Drug Class

Amiodarone (a-mi-oh-da-rone) is a class III antiarrhythmic agent

Amiodarone (Pacerone, Nexterone) Age Range

Amiodarone is approved for use in adults over the age of 18 years. Children younger than 18 years of age may be prescribed amiodarone if a doctor decides it is the best medication to treat their condition.

Uses

Amiodarone (Pacerone, Nexterone) Uses

Amiodarone is used to treat and prevent serious, life-threatening ventricular arrhythmias and suppress and prevent supraventricular tachycardias (abnormal heartbeats) when other medications cannot be tolerated or did not help. 

There may be other off-label uses of amiodarone, such as atrial fibrillation. Your doctor or pharmacist can give you further drug information.

Amiodarone (Pacerone, Nexterone) Mechanism of Action

Amiodarone is a class III antiarrhythmic agent. It functions by inhibiting a number of receptors and channels in your heart that are essential for the electrical activity of the heart. Amiodarone slows down the electrical activity to restore normal heart rhythm and maintain a relatively stable heartbeat.

Amiodarone (Pacerone, Nexterone) Doses

Oral amiodarone is available as 100 mg, 200 mg, and 400 mg tablets. The treatment with amiodarone tablets is usually started in the hospital setting. The usual loading or initial dose is 800-1600 mg per day until the cardiac arrhythmias are controlled. It generally takes 1-3 weeks. This is followed by an adjustment dose of 600-800 mg per day for one month and then a maintenance dose of 400 mg per day.

Amiodarone is also available as an intravenous (IV) solution for injection (Nexterone) that is given in the hospital setting only by a healthcare provider. The injection dose is different from the tablet dose. Your healthcare provider will determine the right dosage for you.

Directions

How To Use Amiodarone (Pacerone, Nexterone)

Oral amiodarone (Pacerone) comes as a tablet to take by mouth 1-2 times a day. You can take this medicine with or without food. Take this medication by mouth with a glass of water. Try to take your medication at approximately the same time every day. 

Amiodarone injection (Nexterone) is given as an infusion into a vein. This injection is given by your care team in a clinic or hospital setting where monitoring of your heart can be done in case the medication results in serious side effects. 

Read the instructions on your prescription label carefully. Take amiodarone exactly as prescribed. Do not take a bigger or smaller dose of this medicine or take it more or less frequently than your doctor has prescribed.

Talk to your care team regarding the use of this drug in children. Special care may be required.

Your doctor will probably start you on a high dose of amiodarone and gradually decrease the dose. Follow the dosing instructions carefully. The dose is based on your medical condition and treatment response. Do not stop taking amiodarone or change the dose without talking to your healthcare professional first. 

Missed dose: If you miss a dose of amiodarone, take it as soon as you remember. However, if it is almost time for your next dose, skip the missed dose and take the next dose according to your regular dosing schedule. Do not take a double dose to make up for a missed dose.

Storage: Store amiodarone at room temperature (between 15-30° C or 59-86° F) away from moisture, heat, and direct sunlight in a tightly closed container. Do not store medications in the bathroom where they can be exposed to moisture and heat. Keep all medications safely out of reach of children and pets.

Unused medicine: Unused amiodarone should be disposed of in a way that children, other people, and pets cannot get to them. Do not throw amiodarone in the trash or flush it down the toilet. The best way to dispose of expired or unneeded amiodarone is through a drug take-back program. Learn more about proper medication disposal. 

NOTE: This medication guide is a summary and may not contain all possible drug information on amiodarone. The information contained here may not be up-to-date. This sheet is for information purposes only. If you have questions about amiodarone, talk to your doctor or pharmacist for medical advice.

Discounted prices for amiodarone (Pacerone, Nexterone) start at $20.19.

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Side Effects

Amiodarone (Pacerone, Nexterone) Side Effects

Possible side effects of amiodarone are listed below. Call your doctor if these side effects are severe or persistent after a few days.

