Effects of amikacin injection: A Synthesis of Findings from 11 Studies

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Original Abstract of the Article

Major Research Findings

Amiodarone is an effective drug for maintaining sinus rhythm in atrial fibrillation, but it is associated with potentially serious toxic effects. 9 Dronedarone, a new antiarrhythmic agent pharmacologically related to amiodarone, was developed to reduce the risk of side effects. 9 Amiodarone is predominantly a Vaughan Williams Class III agent, but also possesses electrophysiological characteristics of the other three Vaughan Williams classes (Class I and IV and minor Class II effects). 4 Amiodarone’s primary mechanism is to prolong the cardiac action potential and repolarization time leading to an increased refractory period and reduced membrane excitability. 4 The efficacy and tolerability of intravenous (IV) amiodarone for acute treatment of recurrent and refractory ventricular tachycardia and ventricular fibrillation has been demonstrated in clinical trials. 4 The ARREST trial, a randomized trial comparing IV amiodarone to placebo, found a significant improvement in the proportion of patients surviving to the emergency department following out-of-hospital cardiac arrest in amiodarone-treated patients. 4 Intravenous amiodarone is an effective anti-arrhythmic agent for the acute treatment of life-threatening ventricular arrhythmias and represents an important treatment option for emergency anti-arrhythmic therapy for patients suffering from cardiac arrest. 4 Unlike other antiarrhythmic class I drugs, amiodarone showed in preliminary studies, benefits also in patients with left ventricular dysfunction. 3 These positive results have induced the development of large randomised controlled studies: their results are reviewed and the controversial points are discussed. 3 In a meta-analysis of randomised controlled trials the use of amiodarone in heart failure was associated with an approximate 20 to 25% reduction in deaths. 3 However, amiodarone was also associated with a 120 to 124% increase in side effects. 3 Lidocaine is still considered the drug of choice in the treatment of life-threatening ventricular arrhythmias in the setting of acute myocardial infarction (A.M.I.). 2 This is mainly due to its proved efficacy and high therapeutic index. 2 Lidocaine has well-defined electrophysiologic properties (class 1 B) and does not seem to be effective in all of these patients, so we compared its antiarrhythmic efficacy with the one of amiodarone (A), an antiarrhythmic agent provided of electrophysiologic properties quite different from L (class 4) and usually well tolerated. 2 Amiodarone is an effective antiarrhythmic drug, but it has serious side effects and conducted trials did not support its prophylactic use in survivors of acute myocardial infarction. 7 It is possible that the prophylactic use of the drug has not been tested effectively. 7 To optimize therapy outcome, markers of drug efficacy might be developed to identify patients who, although at arrhythmic risk, would not benefit from amiodarone treatment. 7 We investigated descriptors of QT/RR relationship for their potential value in predicting inefficient amiodarone treatment. 7 Amiodarone is very effective against a variety of dysrhythmias but has poor pharmacodynamic properties and many undesired side-effects. 5 Its short- and rapid-acting derivative E 047/1 may circumvent some of these drawbacks. 5 It is easier to titrate while retaining the high efficacy of amiodarone and may have acceptable influences on haemodynamics and cardiac conduction in patients who develop serious, destabilizing ventricular tachydysrhythmias after cardiac surgery. 5 Amiodarone is an excellent antiarrhythmic medication; however, it has numerous systemic and ocular adverse effects. 10

Benefits and Risks

Benefits Summary

Amiodarone is an effective drug for treating atrial fibrillation and ventricular arrhythmias. 9 4 A meta-analysis showed that it reduced mortality in heart failure patients by approximately 20 to 25%. 3 Intravenous administration of amiodarone has been shown to significantly improve the survival rate of patients following out-of-hospital cardiac arrest. 4 Dronedarone has a lower risk of side effects compared to amiodarone. 9

Risks Summary

Amiodarone can cause serious side effects, including thyroid dysfunction, pulmonary toxicity, and hepatotoxicity. 3 10 It can also cause eye side effects. 10 Although dronedarone has a lower risk of side effects than amiodarone, caution is still needed. 9

