Steady-state serum amiodarone concentrations: Relationships with antiarrhythmic efficacy and toxicity

H. H. Rotmensch, B. Belhassen, B. N. Swanson, D. Shoshani, S. R. Spielman, A. J. Greenspon, A. M. Greenspan, P. H. Vlasses, L. N. Horowitz

Research output: Contribution to journalArticlepeer-review


The relationship of apparent steady-state serum concentrations of amiodarone and its metabolite, desethylamiodarone, to therapeutic and toxic effects was assessed in 127 patients who had treatment-resistant ventricular or supraventricular arrhythmias or were intolerant to other agents. After at least 2 months (mean, 9.8) of treatment with daily maintenance doses of 200 to 600 mg, arrhythmias were effectively suppressed in 78% of patients. Arrhythmias recurred in 47% of patients with serum amiodarone concentrations of less than 1.0 mg/L, whereas only 14% of patients with higher concentrations had recurrences (p < 0.005). Side effects, most of them mild, occurred in 57%; only 9 patients required discontinuation of drug therapy. The risk of developing adverse reactions was related to serum amiodarone concentrations (p < 0.0001). Adverse reactions were common in patients with serum values exceeding 2.5 mg/L, although pulmonary complications did occur at lower concentrations. Monitoring serum amiodarone concentrations may differentiate failure of drug therapy from suboptimal dosing and reduce the incidence of concentration-related side effects.

Original languageEnglish
Pages (from-to)462-469
Number of pages8
JournalAnnals of Internal Medicine
Issue number4
StatePublished - 1984
Externally publishedYes


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