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Key takeaways
Amiodarone treats severe heart arrhythmias, but it has significant side effects. Alternatives include Multaq, Betapace, Tikosyn, Tambocor, and Rythmol SR for those who cannot tolerate it.
Natural alternatives and lifestyle changes, such as herbal supplements, a heart-healthy diet, and stress-relief practices, are considered alongside or in addition to medication for heart arrhythmia management.
Switching from amiodarone to an alternative requires careful monitoring, possibly involving a wash-out period, with decisions on timing and choice of the new medication based on individual health status and risk of side effects or drug interactions.
Amiodarone is a prescription drug used to treat severe heart arrhythmias (irregular heartbeats). It is approved to treat life-threatening ventricular tachycardia or ventricular fibrillation. However, it’s commonly used off-label to treat atrial fibrillation (Afib). Amiodarone belongs to a class of drugs called antiarrhythmics that work by blocking certain electrical signals to control heart rhythm.
Amiodarone is considered one of the most potent antiarrhythmic drugs. However, its use comes with a high risk of side effects, such as gastrointestinal problems, lung toxicity, and thyroid dysfunction. For people who are unable to tolerate the side effects of amiodarone, other treatments are available. Your doctor may prescribe an amiodarone alternative if you have a medical condition that puts you at risk for serious problems with amiodarone (contraindications).
Continue reading to learn more about amiodarone alternatives, why they might be prescribed, and other factors to consider when finding the best treatment option.
What can I take in place of amiodarone?
Other treatment options are available to treat heart rhythm problems, such as atrial fibrillation. In many cases, healthcare providers may recommend other drugs before prescribing amiodarone. There are various antiarrhythmics that are sub-grouped into different classes and may be used instead of amiodarone. Certain drugs, such as dronedarone, dofetilide, and sotalol, work similarly to amiodarone as class III antiarrhythmics.
The best treatment option will depend on several factors, including other medical conditions you have, other drugs you take, and possible side effects you might experience from a drug. The goal of therapy with an antiarrhythmic is to maintain sinus rhythm and improve quality of life.
Compare amiodarone alternatives |
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|---|---|---|---|
| Drug name | Uses | Dosage | Savings options |
| Pacerone (amiodarone) | Malignant ventricular arrhythmias, treatment and prevention of atrial fibrillation (off-label) | 100 to 400 mg once daily | Pacerone coupons |
| Multaq (dronedarone) | Prevention of atrial fibrillation or atrial flutter | 400 mg twice daily | Multaq coupons |
| Tikosyn (dofetilide) | Treatment or prevention of atrial fibrillation or atrial flutter | 500 mcg every 12 hours | Tikosyn coupons |
| Betapace (sotalol) | Life-threatening ventricular arrhythmias, prevention of atrial fibrillation or atrial flutter | 80 to 160 mg twice daily | Betapace coupons |
| Tambocor (flecainide) | Prevention of ventricular arrhythmias, prevention of atrial fibrillation or supraventricular tachycardia | 50 to 300 mg per day for atrial fibrillation or 100 to 400 mg per day for ventricular arrhythmias (divided into two or three doses) | Flecainide coupons |
| Rythmol SR (propafenone) | Ventricular arrhythmias, prevention of atrial fibrillation or atrial flutter or supraventricular tachycardia | 150 to 300 mg every 8 hours | Propafenone coupons |
Top 5 amiodarone alternatives
1. Multaq (dronedarone)
Dronedarone is a close cousin of amiodarone. As an analog of amiodarone, dronedarone is chemically similar to amiodarone. However, dronedarone does not contain iodine, a chemical in amiodarone that affects thyroid function. While its side effect profile is better than that of amiodarone, dronedarone may be less effective than amiodarone. Still, dronedarone can be an appropriate alternative for people who can’t tolerate amiodarone’s side effects. People with kidney problems should avoid the use of dronedarone.
2. Betapace (sotalol)
Sotalol is an effective medication to manage heart rhythm problems, but treatment is usually started in a hospital or clinic due to potential adverse effects (QT prolongation). It can be used to prevent irregular heart rhythms in people with heart valves or heart muscle problems. Sotalol has a beta-blocker effect that can decrease heart rate, and its use may need to be avoided in people with a slow heartbeat (bradycardia). Taking sotalol with bradycardia could increase the risk of a dangerous abnormal heart rhythm called torsades de pointes. Sotalol is cleared from the body through the kidneys and should also be avoided in people with kidney problems.
