Meta Information
ID:amiodarone
Name:
Schema Version:AIM-2.0
Interactions
Target id:
/class/qt-prolonging-agents
Target name:
QT-Prolonging Medications
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Amiodarone prolongs the QT interval of the heart's electrical cycle; combining it with other drugs that have the same effect creates an additive risk for a dangerous arrhythmia called Torsades de Pointes.
Actionable advice:
Avoid co-administration of other QT-prolonging drugs (e.g., certain antibiotics, antipsychotics) whenever possible; if necessary, this requires frequent ECG monitoring.
Target id:
/class/bradycardic-agents
Target name:
Heart Rate Lowering Agents
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Amiodarone slows the heart rate; using it with other medications that also slow the heart rate (like beta-blockers or diltiazem/verapamil) can lead to severe bradycardia, heart block, or sinus arrest.
Actionable advice:
Use this combination with extreme caution and monitor heart rate and rhythm closely, especially when initiating therapy.
Target id:
/intervention/warfarin
Target name:
Warfarin
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Amiodarone inhibits the CYP2C9 enzyme, significantly slowing the breakdown of warfarin, which can lead to excessive anticoagulation and severe bleeding.
Actionable advice:
Your warfarin dose must be reduced (typically by 30-50%) when starting amiodarone; frequent INR monitoring is required.
Target id:
/intervention/simvastatin
Target name:
Simvastatin
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Amiodarone potently inhibits the CYP3A4 enzyme, which breaks down simvastatin, leading to dangerously high statin levels and increasing the risk of severe muscle damage (rhabdomyolysis).
Actionable advice:
Do not take simvastatin with amiodarone; use an alternative statin like pravastatin or rosuvastatin.
Target id:
/intervention/lovastatin
Target name:
Lovastatin
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Amiodarone potently inhibits the CYP3A4 enzyme, which breaks down lovastatin, leading to dangerously high statin levels and increasing the risk of severe muscle damage (rhabdomyolysis).
Actionable advice:
Do not take lovastatin with amiodarone; use an alternative statin like pravastatin or rosuvastatin.
Target id:
/intervention/atorvastatin
Target name:
Atorvastatin
Severity:
moderate
Interaction type:
adverse
Nature:
absolute
Description:
Amiodarone inhibits the CYP3A4 enzyme, which can increase levels of atorvastatin and the associated risk of muscle pain and damage.
Actionable advice:
If taking atorvastatin, the dose should generally not exceed 20mg daily and you should monitor for muscle-related side effects.
Target id:
/intervention/digoxin
Target name:
Digoxin
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Amiodarone inhibits the P-glycoprotein pump, preventing the elimination of digoxin and causing its levels to rise, which increases the risk of digoxin toxicity.
Actionable advice:
Your digoxin dose must be reduced (typically by 50%) when starting amiodarone, and blood levels should be monitored.
Target id:
/intervention/sofosbuvir
Target name:
Sofosbuvir (Hepatitis C Medication)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Co-administration with sofosbuvir-containing regimens for Hepatitis C can cause severe, life-threatening symptomatic bradycardia (dangerously slow heart rate).
Actionable advice:
Avoid this combination completely unless no other options are available and continuous cardiac monitoring is in place.
Target id:
/dietary/grapefruit-pomelo
Target name:
Grapefruit and Grapefruit Juice
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Grapefruit contains compounds that inhibit the CYP3A4 enzyme in the gut, which reduces the breakdown of amiodarone and can lead to dangerously high levels of the drug in the body.
Actionable advice:
Avoid consuming grapefruit or grapefruit juice entirely while on amiodarone therapy.
Target id:
/intervention/saint-johns-wort
Target name:
St. John's Wort
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Description:
St. John's Wort strongly induces the CYP3A4 enzyme, which significantly speeds up the breakdown of amiodarone, potentially making it ineffective and allowing arrhythmias to return.
Actionable advice:
Avoid St. John's Wort completely while taking amiodarone.
Target id:
/class/p-glycoprotein-inducers
Target name:
P-glycoprotein and CYP3A4 Inducers
Severity:
major
Interaction type:
diminishing
Nature:
absolute
Description:
Strong enzyme inducers (like rifampin or certain seizure medications like carbamazepine and phenytoin) accelerate the metabolism of amiodarone, reducing its concentration and effectiveness.
Actionable advice:
Avoid this combination if possible; if not, your amiodarone dose may need to be increased with careful monitoring.
Target id:
/class/cyp3a4-substrates
Target name:
CYP3A4 Substrates
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Amiodarone is a potent inhibitor of the CYP3A4 enzyme, which can significantly increase blood levels of many other drugs (e.g., fentanyl, colchicine, certain benzodiazepines), raising their toxicity risk.
Actionable advice:
Review all medications with your doctor or pharmacist, as dose adjustments for other drugs are often necessary.
