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Halogenated Anesthetics: In general, adverse cardiovascular effects such as hypotension and atropine-resistant bradycardia can occur in patients receiving amiodarone who subsequently are administered any general anesthetics, particularly volatile anesthetics. Haloperidol: QT prolongation and torsade de pointes TdP have been observed during haloperidol treatment. Excessive doses particularly in the overdose setting or IV administration of haloperidol may be associated with a higher risk of QT prolongation.
According to the manufacturer of haloperidol, caution is advisable when prescribing the drug concurrently with medications known to prolong the QT interval.
In addition, haloperidol is a substrate for CYP3A4 and CYP2D6. Mild to moderate increases in haloperidol plasma concentrations have been reported during concurrent use of haloperidol and inhibitors of CYP3A4 or CYP2D6.
Therefore, it is advisable to closely monitor for adverse events when haloperidol is co-administered with drugs that inhibit CYP3A4 and CYP2D6 and prolong the QT interval, such as amiodarone. Halothane: In general, adverse cardiovascular effects such as hypotension and atropine-resistant bradycardia can occur in patients receiving amiodarone who subsequently are administered any general anesthetics, particularly volatile anesthetics.
Hawthorn, Crataegus laevigata: It would be prudent to avoid use of Hawthorn, Crataegus laevigata also known as C. Following hawthorn administration to guinea pigs, the cardiac action potential duration is increased and the refractory period is prolonged.
Hawthorn may also lower peripheral vascular resistance. Hawthorn thus has effects similar to the class III antiarrhythmics and would theoretically interact with drugs with similar cardiac electrophysiology e.
Nimodipine: CYP3A4 inhibitors which theoretically may decrease hepatic metabolism of nimodipine include amiodarone. Coadministration may increase the concentration and clinical effect of nintedanib.
If concomitant use of amiodarone and nintedanib is necessary, closely monitor for increased nintedanib side effects including gastrointestinal toxicity, elevated liver enzymes, and hypertension. A dose reduction, interruption of therapy, or discontinuation of therapy may be necessary. Nisoldipine: Because nisoldipine is metabolized by CYP3A4, inhibitors of these enzymes, such as amiodarone, have the potential to increase the bioavailability of nisoldipine. The dosage should be adjusted based on clinical response with careful monitoring of efficacy and safety parameters.
Although extremely rare, torsade de pointes has been reported during post-marketing surveillance of norfloxacin. These reports generally involved patients with concurrent medical conditions or concomitant medications that may have been contributory. Drugs with a possible risk for QT prolongation and TdP, such as amiodarone, should be used cautiously with norfloxacin. Nortriptyline: The concomitant use of amiodarone and other drugs known to prolong the QT interval should only be done after careful assessment of risks versus benefits, especially when the coadministered agent might decrease the metabolism of amiodarone.
Octreotide: The concomitant use of amiodarone and other drugs known to prolong the QT interval, such as octreotide, should only be done after careful assessment of risks versus benefits, especially when the coadministered agent might decrease the metabolism of amiodarone. Arrhythmias, sinus bradycardia, and conduction disturbances have occurred during octreotide therapy warranting more cautious monitoring during octreotide administration in higher risk patients with cardiac disease.
Since bradycardia is a risk factor for development of TdP, the potential occurrence of bradycardia during octreotide administration could theoretically increase the risk of TdP in patients receiving drugs that prolong the QT interval. Ofloxacin: The concomitant use of amiodarone and other drugs known to prolong the QT interval, such as ofloxacin, should only be done after careful assessment of risks versus benefits.
Ofloxacin has been associated with QT prolongation and infrequent cases of arrhythmia.
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Do not take Cordarone Tablets if you: Tell your doctor about all of your medical conditions including if you: Tell your doctor about all the medicines you take including prescription and nonprescription medicines, vitamins and herbal supplements. Cordarone Tablets and certain other medicines can interact with each other causing serious side effects.
Sometimes the dose of Cordarone Tablets or other medicines must be changed when they are used together. Especially, tell your doctor if you are taking:Know the medicines you take. Keep a list of them with you at all times and show it to your doctor and pharmacist each time you get a new medicine.
Do not take any new medicines while you are taking Cordarone Tablets unless you have talked with your doctor. Cordarone Tablets can cause serious side effects that lead to death including lung damage, liver damage, worse heartbeat problems, and thyroid problems. These are not all the side effects with Cordarone Tablets.
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Potassium levels should be within the normal range prior and during administration of these agents. In the absence of electrolyte imbalances, these agents can be used together safely.
Indinavir: Coadministration of indinavir and amiodarone is contraindicated due to the potential for serious or life-threatening reactions, such as cardiac arrhythmias. Indinavir is an inhibitor of CYP3A4 and increased plasma concentrations of drugs extensively metabolized by this enzyme, such as amiodarone, should be expected with concurrent use. Indomethacin: Amiodarone inhibits CYP2C9. Caution is recommended when administering amiodarone with CYP2C9 substrates including indomethacin.
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Celecoxib: Since celecoxib is metabolized by cytochrome P450 2C9, concurrent administration with amiodarone, which can inhibit this enzyme, may result in increased levels of celecoxib. The clinical significance of this interactions has not been established. Ceritinib: Use caution with co-administration of ceritinib and amiodarone. First, amiodarone is established to have a causal association with QT prolongation and torsade de pointes TdP.
Coadministration of ceritinib and a drug that prolongs the QT interval is not advised as ceritinib also prolongs the QT interval. Increased concentrations of both ceritinib and amiodarone may occur during concurrent use, which could result in a potential for serious or life-threatening reactions, including cardiac arrhythmias. Cerivastatin: Amiodarone may inhibit hepatic CYP3A4 isoenzymes, and therefore has the potential to increase serum concentrations of cerivastatin.
Monitor for signs and symptoms of myopathy in patients receiving amiodarone concurrently with these HMG-CoA reductase inhibitors.
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During treatment, if pulmonary toxicity is suspected, this should be repeated and associated with lung function testing including, where possible, measurement of transfer factor.
This is not a complete list of side effects and others may occur.
Close monitoring of therapeutic response is warranted for patients receiving combination therapy, including serum drug concentration monitoring.
Atorvastatin: Monitor for signs and symptoms of myopathy in patients receiving amiodarone concurrently with atorvastatin. Avanafil: Avanafil is a substrate of and primarily metabolized by CYP3A4. Studies have shown that drugs that inhibit CYP3A4 can increase avanafil exposure.
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Axitinib: Use caution if coadministration of axitinib with amiodarone is necessary, due to the risk of increased axitinib-related adverse reactions.
If nefazodone and amiodarone are administered concomitantly, increased amiodarone plasma concentrations may occur, which could result in a potential for serious or life-threatening reactions, including cardiac arrhythmias.