Comparison of Studies

Commonalities of Studies

All these studies demonstrate that amiodarone is effective in treating atrial fibrillation and ventricular arrhythmias. 9 4 3 They also share that amiodarone can cause side effects. 3 10

Differences of Studies

There are differences in the types and severity of amiodarone side effects, the duration of the effects, and so on. 9 4 3 11 There are also differences in the patients studied and the design of the studies. 9 4 3 11 2 7 5 1 6 8

Consistency and Contradictions in the Findings

While these studies show that amiodarone is effective in treating atrial fibrillation and ventricular arrhythmias, the findings on side effects vary depending on the study. 3 10 Further research on amiodarone side effects is needed. 10

Points to Note When Applying the Results to Real Life

Amiodarone can cause serious side effects, so it is important to take it as directed by your doctor. 3 10 Regular medical checkups are needed to detect amiodarone side effects early. 3 10

Limitations of Current Research

These studies have a limited number of participants, so it is unclear whether the results can be generalized. 9 4 3 11 Also, the differences in the study designs and evaluation methods make it difficult to directly compare the results. 9 4 3 11 2 7 5 1 6 8

Future Research Directions

Larger-scale studies on the side effects of amiodarone are needed. 3 10 Development of new therapies to reduce the side effects of amiodarone is also expected. 3 10

Conclusion

Amiodarone is an effective drug for treating atrial fibrillation and ventricular arrhythmias, but it can cause serious side effects. 3 10 When considering the use of amiodarone, it is important to discuss the risks and benefits with your doctor and make an informed decision. 3 10

Literature analysis of 11 papers
Positive Content
8
Neutral Content
0
Negative Content
3
Article Type
8
3
2
1
11
1.

Amiodarone and N-desethylamiodarone concentrations in plasma, red blood cells, and myocardium after a single oral dose: relation to hemodynamic effects in surgical patients.

Author: EscoubetB, JaillonP, BergerY, ComminP, MenaschéP, PiwnicaA, EchterE

Impaired hemodynamics

Oral amiodarone, an antiarrhythmic drug, was found to impair hemodynamics in surgical patients. The drug decreased cardiac index and heart rate, and increased capillary wedge pressure. Measuring amiodarone plasma concentration was the easiest method for monitoring the drug, but further investigation is needed to determine the clinical utility of drug monitoring during chronic administration.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

2.

[Intravenous administration of lidocaine and amiodarone in patients with acute myocardial infarction].

Author: CapucciA, MelandriG, MantovaniB, MarestaA, MagnaniB

Reduced ventricular arrhythmias
Blood pressure decrease
QTc prolongation
Ventricular fibrillation

Amiodarone was as effective as lidocaine in treating life-threatening ventricular arrhythmias in patients with acute myocardial infarction. Amiodarone prolonged the QTc interval and slightly decreased systolic blood pressure.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : Italian

3.

Overview and meta-analysis of randomised trials of amiodarone in chronic heart failure.

Author: PiepoliM, VillaniG Q, PonikowskiP, WrightA, FlatherM D, CoatsA J

Reduction in deaths
Increased side effects

This article reviews the use of amiodarone in patients with heart failure. While meta-analysis suggests a significant reduction in deaths, it also highlights a significant increase in side effects associated with amiodarone use.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.

Language : English

4.

Intravenous amiodarone for ventricular arrhythmias: overview and clinical use.

Author: GonzalezE R, KannewurfB S, OrnatoJ P

Arrhythmia Treatment
Cardiac Arrest Survival

Intravenous amiodarone is an effective anti-arrhythmic agent for the acute treatment of life-threatening ventricular arrhythmias, such as ventricular tachycardia and fibrillation. The drug's efficacy has been demonstrated in clinical trials, including the ARREST trial which showed improved survival in amiodarone-treated patients following cardiac arrest.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.

Language : English

5.

First clinical experience with the rapid-, short-acting amiodarone derivative E 047/1 after cardiac surgery.

