Low-dose Amiodarone Is Safe: A Systematic Review and Meta-analysis

Area of Science:

• Cardiology
• Pharmacology

Background:

• Amiodarone is a widely used antiarrhythmic drug (AAD) for various arrhythmias.
• Its use is limited by dose- and duration-dependent side effects.
• Low-dose amiodarone regimens are increasingly considered to mitigate risks.

Purpose of the Study:

• To determine the incidence of side effects leading to discontinuation of low-dose (≤200 mg/day) and very-low-dose (≤100 mg/day) amiodarone.
• To compare the safety profiles of these low-dose amiodarone regimens.

Main Methods:

• A systematic literature search was conducted through June 2019.
• Included studies reported amiodarone side effect incidence or prevalence.
• Data from 10 observational cohort studies (901 patients) were meta-analyzed using random-effects modeling.

Main Results:

• The pooled incidence of overall side effects for low-dose amiodarone (≤200 mg/day) was 17% (95% CI: 12-22%).
• Side effects requiring discontinuation occurred in 6% (95% CI: 3-11%) of patients on low-dose amiodarone.
• For very-low-dose amiodarone (≤100 mg/day), overall side effects were 11% (95% CI: 4-27%), with only 2% (95% CI: 1-6%) requiring discontinuation.

Conclusions:

• Very-low-dose amiodarone (≤100 mg/day) demonstrates a low incidence of significant side effects.
• The rate of amiodarone discontinuation due to adverse events is substantially reduced with very-low-dose regimens.
• These findings support the use of very-low-dose amiodarone for managing arrhythmias when safety is a primary concern.