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. 1992 May;47(5):372–376. doi: 10.1136/thx.47.5.372

Pulmonary complications after long term amiodarone treatment.

J Roca 1, M Heras 1, R Rodriguez-Roisin 1, J Magriñà 1, A Xaubet 1, G Sanz 1
PMCID: PMC463754  PMID: 1609381

Abstract

BACKGROUND: Amiodarone hydrochloride is an antiarrhythmic agent useful in arrhythmias refractory to standard therapy. Although interstitial pneumonitis is known to be its most serious side effect, several aspects of amiodarone lung toxicity are still controversial. METHODS: Pulmonary side effects were examined in a sample of 61 symptomless patients (mean (SD) age 55 (7) years) who had had long term treatment with amiodarone (daily maintenance dose 400 mg), selected from 482 men attending the University of Barcelona myocardial infarction project. To allow for the confounding effects of coronary artery disease and tobacco history on lung function, 46 patients who had taken amiodarone for more than one year were matched with a control group from the same population. Subjects underwent measurement of lung volumes, arterial blood gas analysis and an incremental bicycle exercise test. RESULTS: Most lung function values were close to predicted values, though there was a small increase in resting alveolar-arterial oxygen tension difference (A-aDO2) at rest (4.8 (1.4) kPa in both groups). There were no differences in the results of forced spirometry or static lung volumes between the two groups, or in the fall in A-aDO2 from rest to exercise. There was a small difference between the amiodarone and the control group in transfer factor for carbon monoxide corrected for lung volume (KCO 1.67 (0.3) and 1.83 (0.3) mmol min-1 kPa-1 l-1 respectively) and in exercise capacity (140 (25) and 120 (30)w). Only three patients showed lung function impairment consistent with pneumonitis. No relation between lung function measures and cumulative doses of amiodarone or desethylamiodarone was found. CONCLUSIONS: The prevalence of clinically evident pulmonary side effects was 4.9%, which is lower than that reported in studies in which higher daily maintenance doses of amiodarone were given. The slightly lower KCO values and lower work load achieved by the patients taking amiodarone suggest a small effect of amiodarone in doses of 400 mg on lung function. A role for individual susceptibility to pulmonary complications of amiodarone treatment is suggested.