3. Tikosyn (dofetilide)
Dofetilide works similarly to sotalol, dronedarone, and amiodarone as a class III antiarrhythmic. Like sotalol, dofetilide is effective at slow heart rates and needs to be started in an inpatient setting due to potential QT prolongation. It should also be avoided in people with kidney impairment, as the drug is cleared through the kidneys. Dofetilide is one of the few safe options for treating arrhythmias in people with heart failure. Due to the risk of potential heart rhythm problems, treatment with dofetilide generally needs to be started in the hospital by a trained healthcare professional.
4. Tambocor (flecainide)
Flecainide is a class IC antiarrhythmic that is commonly prescribed to treat AF. It is often taken twice daily for long-term AF treatment, but it can also be taken as needed. Flecainide should be avoided in people with structural heart disease. It is often taken with a beta-blocker or calcium channel blocker to prevent atrial flutter. Drug interactions should be monitored as certain medications, such as some antidepressants, can affect how flecainide is processed in the body.
5. Rythmol SR (propafenone)
Propafenone works similarly to flecainide as a class IC antiarrhythmic. It is an effective option for AF but is often used for severe ventricular arrhythmias. Like flecainide, propafenone should be avoided in people with structural heart disease. Propafenone can be taken twice daily or as needed, and it should be taken with a low-dose beta-blocker or calcium channel blocker to prevent atrial flutter. Propafenone carries a risk for many of the same drug interactions as those of flecainide.
Natural alternatives to amiodarone
There is no one-size-fits-all treatment for an irregular heart rhythm. Your provider may recommend you try alternative or complementary therapies in addition to the medication you are already taking. Although the use of alternative treatments may be appealing to avoid prescription side effects, it’s important to try natural alternatives under the supervision of your doctor.
Herbal supplements
Certain herbal agents have been used for their cardiovascular benefits. The leaves, flowers, and berries of the hawthorn plant have been used for therapeutic purposes, such as maintaining heart health. The motherwort plant has also been shown to have protective effects on the heart, such as regulating heart rhythm. There are no herbal supplements that have been approved by the FDA for cardiac arrhythmias, and studies are still being conducted to evaluate their effects.
Electrolytes
Electrolytes are essential parts of maintaining a normal heart rhythm. Low levels of magnesium and potassium may contribute to an irregular heartbeat. Sodium and calcium imbalances could also trigger an arrhythmia. Your provider may recommend eating a diet that provides sufficient electrolytes or supplementing with electrolytes. In severe cases, aggressive treatment may be needed to prevent arrhythmias from causing serious complications.
Heart healthy diet
Eating a healthy diet can also have cardiovascular benefits. For instance, the Mediterranean diet may have positive effects on reducing obesity and high blood pressure, which are risk factors for heart complications. Avoiding processed foods, excess sugars, and large amounts of salt can be beneficial for the heart.
Lifestyle changes
Chronic stress and anxiety may contribute to an abnormal heart rhythm. You might want to try stress-relieving techniques and therapies, such as yoga or acupuncture, to help keep stress under control. Clinical trials have shown that 87% to 100% of people experienced normal sinus rhythm after acupuncture. Some studies have shown promising results with yoga for managing heart rhythm problems. In addition to managing heart rate, yoga may help promote normal blood pressure.
Surgery
Surgical procedures, such as ablation, may be recommended if prescription medications are not working for you. Ablation is a type of surgery used to treat atrial fibrillation. The procedure involves the use of heat or freezing to cause scarring on the inside of the heart and disrupt abnormal electrical signals. Ablation is mainly used to help manage symptoms of atrial fibrillation. It may not be a good option for you if you have structural problems with your heart.
How to switch to an amiodarone alternative
Your provider’s goal will be to reduce the risk of an arrhythmia and potential side effects or drug interactions when switching between different antiarrhythmic drugs. Switching an antiarrhythmic drug to another may involve a wash-out period, in which the first drug is discontinued for weeks before starting the next drug. Because of its long half-life and risk of drug interactions, amiodarone may be discontinued for some time before switching to an alternative. However, you should consult with a healthcare provider first if you want to switch to an alternative.
In some cases, your provider may recommend switching to an alternative relatively quickly after the discontinuation of amiodarone. Clinical studies have shown that the rapid switching of amiodarone to dronedarone is not linked to any serious side effects. However, in most cases, cardiologists will recommend waiting at least six weeks after stopping amiodarone before trying a different medication.
Switching to an amiodarone alternative generally involves consistent monitoring, especially if the alternative drug is started in the hospital. When switching between antiarrhythmic drugs, your provider may need to run specific tests, such as electrocardiograms, chest X-rays, pulmonary function tests, and other lab tests. Your provider may also recommend frequent follow-up visits to assess how the new treatment is working for you.
Always seek medical advice if you are unsure how to take your medication or have other concerns about your treatment.