AF Association

Amiodarone interaction with NOACs /warfarin

This appeared in my email from Medscape. It was one in the case challenge

series.

Below is the bottom line

NOACs for Atrial Fibrillation: Important Drug/Drug Interactions

What is the take-home message from drug interactions with NOACs? I think the most important thing to remember is the drug amiodarone. Amiodarone is often used in patients with atrial fibrillation, the condition that is the most common indication for a NOAC. If possible, use of amiodarone in patients who are on NOACs should be avoided.

It is important to remember that warfarin also has a potentially significant interaction with amiodarone as well. The difference is that it is easier to measure the drug interaction with warfarin—that is, you can serially measure the international normalized ratio and adjust the dose of warfarin as needed. This is much harder to do with NOACs. There may be a role for continued use of warfarin in patients who must be on amiodarone or dronedarone.

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That's interesting and something to bear in mind.

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ESC (European Society of Cardiology) guidelines are that amiodarone is the drug of last resort anyway .Maybe not in US?

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Please can we have the link to the article?

Maybe amiodorone should be the drug of last choice in Europe, but not every A & E on the continent has heard of that!

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medscape.com/viewarticle/89...

It's free to join Medscape if you can't view it

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Odd that they also mention dromedarone but not sotalol which works by the same quantum mechanism as dronedarone. I wonder if there's actually a proven problem with dronedarone or whether it's been thrown in 'because it's like amiodarone' ?

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Good point. Sometimes I think we know too much ( or too little).

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When discussing my ablation I was horrified to discover just how little my EP (i.e. ELECTRO-physicist) knew about how electric charge moved around the body !

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