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Selected References

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  1. Adams G. D., Kehoe R., Lesch M., Glassroth J. Amiodarone-induced pneumonitis. Assessment of risk factors and possible risk reduction. Chest. 1988 Feb;93(2):254–263. doi: 10.1378/chest.93.2.254. [DOI] [PubMed] [Google Scholar]
  2. Akoun G. M., Gauthier-Rahman S., Milleron B. J., Perrot J. Y., Mayaud C. M. Amiodarone-induced hypersensitivity pneumonitis. Evidence of an immunological cell-mediated mechanism. Chest. 1984 Jan;85(1):133–135. doi: 10.1378/chest.85.1.133. [DOI] [PubMed] [Google Scholar]
  3. Crystal R. G., Gadek J. E., Ferrans V. J., Fulmer J. D., Line B. R., Hunninghake G. W. Interstitial lung disease: current concepts of pathogenesis, staging and therapy. Am J Med. 1981 Mar;70(3):542–568. doi: 10.1016/0002-9343(81)90577-5. [DOI] [PubMed] [Google Scholar]
  4. Darmanata J. I., van Zandwijk N., Düren D. R., van Royen E. A., Mooi W. J., Plomp T. A., Jansen H. M., Durrer D. Amiodarone pneumonitis: three further cases with a review of published reports. Thorax. 1984 Jan;39(1):57–64. doi: 10.1136/thx.39.1.57. [DOI] [PMC free article] [PubMed] [Google Scholar]
  5. Ferris B. G. Epidemiology Standardization Project (American Thoracic Society). Am Rev Respir Dis. 1978 Dec;118(6 Pt 2):1–120. [PubMed] [Google Scholar]
  6. Goldman L., Hashimoto B., Cook E. F., Loscalzo A. Comparative reproducibility and validity of systems for assessing cardiovascular functional class: advantages of a new specific activity scale. Circulation. 1981 Dec;64(6):1227–1234. doi: 10.1161/01.cir.64.6.1227. [DOI] [PubMed] [Google Scholar]
  7. Heger J. J., Prystowsky E. N., Jackman W. M., Naccarelli G. V., Warfel K. A., Rinkenberger R. L., Zipes D. P. Clinical efficacy and electrophysiology during long-term therapy for recurrent ventricular tachycardia or ventricular fibrillation. N Engl J Med. 1981 Sep 3;305(10):539–545. doi: 10.1056/NEJM198109033051002. [DOI] [PubMed] [Google Scholar]
  8. Heras M., Roca J., Sanz G., Rodríguez-Roisín R., Navarro F., Magriñ M., Agustí-Vidal A., Betriu A. Alteraciones subclínicas producidas por el tratamiento prolongado con amiodarona. Rev Esp Cardiol. 1987 Jan-Feb;40(1):44–50. [PubMed] [Google Scholar]
  9. Israël-Biet D., Venet A., Caubarrère I., Bonan G., Danel C., Chrétien J., Hance A. J. Bronchoalveolar lavage in amiodarone pneumonitis. Cellular abnormalities and their relevance to pathogenesis. Chest. 1987 Feb;91(2):214–221. doi: 10.1378/chest.91.2.214. [DOI] [PubMed] [Google Scholar]
  10. Kopelman H. A., Horowitz L. N. Efficacy and toxicity of amiodarone for the treatment of supraventricular tachyarrhythmias. Prog Cardiovasc Dis. 1989 Mar-Apr;31(5):355–366. doi: 10.1016/0033-0620(89)90030-3. [DOI] [PubMed] [Google Scholar]
  11. Kudenchuk P. J., Pierson D. J., Greene H. L., Graham E. L., Sears G. K., Trobaugh G. B. Prospective evaluation of amiodarone pulmonary toxicity. Chest. 1984 Oct;86(4):541–548. doi: 10.1378/chest.86.4.541. [DOI] [PubMed] [Google Scholar]
  12. Magro S. A., Lawrence E. C., Wheeler S. H., Krafchek J., Lin H. T., Wyndham C. R. Amiodarone pulmonary toxicity: prospective evaluation of serial pulmonary function tests. J Am Coll Cardiol. 1988 Sep;12(3):781–788. doi: 10.1016/0735-1097(88)90321-x. [DOI] [PubMed] [Google Scholar]
  13. Marchlinski F. E., Gansler T. S., Waxman H. L., Josephson M. E. Amiodarone pulmonary toxicity. Ann Intern Med. 1982 Dec;97(6):839–845. doi: 10.7326/0003-4819-97-6-839. [DOI] [PubMed] [Google Scholar]
  14. Martin W. J., Howard D. M. Amiodarone-induced lung toxicity. In vitro evidence for the direct toxicity of the drug. Am J Pathol. 1985 Sep;120(3):344–350. [PMC free article] [PubMed] [Google Scholar]
  15. Mason J. W. Amiodarone. N Engl J Med. 1987 Feb 19;316(8):455–466. doi: 10.1056/NEJM198702193160807. [DOI] [PubMed] [Google Scholar]
  16. Olsen T., Laurberg P., Weeke J. Low serum triiodothyronine and high serum reverse triiodothyronine in old age: an effect of disease not age. J Clin Endocrinol Metab. 1978 Nov;47(5):1111–1115. doi: 10.1210/jcem-47-5-1111. [DOI] [PubMed] [Google Scholar]
  17. Rakita L., Sobol S. M., Mostow N., Vrobel T. Amiodarone pulmonary toxicity. Am Heart J. 1983 Oct;106(4 Pt 2):906–916. doi: 10.1016/0002-8703(83)90015-7. [DOI] [PubMed] [Google Scholar]
  18. Roca J., Rodriguez-Roisin R., Cobo E., Burgos F., Perez J., Clausen J. L. Single-breath carbon monoxide diffusing capacity prediction equations from a Mediterranean population. Am Rev Respir Dis. 1990 Apr;141(4 Pt 1):1026–1032. doi: 10.1164/ajrccm/141.4_Pt_1.1026. [DOI] [PubMed] [Google Scholar]
  19. Roca J., Sanchis J., Agusti-Vidal A., Segarra F., Navajas D., Rodriguez-Roisin R., Casan P., Sans S. Spirometric reference values from a Mediterranean population. Bull Eur Physiopathol Respir. 1986 May-Jun;22(3):217–224. [PubMed] [Google Scholar]
  20. Rosenbaum M. B., Chiale P. A., Halpern M. S., Nau G. J., Przybylski J., Levi R. J., Lázzari J. O., Elizari M. V. Clinical efficacy of amiodarone as an antiarrhythmic agent. Am J Cardiol. 1976 Dec;38(7):934–944. doi: 10.1016/0002-9149(76)90807-9. [DOI] [PubMed] [Google Scholar]
  21. Rotmensch H. H., Belhassen B., Swanson B. N., Shoshani D., Spielman S. R., Greenspon A. J., Greenspan A. M., Vlasses P. H., Horowitz L. N. Steady-state serum amiodarone concentrations: relationships with antiarrhythmic efficacy and toxicity. Ann Intern Med. 1984 Oct;101(4):462–469. doi: 10.7326/0003-4819-101-4-462. [DOI] [PubMed] [Google Scholar]
  22. Rotmensch H. H., Liron M., Tupilski M., Laniado S. Possible association of pneumonitis with amiodarone therapy. Am Heart J. 1980 Sep;100(3):412–413. doi: 10.1016/0002-8703(80)90165-9. [DOI] [PubMed] [Google Scholar]
  23. Sanz G., Castañer A., Betriu A., Magriña J., Roig E., Coll S., Paré J. C., Navarro-López F. Determinants of prognosis in survivors of myocardial infarction: a prospective clinical angiographic study. N Engl J Med. 1982 May 6;306(18):1065–1070. doi: 10.1056/NEJM198205063061801. [DOI] [PubMed] [Google Scholar]
  24. Xaubet A., Roca J., Rodriguez-Roisin R., Herranz J., Marin A., Lomeña F., Montserrat J. M., Agustí-Vidal A. Bronchoalveolar lavage cellular analysis and gallium lung scan in the assessment of patients with amiodarone-induced pneumonitis. Respiration. 1987;52(4):272–280. doi: 10.1159/000195336. [DOI] [PubMed] [Google Scholar]

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