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Amiodarone pulmonary toxicity

Edward D Chan, MD
Talmadge E King, Jr, MD
Section Editor
Kevin R Flaherty, MD, MS
Deputy Editor
Helen Hollingsworth, MD


Amiodarone is an iodinated benzofuran derivative that is used to suppress ventricular and supraventricular tachyarrhythmias. (See "Clinical uses of amiodarone".)

Pulmonary toxicity is among the most serious adverse effects of amiodarone. Several forms of pulmonary disease occur among patients treated with amiodarone, including interstitial pneumonitis, organizing pneumonia, acute respiratory distress syndrome (ARDS), diffuse alveolar hemorrhage (DAH), pulmonary nodules and solitary masses, and also (rarely) pleural effusion. Other adverse effects from amiodarone include photosensitivity, blue-gray discoloration of the skin, thyroid dysfunction, corneal deposits, abnormal liver function tests, and bone marrow suppression [1].

The types, pathogenesis, risk factors, diagnosis, and treatment of amiodarone pulmonary toxicity will be reviewed here. The other major side effects of amiodarone are discussed separately. (See "Monitoring and management of amiodarone side effects".)


Interstitial pneumonitis is the most common presentation of amiodarone-induced pulmonary disease. Interstitial pneumonitis usually presents after two or more months of therapy, especially in patients in whom the dose of amiodarone exceeds 400 mg per day [2]. The incidence of pulmonary toxicity from amiodarone is not precisely known; it is estimated to be 1 to 5 percent, depending on the dose of amiodarone [3-6]. The rate increases at higher doses of amiodarone, particularly long-term use of doses over 500 mg daily.

Pathogenesis — The mechanisms involved in amiodarone-induced interstitial pneumonitis are incompletely understood. Two major hypotheses have been suggested, a direct toxic injury to lung cells and an indirect immunologic reaction [7]. Genetic susceptibility of certain individuals may play an additional role in determining the type of injury that ensues. Whether these processes pertain to other forms of amiodarone-induced lung toxicity is not known.

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Literature review current through: Nov 2017. | This topic last updated: Nov 01, 2017.
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