Avoid. Due to substantial toxicity, including pulmonary toxicity, amiodarone should only be used for recurrent ventricular fibrillation or recurrent hemodynamically unstable ventricular tachycardia IF these are deemed to be life-threatening AND have not responded to or cannot tolerate other available antiarrhythmics. Should be avoided in atrial fibrillation unless the patient also has ventricular hypertrophy or heart failure, and attempts at using other antiarrhythmics have failed.
- FDA monograph: Cordarone
Avoid. It should be used only as a second-line agent for atrial fibrillation and heart failure if safer alternatives are ineffective. There is strong evidence that other agents are both safer and more efficacious for atrial fibrillation and heart failure. Care should be taken with patients with renal impairment, as lower dosages may be necessary to reduce the risk of toxicity. Due to a strong risk of toxicity, the lowest effective dose should be used, and dosages higher than 125 μg/dose should be avoided.
- FDA monograph: Lanoxin
- FDA prescribing information: Lanoxin
- Marcel Gossselink AT, van Veldhuisen DJ, Crijns HJGM. (1997). When, and when not, to use digoxin in the elderly. Drug & Aging. 10(6): 411-20.
- Currie GM, Wheat JM, Kiat H. (2011). Pharmacokinetic considerations for digoxin in older people. The Open Cardiovascular Medicine Journal. 5:130-135.