Target id:
/class/p-glycoprotein-substrates
Target name:
P-glycoprotein Substrates
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Amiodarone is a potent inhibitor of the P-glycoprotein (P-gp) efflux pump, which can significantly increase the absorption and decrease the elimination of many other drugs (e.g., dabigatran, rivaroxaban), raising their toxicity risk.
Actionable advice:
Review all medications for P-gp substrate status and consider dose adjustments or alternative therapies.
Target id:
/dietary/meal
Target name:
Any Caloric Meal
Severity:
moderate
Interaction type:
requirement
Nature:
temporal
Temporal spacing:
Hours before target:
0
Hours after target:
0
Description:
Taking amiodarone with food, particularly a high-fat meal, significantly increases its absorption. Taking it consistently with meals helps maintain stable drug levels.
Actionable advice:
Always take your amiodarone dose with a meal to ensure consistent absorption.
Target id:
/condition/sun-exposure
Target name:
Sun Exposure
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Amiodarone deposits in the skin and makes it extremely sensitive to sunlight (photosensitivity), leading to severe sunburns and, with long-term use, a blue-gray skin discoloration.
Actionable advice:
Use broad-spectrum sunscreen (SPF 50+), wear protective clothing, and avoid prolonged sun exposure.
Target id:
/condition/thyroid-disorders
Target name:
Thyroid Disorders
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Due to its high iodine content and direct effects on the thyroid gland, amiodarone can induce or worsen both underactive (hypothyroidism) and overactive (hyperthyroidism) thyroid conditions.
Actionable advice:
Regular monitoring of thyroid function (TSH) is mandatory before and during therapy.
Target id:
/condition/hepatic-impairment
Target name:
Hepatic Impairment
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Amiodarone can cause severe liver injury and is metabolized by the liver; its use in patients with pre-existing liver disease requires extreme caution and may be contraindicated.
Actionable advice:
Avoid use in severe liver disease; monitor liver enzymes closely in all patients.
Target id:
/condition/lung-disease
Target name:
Lung Disease (e.g., Pulmonary Fibrosis)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Amiodarone can cause serious and potentially fatal lung toxicity, which presents as inflammation or scarring of the lungs. Pre-existing lung disease may increase this risk.
Actionable advice:
Report any new or worsening cough or shortness of breath to your doctor immediately.
Target id:
/condition/pregnancy
Target name:
Pregnancy
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Amiodarone crosses the placenta and can cause severe harm to the developing fetus, including thyroid dysfunction, growth retardation, and heart problems.
Actionable advice:
Amiodarone is contraindicated in pregnancy except for life-threatening arrhythmias unresponsive to other treatments.
Target id:
/condition/lactation
Target name:
Breastfeeding (Lactation)
Severity:
major
Interaction type:
adverse
Nature:
absolute
Description:
Amiodarone is concentrated in breast milk and can cause adverse effects, particularly on the thyroid, in a nursing infant.
Actionable advice:
Breastfeeding is not recommended while taking amiodarone.
Target id:
/biomarker/thyroid-panel
Target name:
Thyroid Panel
Severity:
major
Interaction type:
assay_interference
Nature:
absolute
Description:
Amiodarone and its metabolites interfere with the conversion of T4 to T3 and can alter thyroid function tests, often causing elevated T4 and reverse T3 levels, which complicates interpretation.
Actionable advice:
Your doctor must interpret thyroid tests with caution, relying more on TSH and clinical symptoms.
Target id:
/biomarker/comprehensive-liver-function-panel
Target name:
Comprehensive Liver Function Panel
Severity:
major
Interaction type:
requirement
Nature:
absolute
Description:
Amiodarone can cause liver damage, ranging from mild enzyme elevation to severe hepatitis. Regular monitoring of liver function is required to detect toxicity early.
Actionable advice:
Obtain baseline liver function tests before starting and monitor them every 6 months during therapy.
Target id:
/procedure/chest-x-ray
Target name:
Chest X-Ray and Pulmonary Function Tests
Severity:
major
Interaction type:
requirement
Nature:
absolute
Description:
Amiodarone can cause serious and potentially fatal lung toxicity. Baseline and periodic imaging and lung function tests are essential for early detection.
Actionable advice:
Obtain a baseline chest X-ray before starting therapy and monitor for any new respiratory symptoms.
Target id:
/procedure/ophthalmologic-exam
Target name:
Ophthalmologic Exam
Severity:
major
Interaction type:
requirement
Nature:
absolute
Description:
Amiodarone commonly causes benign corneal microdeposits and, rarely, a more serious optic neuropathy that can lead to blindness. Regular eye exams are necessary for monitoring.
Actionable advice:
A baseline and annual ophthalmologic exam is recommended to monitor for any changes in your vision.