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Klinische Besonderheiten der Therapie mit Amiodaron

Clinical aspects of treatment with amiodarone

  • Mitteilungen der Arbeitsgruppe 1 der Deutschen Gesellschaft für Kardiologie
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Herzschrittmachertherapie + Elektrophysiologie Aims and scope Submit manuscript

Zusammenfassung

Vielfältige und komplexe elektrophysiologische Eigenschaften machen Amiodaron zu einem sehr wirksamen Antiarrhythmikum. Dies gilt sowohl für die Behandlung supraventrikulärer als auch ventrikulärer Herzrhythmusstörungen. Diese ausgeprägte, anderen Antiarrhythmika überlegende Wirksamkeit ist allerdings mit einem sehr komplexen Nebenwirkungsprofil vergesellschaftet, so dass durchaus von einem besonderen Antiarrhythmikum gesprochen werden kann. Die bei anderen Antiarrhythmika gefürchteten proarrhythmischen Effekten treten eher in den Hintergrund, häufiger sind eine Reihe extrakardialer unerwünschter Wirkungen, die im Einzelfall gravierend sein können. Die Häufigkeit der meisten unerwünschten Wirkungen korreliert mit der aufgenommenen Substanzmenge (d. h. der Dosis und der Therapiedauer). Die Zahl der Berichte über schwerwiegende extrakardiale Effekte von Amiodaron hat in den letzten Jahren, parallel zur Verordnung niedrigerer Erhaltungsdosen (100–200 mg/Tag) abgenommen. Früher übliche hohe Erhaltungsdosen (≥300 mg/Tag) sind mittlerweile weitgehend obsolet. Die vorliegende Arbeit beschäftigt sich mit den Besonderheiten der Anwendung von Amiodaron, die vom Anwender beachtet werden müssen, um die Therapiesicherheit im Langzeitverlauf zu gewährleisten.

Abstract

Amiodarone has multiple and complex electrophysiological effects that render it a very effective antiarrhythmic drug for the treatment of both, supraventricular and ventricular arrhythmias. Proarrhythmic effects of amiodarone in patients with structural heart disease are rare. However, extracardiac adverse effects occurring in association with amiodarone treatment are frequent and feared. These adverse effects have usually been related to total amiodarone exposure (i. e., dose and duration of treatment). Parallel to a more frequent use of lower amiodarone maintenance doses (100–200 mg/day), the incidence of severe unwanted extracardiac side effects has decreased. High-dose maintenance regiments (daily dose ≥300 mg) are usually obsolete. This paper discusses recommendations regarding the monitoring of cardiac and extracardiac side effects of amiodarone. They need to be regarded by physicians using amiodarone to ensure long-term safety of amiodarone therapy.

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Authors and Affiliations

  1. Medizinische Klinik mit Schwerpunkt Kardiologie, Campus Virchow-Klinikum, Charité – Universitätsmedizin Berlin, Augustenburger Platz 1, 13353, Berlin, Deutschland

    W. Haverkamp & A. Parwani

  2. Klinik für Kardiologie, Nephrologie und Diabetologie, Evangelisches Klinikum Bethel, Bielefeld, Deutschland

    C. Israel

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  1. W. Haverkamp
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  2. C. Israel
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  3. A. Parwani
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Correspondence to W. Haverkamp.

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W. Haverkamp, C. Israel und A. Parwani geben an, dass kein Interessenkonflikt besteht.

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Haverkamp, W., Israel, C. & Parwani, A. Klinische Besonderheiten der Therapie mit Amiodaron. Herzschr Elektrophys 28, 307–316 (2017). https://doi.org/10.1007/s00399-017-0516-0

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