Interactions between Amiodarone and Efavirenz

Efavirenz has a moderate potential interaction with Alcoholism.

During clinical trials, efavirenz was associated with an increase in the occurrence of serious psychiatric events, including severe depression, suicidal ideation, nonfatal suicide attempts, aggressive behavior, paranoid reactions, and manic reactions. Other factors associated with an increased occurrence of these psychiatric symptoms were history of injectable drug use, psychiatric history, or use of psychiatric medications at study entry; similar associations were observed in the efavirenz and control groups. Therapy with efavirenz should be administered cautiously in patients with current/history of psychiatric illness, emotional instability, or substance abuse. Patients with serious psychiatric adverse reactions should receive prompt medical evaluation to assess the possibility that symptoms are related to efavirenz use, and if so, to determine whether the risks of continued therapy outweigh the benefits.

Amiodarone has a major potential interaction with Cardiogenic Shock.

The use of amiodarone is contraindicated for use in patients with cardiogenic shock, severe sinus node dysfunction causing marked sinus bradycardia, second- or third-degree AV block, or symptomatic bradycardia in the absence of a functioning pacemaker.

Efavirenz has a moderate potential interaction with Depression.

During clinical trials, efavirenz was associated with an increase in the occurrence of serious psychiatric events, including severe depression, suicidal ideation, nonfatal suicide attempts, aggressive behavior, paranoid reactions, and manic reactions. Other factors associated with an increased occurrence of these psychiatric symptoms were history of injectable drug use, psychiatric history, or use of psychiatric medications at study entry; similar associations were observed in the efavirenz and control groups. Therapy with efavirenz should be administered cautiously in patients with current/history of psychiatric illness, emotional instability, or substance abuse. Patients with serious psychiatric adverse reactions should receive prompt medical evaluation to assess the possibility that symptoms are related to efavirenz use, and if so, to determine whether the risks of continued therapy outweigh the benefits.

Efavirenz has a moderate potential interaction with Drug Dependence.

During clinical trials, efavirenz was associated with an increase in the occurrence of serious psychiatric events, including severe depression, suicidal ideation, nonfatal suicide attempts, aggressive behavior, paranoid reactions, and manic reactions. Other factors associated with an increased occurrence of these psychiatric symptoms were history of injectable drug use, psychiatric history, or use of psychiatric medications at study entry; similar associations were observed in the efavirenz and control groups. Therapy with efavirenz should be administered cautiously in patients with current/history of psychiatric illness, emotional instability, or substance abuse. Patients with serious psychiatric adverse reactions should receive prompt medical evaluation to assess the possibility that symptoms are related to efavirenz use, and if so, to determine whether the risks of continued therapy outweigh the benefits.

Amiodarone has a major potential interaction with Heart Block.

The use of amiodarone is contraindicated for use in patients with cardiogenic shock, severe sinus node dysfunction causing marked sinus bradycardia, second- or third-degree AV block, or symptomatic bradycardia in the absence of a functioning pacemaker.

Amiodarone has a major potential interaction with Heart Failure.

Antiarrhythmic agents can induce severe hypotension (particularly with IV administration) or induce or worsen congestive heart failure (CHF). Patients with primary cardiomyopathy or inadequately compensated CHF are at increased risk. Antiarrhythmic agents should be administered cautiously and dosage and/or frequency of administration modified in patients with hypotension or adequately compensated CHF. Alternative therapy should be considered unless these conditions are secondary to cardiac arrhythmia.

Amiodarone has a major potential interaction with Hemodialysis.

Amiodarone and its active metabolite are not removed by hemodialysis.

Amiodarone has a moderate potential interaction with Hyperkalemia.

Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.

Amiodarone has a moderate potential interaction with Hyperthyroidism.

Amiodarone inhibits peripheral conversion of thyroxine (T4) to triiodothyronine (T3) and also contributes inorganic iodine that can result in altered thyroid function tests, hypothyroidism, or hyperthyroidism. Therapy with amiodarone should be administered cautiously in patients with thyroid dysfunction. Clinical monitoring, including baseline and periodic evaluation of thyroid function is recommended. Modification of thyroid therapy may be necessary.

