Anaphylactic shock associated with intravenous amiodarone

Area of Science:

• Cardiology
• Clinical Pharmacology
• Allergy and Immunology

Background:

• Atrial fibrillation is a common cardiac arrhythmia.
• Amiodarone is a widely used Class III antiarrhythmic agent for managing atrial fibrillation.
• Drug-induced anaphylaxis is a critical adverse event requiring prompt recognition.

Purpose of the Study:

• To highlight the rare but potentially fatal complication of anaphylactic shock following intravenous amiodarone administration.
• To emphasize the importance of patient history regarding allergies, particularly to iodine and iodinated contrast media, before initiating amiodarone therapy.

Main Methods:

• Case report of a 64-year-old female patient presenting with atrial fibrillation and rapid ventricular response.
• Intravenous administration of amiodarone for pharmacological cardioversion.
• Monitoring for adverse reactions during and after amiodarone infusion.

Main Results:

• The patient developed pruritus, urticaria, dyspnea, and bronchoconstriction shortly after amiodarone infusion.
• A significant drop in blood pressure (64/40 mmHg) indicated anaphylactic shock.
• The patient required intensive care unit admission for supportive treatment.

Conclusions:

• Anaphylactic shock is a rare but life-threatening adverse reaction to amiodarone.
• Thorough patient screening for prior allergic reactions, especially to iodine-containing substances, is crucial before prescribing amiodarone.
• Alternative antiarrhythmic agents should be considered in patients with a history of relevant allergies.