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Emergency Medicine Journal : EMJ logoLink to Emergency Medicine Journal : EMJ
. 2006 Aug;23(8):660. doi: 10.1136/emj.2005.033860

Amiodarone induced thrombophlebitis

R Showkathali 1, M J Earley 1, S Sporton 1
PMCID: PMC2564183  PMID: 16858113

Thrombophlebitis of peripheral vein is a well recognised complication of intravenous amiodarone use in high doses (300–1200 mg) or prolonged infusion. This case demonstrates that even smaller doses of amiodarone can cause significant thrombophlebitis, if given in a small vein.

A 79‐year‐old man presented to his local emergency department with haemodynamically stable ventricular tachycardia. Amiodarone, 150 mg, was given via a 20‐gauge cannula into a small vein on the dorsum of his left hand. Figure 1, a photograph of the hand, was taken 72 h after his original admission and shows severe amiodarone induced thrombophlebitis. Although thrombophlebitis is a well recognised complication of intravenous amiodarone, this is usually caused by high doses (300–1200 mg) or prolonged administration in a peripheral vein. A meta‐analysis of 18 randomised controlled trials studying intravenous amiodarone to convert atrial fibrillation reported a rate of 8% of phlebitis among the 550 patients who received amiodarone.1

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Figure 1 Severe amiodarone induced thrombophlebitis.

This case clearly demonstrates that even small doses of amiodarone can cause significant thrombophlebitis, if given in a small vein. In cases where peripheral administration is necessary a large bore cannula in the largest vein available should be used.

References

  • 1.Hilleman D E, Spinler S A. Conversion of recent‐onset atrial fibrillation with intravenous amiodarone: a meta‐analysis of randomized controlled trials. Pharmacotherapy 20022266–74. [DOI] [PubMed] [Google Scholar]

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