Last update Aug. 25, 2022

Amiodarone

High Risk

Poorly safe. Evaluate carefully. Use safer alternative or interrupt breastfeeding 3 to 7 T ½ (elimination half-lives). Read the Comment.

A powerful antiarrhythmic drug that contains 35% iodine, so it may cause thyroid dysfunction in treated patients. Administered orally and intravenously. It is used occasionally in acute arrhythmias and chronically in preventive or maintenance treatments. Oral and intravenous administration.

It is excreted in breast milk in highly variable amounts that can be significant. (Javot 2019, Khurana 2014, Hall 2003, Plomp 1992, Strunge 1988, McKenna 1983)

Plasma levels in the infant can be between 4% and 60% of maternal levels. (Plomp 1992, Strunge 1988, McKenna 1983),

But no clinical problems have been observed in these infants (Hall 2003, Plomp 1992, Strunge 1988, McKenna 1983), except for a newborn who showed signs of trasient hypothyroidism after his mother had taken amiodarone during pregnancy. (Plomp 1992).

Its very long half-life, which can reach 100 days, should be taken into account.

Chronic use during breastfeeding is not recommended (Hotham 2015, Tan 2001), but if necessary due to poor response to other alternatives, cardiac and thyroid function checks in the infant are mandatory on a periodic basis. (Basaria 2005, Bartalena 2001, Moretti 2000)

Isolated use to reverse acute arrhythmia does not significantly raise the levels of amiodarone in breast milk and neither in the plasma of infants, so stopping breastfeeding would not be necessary. (Javot 2019, Khurana 2014)

Experts authors consider that if it has been taken during a maximum of 3 to 7 days, an interruption to breasfeeding of 24 to 48 hours is sufficient. (Hale)

Alternatives

  • Disopyramide ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Mexiletine ( Safe. Compatible. Minimal risk for breastfeeding and infant.)
  • Procainamide ( Safe. Compatible. Minimal risk for breastfeeding and infant.)

Suggestions made at e-lactancia are done by APILAM team of health professionals, and are based on updated scientific publications. It is not intended to replace the relationship you have with your doctor but to compound it. The pharmaceutical industry contraindicates breastfeeding, mistakenly and without scientific reasons, in most of the drug data sheets.

Jose Maria Paricio, Founder & President of APILAM/e-Lactancia

Your contribution is essential for this service to continue to exist. We need the generosity of people like you who believe in the benefits of breastfeeding.

Thank you for helping to protect and promote breastfeeding.

José María Paricio, founder of e-lactancia.

Other names

Amiodarone is also known as


Amiodarone in other languages or writings:

Group

Amiodarone belongs to this group or family:

Tradenames

Main tradenames from several countries containing Amiodarone in its composition:

Pharmacokinetics

Variable Value Unit
Oral Bioavail. 20 - 55 %
Molecular weight 645 daltons
Protein Binding 96 - 99 %
VD 18 - 148 l/Kg
pKa 6.6 -
Tmax 3 - 7 hours
1.392 ( 360 - 3.408) hours
M/P ratio 3.5 - 13 -
Theoretical Dose 0.03 - 1.8 mg/Kg/d
Relative Dose 11 (0.5 - 43) %
Ped.Relat.Dose 0.18 - 70 %

References

  1. Hale TW. Medications & Mothers' Milk. 1991- . Springer Publishing Company. Available from https://www.halesmeds.com Consulted on March 17, 2022 Full text (link to original source)
  2. Hotham N, Hotham E. Drugs in breastfeeding. Aust Prescr. 2015 Abstract Full text (link to original source) Full text (in our servers)
  3. Khurana R, Bin Jardan YA, Wilkie J, Brocks DR. Breast milk concentrations of amiodarone, desethylamiodarone, and bisoprolol following short-term drug exposure: two case reports. J Clin Pharmacol. 2014 Abstract
  4. Basaria S, Cooper DS. Amiodarone and the thyroid. Am J Med. 2005 Abstract
  5. Hall CM, McCormick KP. Amiodarone and breast feeding. Arch Dis Child Fetal Neonatal Ed. 2003 Abstract Full text (link to original source) Full text (in our servers)
  6. Tan HL, Lie KI. Treatment of tachyarrhythmias during pregnancy and lactation. Eur Heart J. 2001 Abstract Full text (link to original source) Full text (in our servers)
  7. Bartalena L, Bogazzi F, Braverman LE, Martino E. Effects of amiodarone administration during pregnancy on neonatal thyroid function and subsequent neurodevelopment. J Endocrinol Invest. 2001 Abstract
  8. Moretti ME, Lee A, Ito S. Which drugs are contraindicated during breastfeeding? Practice guidelines. Can Fam Physician. 2000 Sep;46:1753-7. Review. Abstract Full text (link to original source) Full text (in our servers)
  9. Plomp TA, Vulsma T, de Vijlder JJ. Use of amiodarone during pregnancy. Eur J Obstet Gynecol Reprod Biol. 1992 Abstract
  10. Strunge P, Frandsen J, Andreasen F. Amiodarone during pregnancy. Eur Heart J. 1988 Abstract
  11. McKenna WJ, Harris L, Rowland E, Whitelaw A, Storey G, Holt D. Amiodarone therapy during pregnancy. Am J Cardiol. 1983 Abstract

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