| Advice for avoiding Drug-Related Problems DRPs due to treatment with amiodarone |
| Warfarin Reduce/give half-dose warfarin at start-up. Monitor the INR values (1) |
| Digitoxin Give half dose digitoxin/digoxin and monitor digitoxin/digoxin determined by procedure (2) |
| Simvastatin No doses above 20 mg or switch to another statin. (3) |
| Atorvastatin Note the dose! No clear recommendations, but maximum 40 mg |
| Metoprolol Bradycardia? The dose may be adjusted (4) |
| General advice |
| When admitted from other hospitals |
| Note in the drug curve if recently treated with amiodarone! |
| Discharge summaries |
| Explain why the GP should follow up the blood values; INR, digitoxin/digoxin and possibly CK. |
| 1. Edvin SB et al, An evaluation of early pharmacodynamic response after simultaneous initiation of warfarin and amiodarone. |
| 2. Laer S et al, Digitoxin intoxication during concomitant use of amiodarone. |
| 3. Marot A et al, Concomitant use of simvastatin and amiodarone resulting in severe rhabdomyolysis: a case report and literature review |
| 4. Fukumoto et al, Effect of amiodarone on the serum concentration/dose ratio of metoprolol in patients with cardiac arrhythmias |