Warnings

Pacerone

Last Reviewed: Dec 17, 2024

Warnings

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

Amiodarone treatment can cause serious health problems in some people. Talk to your doctor or pharmacist about other treatment options if you are at increased risk of complications from amiodarone use.

DAMAGE TO LUNG: Amiodarone can cause inflammation in the lungs (pulmonary interstitial pneumonitis) that could cause serious and fatal damage. You should take this medicine only if you have serious heart problems and can follow up with your doctor frequently to have your lungs checked by getting a chest x-ray done before you begin with the treatment, and then every 3-6 months. If you experience coughing, wheezing, blood spitting up, or trouble breathing that doesn't go away or grows worse over time, call your doctor right away.
DAMAGE TO LIVER: Amiodarone can cause liver injury, which can be life-threatening. You should only take this medication if you have a serious heart problem, and you can have regular follow-ups with your healthcare care provider for monitoring your liver health. You might need to stop taking amiodarone or switch to a lower dose if your liver function tests are abnormal. Call your doctor right away if you experience severe nausea, vomiting, right-sided stomach pain, unusual tiredness, a lack of appetite, or yellowish discoloration of the skin, tongue, or eyes.
ARRHYTHMIAS OR IRREGULAR HEART RHYTHM: Amiodarone can worsen cardiac arrhythmias (abnormal heartbeats), which can be fatal or lead to new arrhythmias. The risk is higher if you have or have ever had low levels of potassium, magnesium, or calcium in the blood, taking medications that affect electrolyte levels, including diuretics (water pills), laxatives (for constipation), or corticosteroids. You should only consume this drug if you have a severe heart problem and can do regular follow-ups to monitor the health of your heart. Call your doctor immediately if you ever experience chest pain, lightheadedness, fainting, fast, slow, or pounding heartbeat.
LONG-TERM ADVERSE EFFECTS: Amiodarone may stay in the body for many weeks, suggesting that the side effects can continue even after you stop taking the medication. It is advised that you speak with your doctor as soon as you notice the presence of any side effects so that you may manage them before they get worse. It is recommended to inform your healthcare providers that you were taking this drug, even if you have been off it for some time.
DIFFICULTIES IN VISION: Amiodarone has the potential to result in severe eye problems, including permanent blindness. While you are taking this medication, this could occur at any point in time. While taking amiodarone, you should have routine eye examinations. If your eyes become dry, sensitive to light, or if you experience halos, blurred vision, or any other vision issues, call your healthcare provider right away.
THYROID DISEASE: Thyroid hormone levels may be lowered or elevated as a result of the use of amiodarone. A history of thyroid problems, such as nodules or goiter, is one of the risk factors. Arrhythmias can be triggered by extremely elevated thyroid hormone levels. Prior to beginning this medication and on a regular basis while you take it, your doctor will run your thyroid function tests to ensure that your thyroid hormone levels are normal.
SLOWING OF HEARTBEAT: Amiodarone can cause slowing of your heartbeat or unusual pauses. Risk factors include a history of abnormal electrolyte levels, taking other medications that slow down the heartbeat, and certain hepatitis C antiviral medications. Seek immediate medical attention if you experience a slow heartbeat, dizziness, or feeling that you're going to faint.
EFFECTS ON FUNCTION OF HEART DEVICES: Long-term use of amiodarone can affect the function of heart devices such as pacemakers or defibrillators. While taking amiodarone, be sure to get frequent checkups to ensure that your device is properly adjusted.
NERVE DIFFICULTIES: Long-term use of amiodarone can affect the function of nerves, which persists even after you stop taking this drug. If you notice tingling or numbness in your hands or feet, call your doctor right away.

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.

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