Am Fam Physician. 2004 Oct 15;70(8):1448.
to the editor: I read with interest the excellent article1 by Dr. Siddoway on the clinical use of the antiarrhythmic drug amiodarone (Cordarone) that appeared in the December 1, 2003, issue of American Family Physician. The author clearly presented the effectiveness and adverse effects related to this therapy that has been used intravenously or orally to convert and prevent recurrences of cardiac arrhythmias. However, there was no mention in the article1 of thrombophlebitis, a common complication associated with intravenous amiodarone.2
Recent studies3 have reported rates of phlebitis as high as 16 percent with the intravenous administration of amiodarone. A meta-analysis4 of 18 randomized controlled trials studying intravenous amiodarone to convert atrial fibrillation reported an 8 percent rate of phlebitis among the 550 patients who received amiodarone. In this systematic review,4 phlebitis was the most common adverse effect of the drug, followed by bradycardia (4 percent of patients) and hypotension (2 percent of patients).
Thrombophlebitis usually occurs when high doses of amiodarone are infused over a long period in peripheral veins. Thus, to avoid this side effect, the drug should be administered in a peripheral vein for a maximum of 24 hours. Afterwards, the drug must be used orally or a central vein access should be considered.5 By following these precautions, this minor but frequent complication can be avoided.
1. Siddoway LA. Amiodarone: guidelines for use and monitoring. Am Fam Physician. 2003;68:2189–96.
2. Aravanis C. Acute thrombophlebitis due to IV use of amiodarone. Chest. 1982;82:515–6.
3. Vardas PE, Kochiadakis GE, Igoumenidis NE, Tsatsakis AM, Simantirakis EN, Chlouverakis GI. Amiodarone as a first-choice drug for restoring sinus rhythm in patients with atrial fibrillation: a randomized, controlled study. Chest. 2000;117:1538–45.
4. Hilleman DE, Spinler SA. Conversion of recent-onset atrial fibrillation with intravenous amiodarone: a meta-analysis of randomized controlled trials. Pharmacotherapy. 2002;22:66–74.
5. Faniel R, Schoenfeld P. Efficacy of i.v. amiodarone in converting rapid atrial fibrillation and flutter to sinus rhythm in intensive care patients. Eur Heart J. 1983;4:180–5.
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