TO THE EDITOR: I read with interest...

TO THE EDITOR: I read with interest the of the first grade article (1) by Dr. Siddoway forward the clinical use of the antiarrhythmic put drugs into amiodarone (Cordarone) that appeared in the December 1 2003 issue of American Family Physician. The author clearly not absented the effectiveness and adverse powers related to this therapy that has been used intravenously or orally to transpose and prevent recurrences of cardiac arrhythmias. However, there was no mention in the article (1) of thrombophlebitis, a usual complication associated with intravenous amiodarone. (2)

modern studies (3) have reported rates of phlebitis as high as 16 percent with the intravenous administration of amiodarone. A meta-analysis (4) of 18 randomized controll trials studying intravenous amiodarone to renew atrial fibrillation reported an 8 percent rate of phlebitis among the 550 patients who received amiodarone. In this systematic review, (4) phlebitis was the greatest in number common adverse effect of the unsalable article followed by bradycardia (4 percent of patients) and hypotension (2 percent of patients).

Thrombophlebitis usually happens when high doses of amiodarone are infused above a long period in peripheral veins. Thus, to avoid this side power the drug should be administered in a peripheral vein for a maximum of 24 hours. Afterwards, the mix with drugs must be used orally or a central vein access should be considered. (5) from following these precautions, this minor however frequent complication can be avoided.

REFERENCES

(1) Siddoway LA. Amiodarone: guidelines for use and monitoring. Am Fam Physician 2003;68:2189-96

(2) Aravanis C Acute thrombophlebitis appropriate to IV use of amiodarone. Chest 1982;82:515-6

(3) Vardas PE Kochiadakis GE Igoumenidis NE Tsatsakis AM, Simantirakis EN Chlouverakis GI. Amiodarone as a first-choice medicine for restoring sinus rhythm in patients with atrial fibrillation: a randomized, controll consideration Chest 2000;117:1538-45.

(4) Hilleman DE Spinler SA. Conversion of recent-onset atrial fibrillation with intravenous amiodarone: a metaanalysis of randomized controll trials. Pharmacotherapy 2002;22:66-74

(5) Faniel R Schoenfeld P Efficacy of i.v. amiodarone in converting rapid atrial fibrillation and beat [i]or[/i] move tremulously to sinus rhythm in intensive care patients. Eur Heart J 1983;4:180-5

HENRIQUE HORTA VELOSO MD

ANGELO AMATO VINCENZO DE PAOLA, MD

VOTCOR-Hospital da Veneravel Ordem Terceira da Penitencia Rua Conde de Bonfim 1033 Tijuca Rio de Janeiro, Brazil 20530-001

COPYRIGHT 2004 American Academy of Family Physicians

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