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Massimo NACCA, Gelsomina RONZA, Cristina AMBROSONE, Luigi BOCCIA
A.O.R.N Sant’Anna e San Sebastiano, Caserta, Italia
Amiodarone is an antiarrhythmic and antianginal drug (Class III), highly lipophilic, with hepatic metabolism and biliary, lacrimal and cutaneous excretion. Because of its high lipophilic nature, it penetrates deeply into the lipid matrix of the cell membranes from which it is released very slowly after its discontinuation. During chronic treatment, amiodarone and its metabolite desetilamiodarone (DEA) accumulate in several organs and tissues, including eyes, adipose tissue, liver, lungs, kidney, heart, skeletal muscle and brain. Oral administration of amiodarone causes adverse effects in about 75% of treated patients, resulting in suspension of therapy in 3-18% of cases. The incidence of adverse effects, including exacerbation of arrhythmia, tends to be highest in the first six months of treatment and to remain on constant values after the first year. The main side effects of amiodarone include microdeposits corneal, neuropathy/optic neuritis, skin discoloration, photosensitivity, hypo/hyperthyroidism, pulmonary toxicity, hepatotoxicity. In particular, at skin level amiodarone induces a slate-gray pigmentation in sun-exposed skin areas, because of amiodarone-lipoprotenin complex formation after light exposure. Dermatologic complications, often overlooked or misdiagnosed, however, are reversible and disappear after discontinuation of drug. Dermopathy, while not generally affecting the outcome of therapy and rarely leading to discontinuation of treatment, has a big impact on patients quality of life.