CAS Number: 1951-25-3
Cordarone | 1951-25-3
Cordarone, the brand name for amiodarone, is a potent antiarrhythmic drug primarily classified as a Class III agent, though it also possesses Class I, II, and IV properties, making it effective for treating various ventricular and supraventricular arrhythmias, including life-threatening ventricular tachycardia, ventricular fibrillation, and atrial fibrillation refractory to other treatments. However, due to its very long half-life (weeks to months) and high iodine content, Cordarone requires careful medical supervision because of its potential for serious adverse effects, including fatal pulmonary toxicity, hepatotoxicity, thyroid dysfunction (both hyper- and hypothyroidism), corneal microdeposits, skin discoloration, and QT prolongation. The provided clinical cases further illustrate these complexities, showing that Cordarone can unmask or exacerbate thyroid conditions, such as a case of amiodarone-induced type II hyperthyroidism triggered by the immune checkpoint inhibitor pembrolizumab, and another case where amiodarone revealed refractory Graves' disease leading to cardiogenic shock, highlighting the need for close monitoring of thyroid function, especially when combined with other interacting drugs.
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References
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Cardiogenic Shock During Anesthesia in the Management of Refractory Graves’ Disease, Unmasked by Cordarone and Treated with Lithium
Lithium concentrates in the thyroid gland and induces structural and functional alterations, thereby justifying its use in cases of severe hyperthyroidism. Rarely, it may cause hyperthyroidism through the intrathyroidal accumulation of iodine or via a transient cytotoxic effect on thyroid cells [1]. Iodine-based treatments promote anti-thyroid autoimmunity. Due to the dual nature of its mechanism of action, lithium may lead to the persistence or transient exacerbation of hyperthyroidism.
DOI: 10.1016/j.ando.2022.12.107 -
Rhythm Versus Safety in Amiodarone Therapy
Amiodarone (Cordarone, Pacerone) is a powerful antiarrhythmic that is effective in converting atrial fibrillation (AF) to sinus rhythm and superior to sotalol in maintaining sinus rhythm. In 665 patients who were receiving anticoagulants and had persistent AF, Singh et al. found a median time to recurrence of AF of 487 days in the amiodarone group versus 74 days in the sotalol group and 6 days in the placebo group, with improved quality of life and improved exercise performance in the amiodarone group.1 In this study known as the Sotalol Amiodarone Atrial Fibrillation Efficacy Trial (SAFE-T), spontaneous conversion occurred in 72.1% of amiodarone patients, 24.2% for sotalol, and 0.8% for placebo. However, the use of amiodarone in AF is not approved by the U.S. Food and Drug Administration (FDA). The unlabeled (off-label) uses of amiodarone include conversion of atrial fibrillation and maintenance of sinus rhythm, and treatment of supraventricular tachycardia.
DOI: 10.18553/jmcp.2006.12.8.687