[Amiodarone--still a useful antiarrhythmic drug]

In former days, amiodarone was mainly used as high-dose prescription for serious ventricular arrhythmias. The indication was life-saving and a high incidence of adverse effects was consequently accepted. Such patients are currently protected by an implantable cardioconverter-defibrillator (ICD), and the typical amiodarone patient receives low-dose treatment for atrial fibrillation. In this situation, the tolerance for adverse effects is lower. Increased photosensitivity is often bothersome and the thyroid function is frequently affected. Cough and dyspnoe may still indicate drug-induced interstitial lung disease and is a feared complication that may have a lethal outcome, but it rarely occurs due to the lower doses prescribed. The pharmacokinetics of amiodarone are peculiar, and there are interactions with many drugs. Treatment must therefore be guided by a specialist of internal medicine or cardiology. Despite these limitations, amiodarone is a useful drug, both in the emergency setting and in the atrial fibrillation patients who respond poorly to conventional treatment. Amiodarone may prove beneficial in the primary prevention of atrial fibrillation, to convert fibrillation, to prevent recurrency, and finally, to reduce a fast ventricular rate that does not respond to standard therapy.