• Headache
• Reduced sex drive
• Constipation
• Loss of appetite
• Flushing
• Difficulty in falling asleep or staying asleep
• Changes in taste and smell 
• Changes in saliva amount 

Some of the adverse effects of amiodarone can be more serious. Call your doctor right away or seek emergency medical help if you experience any of the following symptoms:

• Rash
• Weight gain or loss
• Visual impairment
• Restlessness
• Excessive sweating
• Weakness in muscles and fatigue
• Irritability and nervousness
• Heat or cold intolerance
• Hair thinning
• Changes in menstrual cycle
• Swelling in the front of the neck or goiter
• Swelling of the hands, feet, lower legs or ankles
• Uncontrollable shaking of a part of the body
• Decrease in concentration
• Uncontrollable movements
• Coordination and walking difficulties
• Tingling or numbness in the legs, hands, and feet

The above list may not include all the potential side effects of amiodarone. Talk to your doctor about the risk of side effects. Tell your doctor if the side effects are unusual or severe or if they do not get better over time. You can also report unusual side effects to the Food and Drug Administration at 1-800-FDA-1088.

Amiodarone Overdose: In case of an overdose of amiodarone, call your doctor immediately. You can also call the local poison control center or national poison control center at 1-800-222-1222. Signs and symptoms of amiodarone overdose may include slow heartbeat, excessive sweating, chest tightening, nausea, blurred vision, lightheadedness, and fainting.

Source: FDA

Warnings

Amiodarone (Pacerone, Nexterone) Risks, Warnings, and Complications

Precautions Before Starting Amiodarone (Pacerone, Nexterone)

Tell your healthcare provider if you have ever had an allergic reaction to amiodarone, iodine, or any other medications or any of the ingredients in amiodarone tablets. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of your medications, including prescription drugs, over-the-counter medicines, vitamins, supplements, and any herbal remedy. This can help avoid possible drug interactions.

Give your doctor a complete medical history. Amiodarone may not be right for people with certain medical conditions, such as a history of slow heartbeats that have caused you to faint, if you have ever had low levels of potassium or magnesium in your blood, diarrhea, heart disease, lung disease, thyroid disease, liver disease, any heart rhythm problems other than the arrhythmia that is being treated, if you have a pacemaker or defibrillator implanted in your chest, any vision problems and high or low blood pressure.

Talk to your doctor about the risks of taking this medication if you are 65 years or above. 

Tell your doctor if you are pregnant, could be pregnant, plan to get pregnant, or are breastfeeding. 

Precautions During Use of Amiodarone (Pacerone/Nexterone)

Keep all your doctors’ appointments while you are on amiodarone treatment. Amiodarone is usually started in the hospital setting. Your doctor will order certain tests, such as blood tests, X-rays, electrocardiograms, and regular eye exams before and during your treatment to make sure that it is safe for you to take this medication and to check your body's response to it. Your doctor may reduce your dose during your treatment if you develop side effects. Follow your doctor's directions carefully while you are on this medication.

Do not drink grapefruit juice while you are taking this medication.

Amiodarone can make your skin sensitive to sunlight. Wear protective clothing and sunblock and avoid unnecessary exposure to UV radiation. Exposed skin may turn blue-gray and may not become normal even after you stop taking this medicine.

Tell your doctor that you are on amiodarone before any surgery, including dental procedures or laser eye surgery.

Tell your doctor if you become pregnant while on amiodarone. Amiodarone can cause fetal harm. You should also not breastfeed while you are taking amiodarone.

Do not stop taking amiodarone without discussing it with your doctor. You may need to be closely monitored or even hospitalized when you stop taking amiodarone. 

You should know that amiodarone may remain in your body for many months after you stop taking it, so your healthcare provider will keep a close watch on you. You may continue to experience side effects of amiodarone during this period. Make sure to inform every health care provider who treats you or prescribes you any medication during this time period that you have recently stopped taking amiodarone.

Amiodarone (Pacerone, Nexterone) Drug Interactions

Certain other drugs can affect how amiodarone works. Possible interactions between amiodarone and other medicines can increase the risk of severe adverse reactions. The following medications can have possible drug interactions with amiodarone:

• Antifungals such as ketoconazole (Nizoral), fluconazole (Diflucan), and itraconazole (Onmel, Sporanox)
• Antibiotics such as azithromycin (Zithromax, Zmax), clarithromycin (Biaxin), erythromycin (E.E.S., E-Mycin, Erythrocin)
• Fluoroquinolone antibiotics such as ciprofloxacin (Cipro), levofloxacin (Levaquin), moxifloxacin (Avelox), norfloxacin, lomefloxacin, ofloxacin, and sparfloxacin
• Beta-blockers like propranolol (Hemangeol, Inderal, Innopran)
• Calcium channel blockers such as verapamil (Calan, Covera, Verelan, in Tarka) and diltiazem (Cardizem, Cartia, Diltzac, Tiazac, others)
• Cisapride 
• Clonidine (Catapres, Kapvay) 
• Diuretics or water pills 
• Medications for irregular heartbeat such as digoxin (Lanoxin), disopyramide (Norpace), ivabradine (Corlanor), flecainide, phenytoin (Dilantin, Phenytek), quinidine (in Nuedexta), procainamide, sotalol (Betapace, Sorine, Sotylize), dofetilide (Tikosyn)
• Antipsychotic medications such as thioridazine
• Antidepressants such as trazodone (Oleptro)
• Anticoagulants or blood thinners like warfarin (Coumadin, Jantoven) and  dabigatran (Pradaxa) 
• Cholesterol-lowering medications such as atorvastatin (Lipitor, in Caduet, in Liptruzet), cholestyramine (Prevalite), lovastatin (Altoprev, in Advicor), and simvastatin (Zocor, in Simcor, in Vytorin)
• Clopidogrel (Plavix) 
• Immunosuppressants such as cyclosporine (Gengraf, Neoral, Sandimmune) 
• Dextromethorphan medication in many cough preparations
• HIV protease inhibitors such as indinavir (Crixivan) and ritonavir (Norvir, in Kaletra, in Viekira Pak)
• Certain hepatitis medications such as ledipasvir and sofosbuvir (Harvoni), sofosbuvir (Sovaldi), simeprevir (Olysio)
• TB medications such as rifampin (Rifadin, Rimactane, in Rifamate, in Rifater)
• Lithium (Lithobid)
• Antihistamines such as Loratadine (Claritin)
• Medications for diabetes
• Medications for seizures
• Methotrexate (Otrexup, Rasuvo, Trexall) 
• Narcotic medications for pain, such as fentanyl (Actiq, Duragesic, Fentora, others)
• Herbal products such as St. John's wort

The above list may not describe all possible interactions of amiodarone. Give your doctor or pharmacist a complete list of your medications, including prescription drugs, OTC (non-prescription) medications, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational drugs because some of these substances can cause serious health complications when used with prescription medications.

Pros & Cons

Amiodarone (Pacerone, Nexterone) Pros and Cons

Pharmacist Tips

Amiodarone (Pacerone, Nexterone) Tips from Pharmacists

• Take amiodarone precisely as prescribed. Your doctor or pharmacist will tell you how much to take after you leave the hospital.

• Nausea and vomiting are common side effects of amiodarone, particularly with high doses at the start of the treatment. To manage this side effect, ask your healthcare provider if you can space out the doses throughout the day.

• Amiodarone can cause a number of severe side effects. Since amiodarone stays in the body for several weeks, the side effects may last for a while. It's critical to follow recommendations for routine follow-up and tests to identify side effects early on before they worsen. Even if you have been off this medication for some time, it is still recommended to let your healthcare providers know that you were taking it.

• Give your doctor and pharmacist a complete list of your other drugs to avoid interactions with amiodarone.

• Amiodarone can increase the sensitivity of your skin to sunlight. Wear protective clothing and sunscreen to protect your skin from sunburn, skin irritation, or the long-term effect of bluish skin.

• You should know that amiodarone shouldn't be used during pregnancy because it can lead to birth defects. If you are breastfeeding, you should ask your provider for an alternative option because it can enter the breast milk and harm an infant.

  
  

Rx Savings Tips

Amiodarone (Pacerone, Nexterone) Rx Savings Tips

Amiodarone is a generic medication and is available at significantly lower prices than the brand names. Brand-name Pacerone and generic amiodarone contain the same medicine and are equally effective and safe. Like with most medications, the generic version offers better value. A BuzzRx amiodarone coupon can result in big savings on the brand name and generic forms of the drug. With a BuzzRx discount card, savings card, or discount coupons, the medication could cost you a fraction of retail prices. Amiodarone may be under $21.00 for 90 tablets of the 200 mg dose at Walmart, Walgreens, Rite Aid, CVS Pharmacy, and other participating pharmacies with a BuzzRx discount card or free coupon. For the biggest discounts on amiodarone, give the checkout clerk your BuzzRx amiodarone discount coupon when you drop off your prescriptions.

Common Questions about Amiodarone (Pacerone/Nexterone)