Cordarone: Advanced Antiarrhythmic Therapy for Sustained Cardiac Rhythm Control
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| Product dosage: 200mg | |||
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Cordarone (amiodarone hydrochloride) is a potent Class III antiarrhythmic agent indicated for the management of severe ventricular and supraventricular arrhythmias. With its multi-channel blocking properties and prolonged half-life, it offers a robust therapeutic option for patients refractory to other antiarrhythmic treatments. Its unique pharmacokinetic profile allows for sustained rhythm control in complex cardiac cases, though it requires careful patient selection and monitoring due to its significant side effect potential. This comprehensive profile details its appropriate use in clinical practice.
Features
- Active ingredient: Amiodarone hydrochloride
- Available formulations: 200 mg oral tablets; 150 mg/3 mL intravenous solution
- Mechanism: Potassium channel blockade with additional sodium channel, calcium channel, and beta-adrenergic blocking properties
- Bioavailability: Approximately 50% with oral administration
- Half-life: Extremely variable (15-142 days) due to extensive tissue distribution
- Metabolism: Hepatic via CYP3A4 and CYP2C8
- Excretion: Primarily biliary; negligible renal excretion
Benefits
- Provides effective control of life-threatening ventricular arrhythmias including ventricular tachycardia and fibrillation
- Maintains sinus rhythm in atrial fibrillation and flutter when other agents fail
- Offers once-daily dosing convenience after loading phase due to extended half-life
- Demonstrates efficacy in patients with structural heart disease where other antiarrhythmics are contraindicated
- Reduces arrhythmia-related hospitalizations and improves quality of life in appropriately selected patients
- Provides both oral and intravenous formulations for acute and chronic management
Common use
Cordarone is primarily indicated for the treatment of recurrent hemodynamically unstable ventricular tachycardia and fibrillation that has proven refractory to other antiarrhythmic agents. It is also employed for chemical cardioversion and maintenance of sinus rhythm in symptomatic atrial fibrillation, particularly in patients with structural heart disease, left ventricular hypertrophy, or heart failure where other antiarrhythmics may be proarrhythmic or contraindicated. Off-label uses include rate control in atrial fibrillation and management of arrhythmias in specific populations such as post-cardiac surgery patients.
Dosage and direction
Oral administration: Initiate with loading dose of 800-1600 mg daily in divided doses for 1-3 weeks, then reduce to 600-800 mg daily for one month. Maintenance dose typically ranges from 200-400 mg daily. Lower doses may be effective in some patients.
Intravenous administration: For life-threatening arrhythmias, administer 150 mg over 10 minutes followed by 360 mg over next 6 hours (1 mg/min), then 540 mg over remaining 18 hours (0.5 mg/min). After first 24 hours, continue maintenance infusion of 0.5 mg/min.
Dosage adjustments required in elderly patients and those with hepatic impairment. Regular monitoring of thyroid function, liver enzymes, and pulmonary function is mandatory during therapy.
Precautions
Regular ophthalmologic examinations recommended due to risk of corneal microdeposits (typically reversible upon discontinuation). Baseline and periodic pulmonary function tests including chest X-ray advised to monitor for pulmonary toxicity. Thyroid function tests (TSH, T3, T4) should be performed at baseline, every 3-6 months during treatment, and for several months after discontinuation. Liver function tests required periodically due to risk of hepatotoxicity. ECG monitoring essential during initiation and dosage adjustments due to potential for QT prolongation. Sun protection measures recommended due to photosensitivity. Patients should be advised about potential blue-gray skin discoloration with long-term use.
Contraindications
Hypersensitivity to amiodarone, iodine, or any component of the formulation; severe sinus-node dysfunction or second- or third-degree AV block without functioning pacemaker; cardiogenic shock; marked sinus bradycardia; thyroid dysfunction (unless compelling circumstances exist); pregnancy (second and third trimester) and breastfeeding; concomitant use with drugs that prolong QT interval and create risk of torsades de pointes; severe hepatic impairment.
Possible side effect
Common (>10%): Corneal microdeposits (usually asymptomatic), photosensitivity, nausea, vomiting, fatigue, tremor, peripheral neuropathy, blue-gray skin discoloration (after long-term use).
Serious (require medical attention): Pulmonary toxicity (fibrosis, pneumonitis), hepatotoxicity (elevated transaminases, hepatitis, cirrhosis), thyroid dysfunction (both hyperthyroidism and hypothyroidism), proarrhythmia (torsades de pointes), optic neuropathy/neuritis, neurological effects (ataxia, peripheral neuropathy).
Drug interaction
Major interactions: Warfarin (increased anticoagulant effect - reduce warfarin dose by 33-50%); digoxin (increased serum levels - reduce digoxin dose by 50%); simvastatin (increased risk of myopathy/rhabdomyolysis); phenytoin (increased phenytoin levels); cyclosporine (increased cyclosporine levels); QT-prolonging agents (increased risk of torsades de pointes); beta-blockers and calcium channel blockers (potentiated bradycardia and AV block).
Cordarone inhibits CYP3A4, CYP2C9, and P-glycoprotein, affecting metabolism of numerous medications. Comprehensive medication review essential before initiation.
Missed dose
If a dose is missed, take it as soon as remembered unless it is nearly time for the next dose. Do not double the dose to make up for a missed one. Due to Cordarone’s long half-life, occasional missed doses are unlikely to significantly affect therapeutic efficacy, but consistent adherence is important for maintaining stable drug levels.
Overdose
Symptoms may include bradycardia, hypotension, AV block, cardiogenic shock, hepatic dysfunction, and QT prolongation. Management is supportive with continuous cardiac monitoring. Bradycardia may require pacemaker insertion. Hypotension may respond to fluids and vasopressors. Hemodialysis is not effective due to extensive protein binding and tissue distribution. Charcoal hemoperfusion may be considered in severe cases. Specialist poison control center consultation recommended.
Storage
Store at controlled room temperature (15-30°C/59-86°F). Protect from light and moisture. Keep in original container with tight closure. Do not store in bathroom or near sink. Keep out of reach of children and pets. Do not use after expiration date. Intravenous solution should be stored in original carton and protected from light until use.
Disclaimer
This information is for educational purposes only and does not constitute medical advice. Cordarone is a prescription medication that should only be used under supervision of a qualified healthcare professional familiar with its complex pharmacology and monitoring requirements. Individual patient response may vary. Always consult with a healthcare provider for personalized medical advice and before making any changes to medication regimen.
Reviews
“Cordarone has been invaluable in managing refractory ventricular arrhythmias in our heart failure population. While the monitoring requirements are substantial, its efficacy in difficult cases justifies the careful management approach.” - Cardiology Specialist, 15 years experience
“In our electrophysiology practice, we reserve Cordarone for cases where other options have failed or are contraindicated. The drug’s effectiveness is remarkable, but the potential for multi-organ toxicity demands rigorous follow-up protocols.” - Electrophysiologist, Academic Medical Center
“Patient education is crucial with Cordarone therapy. Those who understand the monitoring requirements and potential side effects generally tolerate the medication well and appreciate its rhythm control benefits.” - Cardiology Nurse Practitioner, Arrhythmia Clinic