title: Amiodarone-induced pulmonary toxicity--a fatal case report and literature review.
abstract: Amiodarone is a widely used and very potent antiarrhythmic substance. Among its adverse effects, pulmonary toxicity is the most dangerous without a causal treatment option. Due to a very long half-life, accumulation can only be prevented by strict adherence to certain dosage patterns. In this review, we outline different safe and proven dosing schemes of amiodarone and compare the incidence and description of pulmonary toxicity. Reason for this is a case of fatal pulmonary toxicity due to a subacute iatrogenic overdosing of amiodarone in a 74-year-old male patient with known severe coronary artery disease, congestive heart failure and ectopic atrial tachycardia with reduced function of kidneys and liver but without preexisting lung disease. Within 30 days, the patient received 32.2 g of amiodarone instead of 15.6 g as planned. Despite early corticosteroid treatment after fast exclusion of all other differential diagnoses, the patient died another month later in our intensive care unit from respiratory failure due to bipulmonal pneumonitis.
authors: Department of Cardiology and Angiology, University Hospital of Muenster, Münster, Germany. ftrange@yahoo.de
authors: Felix T
authors: FT
authors: Range
authors: Ekkehard
authors: E
authors: Hilker
authors: Günter
authors: G
authors: Breithardt
authors: Boris
authors: B
authors: Buerke
authors: Pia
authors: P
authors: Lebiedz
mesh_terms: D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000009:adverse effects* / Q000493:pharmacokinetics / Q000627:therapeutic use; D003324:Coronary Artery Disease / Q000188:drug therapy*; D062787:Drug Overdose; D017809:Fatal Outcome; D006207:Half-Life; D006801:Humans; D017563:Lung Diseases, Interstitial / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis / Q000628:therapy; D008297:Male; D012128:Respiratory Distress Syndrome / Q000139:chemically induced* / Q000150:complications / Q000175:diagnosis / Q000628:therapy
chemical_list: D000889:Anti-Arrhythmia Agents; D000638:Amiodarone
references: J Am Coll Cardiol. 1993 Nov 15;22(6):1723-9
references: 8227846
references: Lancet. 2012 Feb 18;379(9816):648-61
references: 22166900
references: Am Heart J. 1983 Oct;106(4 Pt 2):931-5
references: 6613839
references: Eur Heart J. 2009 May;30(10):1245-53
references: 19336434
references: Lancet. 2000 Nov 25;356(9244):1789-94
references: 11117910
references: Am J Cardiol. 2002 Apr 1;89(7):896-8
references: 11909587
references: J Am Coll Cardiol. 1990 Dec;16(7):1711-8
references: 2254558
references: N Engl J Med. 2002 Dec 5;347(23):1834-40
references: 12466507
references: Lancet. 1997 Mar 8;349(9053):675-82
references: 9078198
references: Chest. 1988 Jun;93(6):1242-8
references: 3286141
references: Circulation. 2000 Mar 21;101(11):1297-302
references: 10725290
references: Circulation. 1990 Jul;82(1):51-9
references: 2364524
references: Circulation. 1995 Dec 1;92(11):3264-72
references: 7586313
references: Lancet. 1997 Mar 8;349(9053):667-74
references: 9078197
references: Am Heart J. 1983 Oct;106(4 Pt 2):906-16
references: 6310979
references: Circulation. 2006 Aug 15;114(7):e257-354
references: 16908781
references: Heart Rhythm. 2007 Sep;4(9):1250-9
references: 17765636
references: Respir Med. 1995 Mar;89(3):233-5
references: 7746919
references: Ann Intern Med. 1984 Oct;101(4):462-9
references: 6476633
references: Lancet. 1997 Nov 15;350(9089):1417-24
references: 9371164
references: Lancet. 1994 Aug 20;344(8921):493-8
references: 7914611
references: J Am Coll Cardiol. 2003 May 21;41(10):1707-12
references: 12767651
references: Europace. 2010 Jun;12(6):785-91
references: 20200016
references: Am Heart J. 1980 Sep;100(3):412-3
references: 7405817
references: Chest. 2001 Jul;120(1):275-82
references: 11451849
references: Am J Cardiol. 1993 Dec 1;72(17):1243-8
references: 7504880
references: Am Heart J. 1991 Jan;121(1 Pt 1):158-71
references: 1985357
references: Am J Cardiol. 1984 Jun 1;53(11):1564-9
references: 6375338
references: Clin Chest Med. 2004 Mar;25(1):65-75
references: 15062598
references: Heart. 2005 Jul;91(7):964-5
references: 15958375
references: Radiology. 1990 Oct;177(1):121-5
references: 2399310
references: N Engl J Med. 2002 Dec 5;347(23):1825-33
references: 12466506