Amiodarone with Lidocaine Interaction Details
Brand Names Associated with Amiodarone
- Amiodarone
- Cordarone®
- Pacerone®
Medical Content Editor Dr. Brian Staiger, PharmD
Last updated
Feb 27, 2024
Interaction Effect
Lidocaine toxicity (cardiac arrhythmia, seizures, coma)
Interaction Summary
Amiodarone can inhibit the metabolism of lidocaine, a CYP3A substrate. Sinus bradycardia has been reported with oral amiodarone given with lidocaine for local anesthesia and seizure associated with increased lidocaine exposure has been reported with concomitant IV amiodarone[1][2]. Monitor heart rate and consider a lower starting dose of lidocaine [1]. Use caution with topical lidocaine/prilocaine in patients receiving a Class III antiarrhythmic agent, such as amiodarone. Consider close surveillance and ECG monitoring, since cardiac effects may be additive. An increased risk of cardiotoxicity, including decreases in cardiac output, total peripheral resistance, and mean arterial pressure, is possible [3]. Drug interactions may persist for weeks to months after discontinuation of amiodarone [1]
Severity
Major
Onset
Rapid
Evidence
Probable
How To Manage Interaction
Amiodarone can inhibit the metabolism of lidocaine, a CYP3A substrate. Sinus bradycardia has been reported with oral amiodarone given with lidocaine for local anesthesia and seizure associated with increased lidocaine exposure has been reported with concomitant IV amiodarone[1][2]. Monitor heart rate and consider a lower starting dose of lidocaine [1]. Use caution with topical lidocaine/prilocaine in patients receiving a Class III antiarrhythmic agent, such as amiodarone. Consider close surveillance and ECG monitoring, since cardiac effects may be additive. An increased risk of cardiotoxicity, including decreases in cardiac output, total peripheral resistance, and mean arterial pressure, is possible [3]. Drug interactions may persist for weeks to months after discontinuation of amiodarone [1].
Mechanism Of Interaction
Decreased lidocaine metabolism
Literature Reports
A) A 71-year-old male developed a seizure following coadministration of lidocaine and amiodarone. The serum lidocaine level increased from 5.4 milligrams/Liter (mg/L) to 12.6 mg/L after two to three days of amiodarone loading. The lidocaine dose was 2 milligrams/minute (mg/min) and the initial loading dose of amiodarone was 600 mg twice daily. Concurrent use of the two drugs appeared to decrease lidocaine clearance, possibly due to inhibition of the cytochrome P450 system by amiodarone [4].
B) Amiodarone did not affect lidocaine pharmacokinetics in a study of 10 patients. Patients had received oral amiodarone for one month before receiving an intravenous bolus of lidocaine. It was suggested that liver blood flow would be the determining factor in the rate of lidocaine clearance and no reason emerged indicating that amiodarone might affect this [5].
C) Severe sinus bradycardia and a long sinoatrial arrest occurred following administration of IV lidocaine in a 64-year-old male with sick sinus syndrome who was receiving amiodarone 600 mg daily. The authors suspect the sinoatrial arrest was secondary to the effects of both lidocaine and amiodarone in depressing the sinus node, especially in patients with the sick sinus syndrome [6].
References
1 ) Product Information: CORDARONE(R) oral tablets, amiodarone oral tablets. Wyeth Pharmaceuticals Inc (per FDA), Philadephia, PA, 2018.
2 ) Product Information: Amiodarone HCl intravenous injection, amiodarone HCl intravenous injection. Wockhardt USA LLC (per DailyMed), Parsippany, NJ, 2017.
3 ) Product Information: EMLA(R) cream, lidocaine prilocaine cream. AstraZeneca Pharmaceuticals, Wilmington, DE, 2005.
4 ) Siegmund J, Wilson J, & Imhoff T: Amiodarone interaction with lidocaine. J Cardiovasc Pharmacol 1993; 21:513-515.
5 ) Nattel S, Talajic M, Beaudoin D, et al: Absence of pharmacokinetic interaction between amiodarone and lidocaine. Am J Cardiol 1994; 73:92-94.
6 ) Keidar S, Grenadier E, & Palant A: Sinoatrial arrest due to lidocaine injection in sick sinus syndrome during amiodarone administration. Am Heart J 1982; 104:1384-1385.
Amiodarone Overview
-
Amiodarone is used to treat and prevent certain types of serious, life-threatening ventricular arrhythmias (a certain type of abnormal heart rhythm when other medications did not help or could not be tolerated. Amiodarone is in a class of medications called antiarrhythmics. It works by relaxing overactive heart muscles.
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Definitions
Severity Categories
Contraindicated
These drugs, generally, should not be used together simultaneously due to the high risk of severe adverse effects. Combining these medications can lead to dangerous health outcomes and should be strictly avoided unless otherwise instructed by your provider.
Major
This interaction could result in very serious and potentially life-threatening consequences. If you are taking this drug combination, it is very important to be under close medical supervision to minimize severe side effects and ensure your safety. It may be necessary to change a medication or dosage to prevent harm.
Moderate
This interaction has the potential to worsen your medical condition or alter the effectiveness of your treatment. It's important that you are monitored closely and you potentially may need to make adjustments in your treatment plan or drug dosage to maintain optimal health.
Minor
While this interaction is unlikely to cause significant problems, it could intensify side effects or reduce the effectiveness of one or both medications. Monitoring for changes in symptoms and your condition is recommended, and adjustments may be made if needed to manage any increased or more pronounced side effects.
Onset
Rapid: Onset of drug interaction typically occurs within 24 hours of co-administration.
Delayed: Onset of drug interaction typically occurs more than 24 hours after co-administration.
Evidence
Level of documentation of the interaction.
Established: The interaction is documented and substantiated in peer-reviewed medical literature.
Theoretical: This interaction is not fully supported by current medical evidence or well-documented sources, but it is based on known drug mechanisms, drug effects, and other relevant information.
How To Manage The Interaction
Provides a detailed discussion on how patients and clinicians can approach the identified drug interaction as well as offers guidance on what to expect and strategies to potentially mitigate the effects of the interaction. This may include recommendations on adjusting medication dosages, altering the timing of drug administration, or closely monitoring for specific symptoms.
It's important to note that all medical situations are unique, and management approaches should be tailored to individual circumstances. Patients should always consult their healthcare provider for personalized advice and guidance on managing drug interactions effectively.
Mechanism Of Interaction
The theorized or clinically determined reason (i.e., mechanism) why the drug-drug interaction occurs.
Disclaimer: The information provided on this page is for informational purposes only and should not be considered medical advice. Always consult with a qualified healthcare professional regarding your specific circumstances and medical conditions.
Where Does Our Information Come From?
Information for our drug interactions is compiled from several drug compendia, including:
The prescribing information for each drug, as published on DailyMED, is also used.
Individual drug-drug interaction detail pages contain references specific to that interaction. You can click on the reference number within brackets '[]' to see what reference was utilized.
The information posted is fact-checked by HelloPharmacist clinicians and reviewed quarterly.