Author: GombotzH, VicenziM, MahlaE, RehakP, MetzlerH

Easier to titrate
Effective against dysrhythmias
Many undesired side-effects
Poor pharmacodynamic properties

E 047/1, a derivative of amiodarone, is effective for treating cardiac dysrhythmias.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Clinical Trial, Phase IIA Phase II trial is a trial that further evaluates the efficacy and safety of a new drug or treatment, whose safety has been confirmed to some extent in a Phase I trial, in a small number of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

6.

Effects of amiodarone and diltiazem on persistent atrial fibrillation conversion and recurrence rates: a randomized controlled study.

Author: ManiosEmmanuel G, MavrakisHercules E, KanoupakisEmmanuel M, KallergisEleftherios M, DermitzakiDespina N, KambourakiDespina C, VardasPanos E

Increased conversion rate
Preserved sinus rhythm
Prolonged sinus rhythm

Oral amiodarone increases conversion rates, prolongs fibrillatory cycle length and atrial effective refractory period, and preserves sinus rhythm after cardioversion in persistent AF patients.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

7.

Individual patterns of dynamic QT/RR relationship in survivors of acute myocardial infarction and their relationship to antiarrhythmic efficacy of amiodarone.

Author: SmetanaPeter, PueyoEsther, HnatkovaKaterina, BatchvarovVelislav, LagunaPablo, MalikMarek

Effective antiarrhythmic drug
Serious side effects

Amiodarone, an antiarrhythmic drug, is effective in treating heart rhythm problems, but it has serious side effects. This study investigated whether certain markers could be used to predict which patients would not benefit from amiodarone treatment.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

8.

[Effects of amiodarone versus sotalol in treatment of atrial fibrillation: a random controlled clinical study].

Author: NiuFan, HuangCong-xin, JiangHong, YangBo, GuoWen-ling, ChenYun-xia, JinChun-rong, LiuZhuo-min

Atrial fibrillation conversion
Sinus rhythm maintenance
Bradycardia

Amiodarone is more effective than sotalol in converting atrial fibrillation to sinus rhythm and maintaining sinus rhythm. The adverse reaction of amiodarone on the heart is less severe than that of sotalol.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
English AbstractA summary of a research paper/publication written in English for a wider audience.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : Chinese

9.

Dronedarone for maintenance of sinus rhythm in atrial fibrillation or flutter.

Author: SinghBramah N, ConnollyStuart J, CrijnsHarry J G M, RoyDenis, KoweyPeter R, CapucciAlessandro, RadzikDavid, AliotEtienne M, HohnloserStefan H,

Reduced ventricular rate
Sinus rhythm maintenance
Pulmonary toxic effects
Thyroid and liver dysfunction

Dronedarone was significantly more effective than placebo in maintaining sinus rhythm and reducing ventricular rate during recurrence of arrhythmia. There was no evidence that dronedarone increased the risk of pulmonary toxicity, thyroid dysfunction, or liver dysfunction.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

10.

Ocular Adverse Effects of Amiodarone: A Systematic Review of Case Reports.

Author: AlshehriMona, JouryAbdulaziz

amiodarone
ocular adverse effects

Cornea verticillata/vortex keratopathy was the most common ocular adverse effect of amiodarone, an antiarrhythmic medication, in 25 case reports. Early recognition of amiodarone-induced ocular adverse effects is crucial to prevent worsening keratopathy or other adverse effects.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

11.

Amiodarone and/or lidocaine for cardiac arrest: A Bayesian network meta-analysis.

Author: ZhaoHongli, FanKai, FengGuilong

Increased hospital admission

This meta-analysis assessed the efficacy of amiodarone and/or lidocaine during cardiac arrest. While studies haven't shown improved long-term survival with antiarrhythmic drugs, some suggest higher hospitalization rates with amiodarone or lidocaine compared to placebo.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Meta-AnalysisA statistical technique that integrates the results of multiple studies to draw more general conclusions about a particular issue.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

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