||November 28, 2005
An Exclusive Continuing Education Publication of Acadiana Consultant Pharmacy Service
Author, Publisher, Editor-in Chief, Typesetter & Printer, Charles S. Feucht,PD,FASCP PharmD candidate
Medication News & Update
BMJ article: ’Sedative hypnotics in older people with insomnia: Meta-analysis of risks and benefits’
A meta-analysis of 24 studies involving 2,417 patients recently released in the British Medical Journal concluded that the benefits of using sedative medications for the treatment of insomnia in people aged 60 years and older may not exceed the risks. Although sleep quality scores improved, total sleep time increased, and the number of nighttime awakenings decreased compared to placebo, adverse events were more common. In fact, adverse cognitive effects were 4.78 times more common, psychomotor events were 2.61 times more common, and reports of daytime fatigue were 3.82 times more common than placebo. To view this article, visit http://bmj.bmjjournals.com/cgi/content/abstract/331/7526/1169
drug interaction alerts for amiodarone.
This is due to the recent warnings about potentially fatal toxicities and many serious drug interactions.
Digoxin, warfarin, quinidine, and procainamide doses need to be reduced by 30% to 50% when patients start amiodarone.
Macrolides, some quinolones, azole antifungals, tricyclic antidepressants, and others can increase arrhythmia risk when combined with amiodarone. Recommend alternatives if possible.
Grapefruit juice can increase amiodarone levels. Tell patients to avoid it.
Lovastatin, simvastatin, and atorvastatin levels can increase...enhancing the risk of myopathy. Recommend an alternative if patients need medium to high doses of these statins.
Phenytoin and cyclosporine levels can increase by 2-fold or greater. Suggest monitoring levels of these drugs.
Ciprofloxacin and other CYP3A4 inhibitors can increase amiodarone levels. Recommend monitoring for amiodarone toxicity.
Rifampin, phenytoin, St. John's wort, and other CYP3A4 inducers can lower amiodarone levels. These patients might need a higher amiodarone dose to control their arrhythmia.
Cholestyramine can lower amiodarone levels and therefore patients might need a higher dose.
Diuretics can increase the risk of arrhythmia by lowering potassium and magnesium levels. Recommend lab and EKG monitoring.
Beta-blockers, verapamil, diltiazem, and others can further slow heart rate when combined with amiodarone. Suggest monitoring heart rate.
This is not a complete list of drugs that can interact with amiodarone. For a helpful summary of important interactions and what to do about them, see our Detail-Document.
Also keep in mind that interactions can occur for several weeks or longer after stopping amiodarone because it takes so long to be eliminated.