A Case of Dronedarone-Induced Hypotensive Shock

Area of Science:

• Cardiology
• Pharmacology

Background:

• Atrial fibrillation (AF) is a prevalent cardiac arrhythmia requiring management.
• Dronedarone is an antiarrhythmic agent used for AF rate and rhythm control, with established benefits in non-permanent AF.
• Dronedarone carries risks, including increased mortality in patients with heart failure or permanent AF.

Observation:

• A 73-year-old female patient developed severe hypotension shortly after initiating dronedarone therapy.
• The hypotension was refractory to intravenous fluids and necessitated intensive care with vasopressor support.
• The patient's blood pressure normalized within 24 hours, correlating with dronedarone's half-life.

Findings:

• Dronedarone was identified as the probable cause of the hypotensive shock.
• While amiodarone is linked to hypotension, potentially due to co-solvents, dronedarone-induced hypotension is considered less common.
• The absence of iodine in dronedarone may contribute to a better side-effect profile compared to amiodarone.

Implications:

• Clinicians should be vigilant for potential hypotensive events when prescribing dronedarone, even if rare.
• Understanding the pharmacokinetic profile of dronedarone is crucial for managing adverse events.
• This case underscores the importance of considering drug-induced hypotension in patients presenting with shock, particularly after initiating new cardiac medications.