Amiodarone has a moderate potential interaction with Hypokalemia.

Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.

Amiodarone has a major potential interaction with Hypotension.

Antiarrhythmic agents can induce severe hypotension (particularly with IV administration) or induce or worsen congestive heart failure (CHF). Patients with primary cardiomyopathy or inadequately compensated CHF are at increased risk. Antiarrhythmic agents should be administered cautiously and dosage and/or frequency of administration modified in patients with hypotension or adequately compensated CHF. Alternative therapy should be considered unless these conditions are secondary to cardiac arrhythmia.

Amiodarone has a moderate potential interaction with Liver Disease.

There have been rare reports of fatal hepatocellular necrosis after treatment with amiodarone. In patients with life-threatening arrhythmias, the potential risk of hepatic injury should be weighed against the potential benefit of amiodarone therapy. Patients with hepatic impairment should be monitored for evidence of progressive hepatic injury. Consideration should be given to reducing the rate of administration or withdrawing treatment if needed.

Efavirenz has a moderate potential interaction with Liver Disease.

Efavirenz is not recommended for patients with moderate or severe liver dysfunction; insufficient data are available to determine whether dose adjustment is needed. Patients with mild liver dysfunction may receive efavirenz without dose adjustment. Due to extensive CYP450-mediated metabolism and limited clinical experience in patients with liver dysfunction, therapy with efavirenz should be administered cautiously in patients with mild liver dysfunction; careful monitoring is recommended for these patients. In addition, postmarketing cases of hepatitis (including fulminant hepatitis progressing to liver failure requiring transplantation or resulting in death) have occurred during therapy with efavirenz; reports have included patients with underlying liver disease (including coinfection with hepatitis B or C). Monitoring of liver enzymes before and during therapy is recommended for all patients.

Efavirenz has a moderate potential interaction with Long QT Syndrome.

QTc prolongation has been observed with the use of efavirenz. Alternatives to efavirenz should be considered when administered to patients at higher risk of torsade de pointes or when coadministered with a medication with known risk of torsade de pointes.

Amiodarone has a moderate potential interaction with Magnesium Imbalance.

Electrolyte imbalance can alter the therapeutic effectiveness of antiarrhythmic agents. Hypokalemia and hypomagnesemia can reduce the effectiveness of antiarrhythmic agents. In some cases, these disorders can exaggerate the degree of QTc prolongation and increase the potential for torsade de pointes. Hyperkalemia can potentiate the toxic effects of antiarrhythmic agents. Electrolyte imbalance should be corrected prior to initiating antiarrhythmic therapy. Clinical monitoring of cardiac function and electrolyte concentrations is recommended.

Amiodarone has a moderate potential interaction with Neurological Disorders.

Reversible and dose-related nervous system toxicity such as dizziness, paresthesia, tremor and involuntary movements, lack of coordination, abnormal gait and ataxia is commonly noted in patients receiving amiodarone. Therapy with amiodarone should be administered cautiously and dosage modifications considered in patients with or predisposed to neurologic dysfunction.

Amiodarone has a moderate potential interaction with Parkinsonism.

Reversible and dose-related nervous system toxicity such as dizziness, paresthesia, tremor and involuntary movements, lack of coordination, abnormal gait and ataxia is commonly noted in patients receiving amiodarone. Therapy with amiodarone should be administered cautiously and dosage modifications considered in patients with or predisposed to neurologic dysfunction.

Amiodarone has a major potential interaction with Psoriasis.

The use of certain antimalarial agents is contraindicated in patients with known prolongation of QT interval as these patients can develop fatal arrhythmias. These drugs should also be avoided in patients with clinical conditions known to prolong the QT interval, such as uncorrected hypokalemia or hypomagnesemia, bradycardia, and certain other cardiac conditions. Caution is advised in patients taking other medications that can prolong the QT interval.

Efavirenz has a moderate potential interaction with Psychiatric Disorders.

