide antibiotics, azole antifungals, cimetidine, certain protease inhibitors: increased exposure of amiodarone. Avoid concomitant use. CYP450 inducers (St. John's Wort): reduced amiodarone serum levels Sources: https://pubmed.ncbi.nlm.nih.gov/11038157/ |
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yes | likely (co-administration study) Comment: CYP450 inhibitors: grapefruit juice, certain fluoroquinolone and macrolide antibiotics, azole antifungals, cimetidine, certain protease inhibitors: increased exposure of amiodarone. Avoid concomitant use. CYP450 inducers (St. John's Wort): reduced amiodarone serum levels Page: 9.0 |
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yes | likely (co-administration study) Comment: CYP450 inhibitors: grapefruit juice, certain fluoroquinolone and macrolide antibiotics, azole antifungals, cimetidine, certain protease inhibitors: increased exposure of amiodarone. Avoid concomitant use. CYP450 inducers (St. John's Wort): reduced amiodarone serum levels Sources: https://pubmed.ncbi.nlm.nih.gov/11038157/ |
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yes | likely (co-administration study) Comment: CYP450 inhibitors: grapefruit juice, certain fluoroquinolone and macrolide antibiotics, azole antifungals, cimetidine, certain protease inhibitors: increased exposure of amiodarone. Avoid concomitant use. CYP450 inducers (St. John's Wort): reduced amiodarone serum levels Page: 9.0 |
Tox targets
Target | Modality | Activity | Metabolite | Clinical evidence |
---|---|---|---|---|
PubMed
Title | Date | PubMed |
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[Amiodarone induced retrobulbar neuritis. Clinical case]. | 1999 Jul |
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Effects of chronic treatment by amiodarone on transmural heterogeneity of canine ventricular repolarization in vivo: interactions with acute sotalol. | 1999 Nov |
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Amiodarone induced lupus. | 1999 Oct |
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Catheter ablation of atrial flutter due to amiodarone therapy for paroxysmal atrial fibrillation. | 2000 Apr |
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Depressed heart rate variability identifies postinfarction patients who might benefit from prophylactic treatment with amiodarone: a substudy of EMIAT (The European Myocardial Infarct Amiodarone Trial). | 2000 Apr |
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Amiodarone-induced AV block and ventricular standstill. A forme fruste of an idiopathic long QT syndrome. | 2000 Aug |
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[Toxic hepatitis caused by intravenous amiodarone]. | 2000 Dec 9 |
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Ocular toxicity of systemic medications: a case series. | 2000 Jan |
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Amiodarone: clinical trials. | 2000 Jan |
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Cardiovascular studies on different classes of soft drugs. | 2000 Mar |
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[Amiodarone-associated optic neuropathy: an independent syndrome? Three patients with bilateral optic neuropathy]. | 2000 Sep |
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Protection against drug- and chemical-induced multiorgan toxicity by a novel IH636 grape seed proanthocyanidin extract. | 2001 |
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The effects of amiodarone on the thyroid. | 2001 Apr |
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[Radiofrequency catheter ablation in children with Wolff-Parkinson-White syndrome and sudden cardiac death who had been resuscitated]. | 2001 Apr |
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Amiodarone stimulates interleukin-6 production in cultured human thyrocytes, exerting cytotoxic effects on thyroid follicles in suspension culture. | 2001 Feb |
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Oral anticoagulants. Pharmacologic issues for use in the elderly. | 2001 Feb |
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Inhibitory effects of CYP3A4 substrates and their metabolites on P-glycoprotein-mediated transport. | 2001 Feb |
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Pharmacologic management of atrial fibrillation: current therapeutic strategies. | 2001 Feb |
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Metabolism of amiodarone (part I): identification of a new hydroxylated metabolite of amiodarone. | 2001 Feb |
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Bioavailability of amiodarone tablets administered with and without food in healthy subjects. | 2001 Feb 15 |
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Thyroid hormone and the cardiovascular system. | 2001 Feb 15 |
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Impressive amelioration of clinical (NYHA class) and echocardiographic parameters in heart failure patients treated with amiodarone and carvedilol. | 2001 Jan |
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Predictors of failure of transoesophageal cardioversion of common atrial flutter. | 2001 Jan |
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[Incidence and timing of thyroid dysfunction with long-term amiodarone therapy]. | 2001 Jan |
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Amiodarone-induced thyrotoxicosis. | 2001 Jan |
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Development of heart failure in bradycardic sick sinus syndrome. | 2001 Jan |
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Thyroidectomy for selected patients with thyrotoxicosis. | 2001 Jan |
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The frequency analysis of signal-averaged ECG of P wave as predictor of efficacy of class III antiarrhythmic drugs to maintain sinus rhythm in recurrent idiopathic atrial fibrillation. | 2001 Jan |
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Dofetilide: a new class III antiarrhythmic agent. | 2001 Jan |
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The effect of amiodarone and/or antioxidant treatment on splenocyte blast transformation. | 2001 Jan |
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Heart rate variability and early recurrence of atrial fibrillation after electrical cardioversion. | 2001 Jan |
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Arrhythmogenic right ventricular dysplasia. | 2001 Jan |
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Amiodarone is safe and highly effective therapy for supraventricular tachycardia in infants. | 2001 Jan |
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Intravenous antiarrhythmic agents. | 2001 Jan |
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Chemical cardioversion of atrial fibrillation or flutter with ibutilide in patients receiving amiodarone therapy. | 2001 Jan 16 |
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"Stable" ventricular tachycardia is not a benign rhythm : insights from the antiarrhythmics versus implantable defibrillators (AVID) registry. | 2001 Jan 16 |
