Caramanno G, Innocente P, Di Giovanna F
Azienda Ospedaliera S. Giovanni di Dio-Agrigento Cardiologia e U.T.I.C.
Clin Ter. 1997 Dec;148(12):627-31.
Amiodarone is a choice drug for the treatment of patients suffering from life-threatening hyperkinetic ventricular arrhythmias and depressed ventricular function. The drug is characterized by a remarkably long halflife and a delayed initial activity after oral administration of the usual loading levels. The aim of this study was to establish: -the clinical tolerance to elevated doses in patients with heart failure presenting complex, hyperkinetic ventricular arrhythmias; -the possibility to shorten hospitalization as a result of the oral loading; -whether this administration route would take less time to be efficacious. For this purpose, 30 patients with heart failure and complex, hyperkinetic ventricular arrhythmias were treated with 0.50 mg/kg body weight of amiodarone for three days and with 0.30 mg/kg on the 4th and 5th days, followed by a maintenance period of treatment with 200-400 mg daily. All patients underwent a 24-h Holter test before and after administration and an echocardiographic examination showing an average ejection fraction of approximately 30%. Amiodarone was clinically well tolerated; only 2 patients required discontinuation of therapy whereas, among the the remaining 28 patients, 2 cases of transient hypotension and 3 cases of gastroenteric disorders were observed. It was concluded that elevated doses of amiodarone were well tolerated, which allowed to reduce the loading period and, therefore, hospitalization.
胺碘酮是治疗患有危及生命的高动力性室性心律失常且心室功能减退患者的首选药物。该药物的特点是半衰期极长，口服常用负荷剂量后初始活性延迟。本研究的目的是确定：- 心力衰竭伴复杂、高动力性室性心律失常患者对高剂量的临床耐受性；- 口服负荷剂量能否缩短住院时间；- 这种给药途径是否能更快起效。为此，对30例心力衰竭伴复杂、高动力性室性心律失常患者，给予0.50mg/kg体重的胺碘酮，连用三天，第4天和第5天给予0.30mg/kg，随后进入每日200 - 400mg的维持治疗期。所有患者在给药前后均接受了24小时动态心电图检查，超声心动图检查显示平均射血分数约为30%。胺碘酮临床耐受性良好；仅2例患者需要停药，而其余28例患者中，观察到2例短暂性低血压和3例胃肠道疾病。得出的结论是，高剂量胺碘酮耐受性良好，这使得可以缩短负荷期，从而缩短住院时间。
