Last updated: April 13, 2023

Summarytoggle arrow icon

Amiodarone is a class III antiarrhythmic agent that blocks voltage-gated potassium channels. It is used in the treatment of acute ventricular tachycardia and persistent ventricular fibrillation (VF) after unsuccessful defibrillation, as well as the long-term treatment of refractory supraventricular arrhythmia (atrial fibrillation). Since amiodarone has a very low negative inotropic effect, it can be used in patients with a reduced ejection fraction (EF). Side effects commonly involve the thyroid, liver, heart, eyes, and central nervous system. Pulmonary side effects, such as lung fibrosis and chronic interstitial pneumonitis, are rare but severe. Because amiodarone is a cytochrome P450 inhibitor, simultaneous administration of other drugs should be considered carefully to minimize the risk of interactions.

Pharmacodynamicstoggle arrow icon


Adverse effectstoggle arrow icon


  • Amiodarone is highly effective but typically limited to short-term treatment because of its side effect profile.
  • Amiodarone accumulation in tissues can cause damage to the thyroid, lungs, nerves, skin, eyes, and heart.
  • The lowest effective dose should be administered.
  • Before initiating amiodarone therapy, patients should receive a baseline ECG, chest x-ray, ophthalmological exam, and thyroid, liver, and pulmonary function tests.
  • Thyroid and liver function should be monitored every 3–6 months and ECG should be performed annually.
Overview of amiodarone adverse effects [4]
GI tract
GU tract

Pulmonary [5]


"Am-IOD-arone" consists of approx. 37% iodine.


  • Asymptomatic rise in AST and ALT is common after initiation of amiodarone therapy.
  • Amiodarone should be discontinued if AST and/or ALT rise above 2x higher than the normal range.



  • Corneal micro-deposits occur in > 90% of patients and rarely cause symptoms but have the potential to result in halo vision (especially at night), photophobia, and blurred vision. [3]

We list the most important adverse effects. The selection is not exhaustive.

Indicationstoggle arrow icon

Contraindicationstoggle arrow icon

We list the most important contraindications. The selection is not exhaustive.

Interactionstoggle arrow icon


Pharmacokineticstoggle arrow icon

  • Lipophilic properties → accumulation of amiodarone in myocardium and muscles → long duration of action
  • Metabolized in the liver by CYP3A4 with biliary excretion
Oral treatment IV bolus
Onset of action 2 days to 3 weeks Within a few hours
Time to peak effect 1 week to 5 months 15 minutes
Half-life elimination 40–55 days 9–36 days


Referencestoggle arrow icon

  1. UpToDate. Amiodarone: Drug Information. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: January 1, 2017. Accessed: April 5, 2017.
  2. Latini R, Tognoni G, Kates RE. Clinical pharmacokinetics of amiodarone. Clin Pharmacokinet. 1984; 9 (2): p.136-156.doi: 10.2165/00003088-198409020-00002 . | Open in Read by QxMD
  3. WebMD. Amiodarone (Rx). In: WebMD, Amiodarone (Rx). New York, NY: WebMD. Updated: January 1, 2017. Accessed: April 5, 2017.
  4. Olshansky B. The Management of Atrial Fibrillation in Patients with Heart Failure. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: September 27, 2016. Accessed: April 5, 2017.
  5. Siddoway LA. Amiodarone: guidelines for use and monitoring.. Am Fam Physician. 2003; 68 (11): p.2189-96.
  6. Giardina EG, Zimetbaum PJ. Monitoring and Management of Amiodarone Side Effects. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. Last updated: February 13, 2017. Accessed: April 5, 2017.
  7. Wolkove N, Baltzan M. Amiodarone pulmonary toxicity. Canadian respiratory journal. 2009; 16 (2): p.43-48.
  8. Agabegi SS, Agabegi ED. Step-Up To Medicine. Lippincott Williams & Wilkins ; 2013
  9. Julian DG, Camm AJ, Frangin G, et al. Randomised trial of effect of amiodarone on mortality in patients with left-ventricular dysfunction after recent myocardial infarction: EMIAT. Lancet. 1997; 349 (9053): p.667–674.doi: 10.1016/S0140-6736(96)09145-3 . | Open in Read by QxMD
  10. Amiodarone and ACLS. Updated: April 5, 2017. Accessed: April 5, 2017.

Icon of a lock3 free articles remaining

You have 3 free member-only articles left this month. Sign up and get unlimited access.
 Evidence-based content, created and peer-reviewed by physicians. Read the disclaimer