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Amiodarone-induced hyperthyroidism. | 2001 Jan 22 |
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Risk of torsades de pointes with non-cardiac drugs. Prolongation of QT interval is probably a class effect of fluoroquinolones. | 2001 Jan 6 |
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Efficacy of sequential antiarrhythmic treatment in sinus rhythm maintenance after successful electrocardioversion in patients with chronic non-valvular atrial fibrillation. | 2001 Jan-Feb |
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Torsade de pointes induced by intravenous and long-term oral amiodarone therapy in a patient with dilated cardiomyopathy. | 2001 Mar |
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The role of pharmacologic treatment to prevent sudden death in the implantable cardioverter defibrillator era. | 2001 Mar |
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Moxifloxacin: clinical efficacy and safety. | 2001 Mar 1 |
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Cost-effectiveness of the implantable cardioverter-defibrillator: results from the Canadian Implantable Defibrillator Study (CIDS). | 2001 Mar 13 |
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[Hyperthyroidism and heart]. | 2001 Mar 15 |
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Visual compatibility of amiodarone hydrochloride injection with various intravenous drugs. | 2001 Mar 15 |
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Patients at lower risk of arrhythmia recurrence: a subgroup in whom implantable defibrillators may not offer benefit. Antiarrhythmics Versus Implantable Defibrillator (AVID) Trial Investigators. | 2001 Mar 15 |
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Circadian variation of paroxysmal atrial fibrillation. PA3 Investigators. Atrial Pacing Peri-ablation for Prevention of Atrial Fibrillation Trial. | 2001 Mar 15 |
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Short- and long-term effects of amiodarone on the two components of cardiac delayed rectifier K(+) current. | 2001 Mar 6 |
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How to manage atrial fibrillation: an update on recent clinical trials. | 2001 Mar-Apr |
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Prenatal diagnosis of junctional ectopic tachycardia. | 2001 Mar-Apr |
Sample Use Guides
In Vivo Use Guide
Sources: https://www.drugs.com/dosage/amiodarone.html
Intravenous: Initial dose: 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen:
-Loading infusions: 150 mg over the first 10 minutes (15 mg/min), followed by 360 mg over the next 6 hours (1 mg/min)
-Maintenance infusion: 540 mg over the remaining 18 hours (0.5 mg/min)
Maintenance dose: After the first 24 hours, continue the maintenance infusion rate of 0.5 mg/min; may increase infusion rate to achieve effective arrhythmia suppression.
-Supplemental infusions: 150 mg over 10 minutes (15 mg/min) for breakthrough episodes of ventricular fibrillation (VF) or hemodynamically unstable ventricular tachycardia(VT)
Maximum dose: Initial infusion rate: 30 mg/min
Oral: Loading dose: 800 to 1600 mg orally per day for 1 to 3 weeks (occasionally longer) until adequate arrhythmia control is achieved or if side effects become prominent, then switch to adjustment dose
Adjustment dose: 600 to 800 mg orally per day for 1 month, then switch to maintenance dose
Maintenance dose: 400 mg orally per day
Route of Administration:
Other
In Vitro Use Guide
Sources: https://www.ncbi.nlm.nih.gov/pubmed/8156930
At concentrations ranging from 75-200 uM, amiodarone induced a significant and dose-dependent release of 51Cr in FRTL-5 cells. In the same molar concentrations, amiodarone was also cytotoxic in CHO cells. In hTF, the release of 51Cr produced by amiodarone occurred at a lower concentration (37.5 vs. 75 uM) and was significantly greater than that in FRTL-5 cells.
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Classification Tree | Code System | Code | ||
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NCI_THESAURUS |
C47793
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UCSF-FDA TRANSPORTAL |
AMIODARONE
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WHO-VATC |
QC01BD01
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FDA ORPHAN DRUG |
70292
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NDF-RT |
N0000175426
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WHO-ESSENTIAL MEDICINES LIST |
12.2
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NCI_THESAURUS |
C93038
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LIVERTOX |
NBK548109
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WHO-ATC |
C01BD01
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100000089825
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DTXSID7022592
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2566
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N0000182141
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PRIMARY | Cytochrome P450 3A4 Inhibitors [MoA] | ||
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D000638
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DB01118
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N3RQ532IUT
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703
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217-772-1
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AMIODARONE
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176
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N0000182138
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PRIMARY | Cytochrome P450 1A2 Inhibitors [MoA] | ||
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1951-25-3
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SUB05451MIG
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2157
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C62002
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N0000185503
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PRIMARY | P-Glycoprotein Inhibitors [MoA] | ||
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N3RQ532IUT
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2663
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CHEMBL633
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N0000185504
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PRIMARY | Cytochrome P450 2C9 Inhibitors [MoA] | ||
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m1748
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PRIMARY | Merck Index | ||
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N0000182137
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PRIMARY | Cytochrome P450 2D6 Inhibitors [MoA] | ||
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Amiodarone
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2012
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ACTIVE MOIETY
METABOLITE (PARENT)
METABOLITE (PARENT)
METABOLITE (PARENT)
METABOLITE (PARENT)
METABOLITE (PARENT)
METABOLITE ACTIVE (PARENT)
SALT/SOLVATE (PARENT)