Zusammenfassung
Amiodaron gilt Jahrzehnte nach seiner Zulassung als das wirksamste Medikament zur Behandlung von tachykarden Herzrhythmusstörungen. Amiodaron wird den Klasse-III-Antiarrhythmika zugerechnet. Seine antiarrhythmische Effektivität hat mehrere Ursachen. Es verlängert nicht nur die kardiale Repolarisation, sondern blockiert die Natrium- und Kalziumkanäle. Hinzu kommen eine unselektive β-Blockade, eine hohe Lipophilität und eine extrem lange Halbwertszeit. Bei Patienten mit Vorhofflimmern ist Amiodaron das am besten wirksame Antiarrhythmikum zur Erhaltung eines Sinusrhythmus. Amiodaron unterdrückt ventrikuläre Arrhythmien, z. B. häufige ventrikuläre Extrasystolen oder nicht anhaltende kurze Salven von ventrikulären Tachykardien, v. a. aber unterdrückt es Kammertachykardien und Kammerflimmern. Bei Patienten mit erhöhtem Risiko für den plötzlichen Herztod, z. B. bei hochgradig eingeschränkter linksventrikulärer Pumpfunktion, ist Amiodaron ein hocheffektives und gleichzeitig sicheres Antiarrhythmikum. Bei diesen Patienten kann eine Therapie mit Amiodaron das Auftreten von appropriaten und inappropriaten ICD-Schocks verhindern. Amiodaron zeigt v. a. bei einer Dauertherapie typische Nebenwirkungen wie Korneaablagerungen, Verfärbungen der Haut, Fotosensitivität, Hypo- und Hyperthyreose, periphere Neuropathie, Optikusneuritis sowie Erhöhungen der Leberwerte. Nach dem Absetzen von Amiodaron sind diese in der Regel reversibel. Irreversible, schwere Nebenwirkungen wie Lungenschädigungen treten unter der heute üblichen Erhaltungsdosis von 200 mg pro Tag sehr selten auf. Im Hinblick auf die Nebenwirkungen sollten regelmäßige Kontrolluntersuchungen von Laborwerten, Lungenfunktion und Sehfähigkeit durchgeführt werden.
Abstract
Decades after its registration, amiodarone is still regarded as the most effective antiarrhythmic drug available for the treatment of tachyarrhythmias. Amiodarone is classified as a class III antiarrhythmic drug. In addition to the prolongation of cardiac repolarization, its leading pharmacologic features are sodium and calcium channel block, nonselective β-adrenergic inhibition as well as high lipophilicity and a very long plasma half-life. In patients with paroxysmal atrial fibrillation, amiodarone is the most effective antiarrhythmic drug in maintaining sinus rhythm. Furthermore, it prevents ventricular arrhythmias, such as frequent ventricular extrasystoles or nonsustained runs of ventricular tachycardia, as well as sustained ventricular tachycardia and ventricular fibrillation. In patients with increased risk for sudden cardiac death, e.g., with severely depressed left ventricular function, amiodarone is a highly effective and safe antiarrhythmic drug. In addition, amiodarone has been shown to reduce the number of appropriate and inappropriate shocks in patients with an implantable cardioverter–defibrillator. During long-term amiodarone treatment, typical side effects including corneal microdeposits, blue–gray skin discoloration, photosensitivity, hypothyroidism, hyperthyroidism, peripheral neuropathy, optical neuritis and hepatotoxicity accrue. Upon cessation of medication, these are almost always reversible. Irreversible, severe adverse effects, such as pulmonary toxicity, are very rare under the currently used maintenance dose of 200 mg/day. With regard to its side effect profile, an adequate follow-up of patients including laboratory values, lung function tests, and visual acuity is necessary.
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Sohns, C., Zabel, M. Aktueller Stellenwert von Amiodaron in der antiarrhythmischen Therapie. Herzschr. Elektrophys. 21, 239–243 (2010). https://doi.org/10.1007/s00399-010-0091-0
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DOI: https://doi.org/10.1007/s00399-010-0091-0
Schlüsselwörter
- Amiodaron
- Herzrhythmusstörungen
- Vorhofflimmern
- Ventrikuläre Tachykardien
- Plötzlicher Herztod
- Implantierbarer Kardioverter/Defibrillator