My cardiologist wants to increase my does of Amiodarone to 300mg daily and Vera-Til SR to 240mg daily as i'm in AF and thinks this is the best route to take. I've had cardioversion twice before and not suitable for ablation due to weight. Has anyone else had a increase in the doses of these meds ?
Thanks
Check out the side effects of amiodarone. I took it for three months and it damaged my thyroid. Had I known the problems associated with this drug, I would have requested something less devastating.
The official view is that it takes 6 months to affect the thyroid. A few years ago I paid for my own checks after 4 months and was glad I did -- I just caught it in time. The other major area to check for is lungs -- this is the real danger.
Ask the doctor to reason aloud with you. What options are there? 1, 2, 3,. What is in favour and what is against each option? Or, there have to be compromises. List them, for and against. Remind the doctor from your own case history if you have ever taken any of the drugs proposed.
For instance, a few weeks ago my doctor wanted me to re-start Flecainide, at 100/100. I refused. I reminded him that my experience was that 100/100 created problems, and 50/50 was more suitable. In addition, for several months after Amiodarone, the dosage of Flecainide was reduced, so, 25/25. Incredible, I had to do that for the doctor. He still wrote down 100/100 on the prescription!!
it's worth checking if he would recommend ablation for you if you lost the weight- good thing to do anyway with things heart in mind
This is what the British National Formulary 67 year 2017 says. "laboratory tests should be performed before treatment and every 6 months." This is the advice book everyone consults. You do not need all the thyroid tests possible, but the needed ones are not cheap -- about the price of a Vitamin D test. So, thanks to this forum, two of us are saying, the standard advice could get you into serious trouble. Test quicker than the recommended 6 months.
I was twice prescribed Amiodarone and did not have tests prior to starting it nor when I refused to take any longer due to side effects. The first time I took it for six months and the second time for about five.
You were fortunate. Now, I understand a doctor not checking for something that is highly unlikely and costs a lot. But when the testing is easy and relatively cheap, there is no excuse. And when experience shows that the guidebook (BNF) is blasé, then no wonder patient support groups like this forum are important.
I'm not sure if I was actually lucky or not. I have what is said to be a form of neuropathy or even a version of type 2 CMT according to another neurologist in my lower left leg. It started in June 2015 and I blamed Bisoprolol at the time as that was what I was then taking. There was improvement in the other symptoms when I stopped bisoprolol but little in the 'neuropathy'. The 'neuopathy' was of very sudden onset over a ten day period.
There is of course no means of proving if it is down to either drug but amiodarone can evidently take years to produce some of its consequences.
BNF often does not spell out things in a simple enough way for doctors to understand for example if a patient is taking warfarin and is then prescribed amiodarone that the warfarin dosage should initially be halved. I had to find that out for myself when my INR went up to 3.9 over a few days.
Yes, when I was prescribed Amiodarone, I checked the BNF "Interactions" page and found the warning. Then I had to really hunt in the medical literature for more precision.
Dose reduction of warfarin is as follows: 40% reduction if amiodarone dose is 400 mg daily, 35% reduction if amiodarone dose is 300 mg daily, 30% reduction if amiodarone dose is 200 mg daily, and 25% reduction if amiodarone dose is 100 mg daily. The effect of amiodarone on the warfarin concentrations can be as early as a few days after initiation of treatment; however, the interaction may not peak for up to seven weeks.
I was first prescribed it when in the Royal Sussex after my heart valve replacement. It was the usual 300mg of amiodarone but only 4grms of warfarin initially that was gradually increased.
On a later occasion a registrar at Eastbourne knowing of my original problems with amiodarone said that I could take bisoprolol instead with my warfarin until my cardioversion. At my next appointment the one I saw said no amiodarone no cardioversion but did not know to reduce the warfarin. Nor did the nurse who checked my rising INR over the next two weeks.When my GP looked at BNF it only vaguely mentioned it as a connection of how the liver reacted. I then found the information on line and gave it to my GP.
I asked the pharmacist where I get my prescriptions why she had not warned me when dispensing the amiodarone. She said that she thought everyone knew about it. Some time later I was in the pharmacy when someone was collecting a prescription for the same combination. She questioned if he had taken them before and what warnings he had been given.
What a mess! To think both warfarin and amiodarone have been known for decades. Then the health professionals are reluctant to allow people so self dose.
My INR nurse was always reluctant to make anything but the small changes to the dosage as her system indicated. When it shot up she asked one of the GP's who agreed.
I considered reducing it more myself but that would then create a problem when tested next time.
Delicate isn't it? If you take charge, then at some point you have to 'admit' it and you feel like a child caught cheating! Also feels like I am going against *my* word. Things have got to the point with my local doctor recently that he now says: what did I advise? What did you do?
For instance, after stopping Amiodarone he advised Flecaine, and NOT bisoprolol. I decided to take bisoprolol.
Doctors still use the printed version of BNF rather that the much more detailed on line one.
Do you subscribe to it? You can get it free online if you tell a couple of white lies about your need for it. I used to get the BMJ as well but when I changed ISP's and E-Mail address at the same time as they changed their file server location to Athens I could not reregister.
I've been on 200mg of Amiodarone for nearly three years but they want to increase it as i'm in constant afib. The EP who put me on it didn't do a base line blood test or chest x-ray, doesn't fill me with lots of confidence.
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