During clinical trials, efavirenz was associated with an increase in the occurrence of serious psychiatric events, including severe depression, suicidal ideation, nonfatal suicide attempts, aggressive behavior, paranoid reactions, and manic reactions. Other factors associated with an increased occurrence of these psychiatric symptoms were history of injectable drug use, psychiatric history, or use of psychiatric medications at study entry; similar associations were observed in the efavirenz and control groups. Therapy with efavirenz should be administered cautiously in patients with current/history of psychiatric illness, emotional instability, or substance abuse. Patients with serious psychiatric adverse reactions should receive prompt medical evaluation to assess the possibility that symptoms are related to efavirenz use, and if so, to determine whether the risks of continued therapy outweigh the benefits.

Efavirenz has a moderate potential interaction with Psychosis.

During clinical trials, efavirenz was associated with an increase in the occurrence of serious psychiatric events, including severe depression, suicidal ideation, nonfatal suicide attempts, aggressive behavior, paranoid reactions, and manic reactions. Other factors associated with an increased occurrence of these psychiatric symptoms were history of injectable drug use, psychiatric history, or use of psychiatric medications at study entry; similar associations were observed in the efavirenz and control groups. Therapy with efavirenz should be administered cautiously in patients with current/history of psychiatric illness, emotional instability, or substance abuse. Patients with serious psychiatric adverse reactions should receive prompt medical evaluation to assess the possibility that symptoms are related to efavirenz use, and if so, to determine whether the risks of continued therapy outweigh the benefits.

Amiodarone has a major potential interaction with Pulmonary Impairment.

Pulmonary toxicities such as hypersensitivity pneumonitis or interstitial/alveolar pneumonitis are potentially fatal (approximately 10% of the time) and have occurred in as many as 10% to 17% of patients administered daily dosages of approximately 400 mg of amiodarone. More frequently, asymptomatic abnormal diffusion capacity has been observed. Patients with preexisting pulmonary dysfunction does not appear to have an increased risk of pulmonary toxicity; however, they have a poorer prognosis if toxicity does develop. Thus, the risks and benefits of amiodarone therapy should be weighed carefully. Clinical monitoring of pulmonary function, including chest X-ray (baseline and every 3 to 6 months) and pulmonary function tests (with diffusion capacity), is recommended in all patients receiving amiodarone therapy. Any new respiratory symptom during treatment should be evaluated promptly and thoroughly, since toxicity is more likely to be reversible if diagnosed and managed early. Patients who develop hypersensitivity pneumonitis should be withdrawn permanently from amiodarone therapy and treated with steroids. In the case of interstitial/alveolar pneumonitis, steroid therapy and dosage reduction or discontinuation of amiodarone, if possible, usually result in clinical improvement. Subsequent rechallenge with amiodarone at reduced dosages does not always lead to return of toxicity and may be considered in some patients. The use of a lower loading dose and maintenance doses may also decrease the incidence of amiodarone- induced pulmonary toxicity.

Efavirenz has a moderate potential interaction with Seizures.

Convulsions have been observed in adult and pediatric patients receiving efavirenz, generally in the presence of known medical history of seizures. Caution should be taken with any patient with history of seizures. Anticonvulsant medications primarily metabolized by the liver (e.g., phenytoin, phenobarbital) may require periodic monitoring of plasma levels.

Amiodarone has a moderate potential interaction with Underactive Thyroid.

Amiodarone inhibits peripheral conversion of thyroxine (T4) to triiodothyronine (T3) and also contributes inorganic iodine that can result in altered thyroid function tests, hypothyroidism, or hyperthyroidism. Therapy with amiodarone should be administered cautiously in patients with thyroid dysfunction. Clinical monitoring, including baseline and periodic evaluation of thyroid function is recommended. Modification of thyroid therapy may be necessary.

Amiodarone has a major potential interaction with Visual Defect/Disturbance.

Optic neuropathy and/or neuritis has occurred during administration of amiodarone and has resulted in visual impairment such as changes in visual acuity, decrease in peripheral vision, and blindness. Optic toxicity can occur at any time following initiation of amiodarone. Therapy with amiodarone should be administered cautiously in patients with visual defects. Regular ophthalmologic examinations including fundoscopy and slit- lamp examinations are recommended.