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Frequency, characteristics, and risk factors for amiodarone neurotoxicity
Carolyn F Orr1, J Eric Ahlskog
1Department of Neurology, Mayo College of Medicine, Rochester, Minnesota 55905, USA.
Objective:
To assess the incidence, severity, and spectrum of neurologic toxic effects associated with administration of amiodarone hydrochloride.
Design:
Retrospective medical record analysis of cardiac patients treated with amiodarone between January 1, 1996, and July 31, 2008.
Setting:
Residents of Olmsted County, Minnesota, treated at the Mayo Clinic.
Patients:
The Mayo Clinic medical records of all adult Olmsted County residents prescribed amiodarone between January 1, 1996, and July 31, 2008, were reviewed and all possible neurologic adverse effects that might be attributable to amiodarone were tabulated.
Main Outcome Measures:
Risk factors and clinical characteristics of patients developing neurologic problems were compared with those who did not.
Results:
Over the 151 months of analysis, 707 patients were treated with amiodarone. Among these patients, the cumulative incidence of likely amiodarone neurotoxic effects was 2.8%; 1.6% of all amiodarone-treated patients were referred to Neurology for a neurotoxic reaction. Neurologic problems included tremor, gait ataxia, peripheral neuropathy, and cognitive impairment. The primary risk factor for amiodarone neurotoxic effects was duration of treatment, not age, drug dose, sex, or indication for therapy. Where this could be assessed, the adverse effects were usually but not always reversible.
Conclusions:
Amiodarone infrequently causes clinically significant neurologic toxic effects. Substantially higher estimates of neurotoxic effects in the early amiodarone era may be related to a much higher daily dose.
Insights
Amiodarone hydrochloride infrequently causes neurotoxic effects, with a 2.8% incidence. Duration of treatment, not dose or age, was the primary risk factor for these neurologic adverse events.
Area of Science:
- Neurology
- Cardiology
- Pharmacology
Background:
- Amiodarone hydrochloride is a widely used antiarrhythmic medication.
- Neurologic adverse effects are a potential concern with amiodarone therapy.
- Understanding the incidence and risk factors for amiodarone-induced neurotoxicity is crucial for patient safety.
Purpose of the Study:
- To determine the incidence, severity, and types of neurologic toxic effects from amiodarone.
- To identify risk factors associated with amiodarone neurotoxicity.
Main Methods:
- Retrospective analysis of medical records of adult patients treated with amiodarone.
- Inclusion criteria: Olmsted County residents treated at Mayo Clinic between January 1, 1996, and July 31, 2008.
- Comparison of clinical characteristics and risk factors between patients with and without neurologic problems.
Main Results:
- The cumulative incidence of likely amiodarone neurotoxic effects was 2.8% among 707 patients.
- Neurologic manifestations included tremor, gait ataxia, peripheral neuropathy, and cognitive impairment.
- The duration of amiodarone treatment was the primary risk factor for neurotoxicity.
Conclusions:
- Amiodarone infrequently causes clinically significant neurologic toxic effects.
- Earlier, higher daily doses of amiodarone may have been associated with greater neurotoxicity.
- Adverse neurologic effects were generally reversible upon discontinuation of amiodarone.
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