Off-label usage for this medication?

[358265]

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Hi guys.

I'm not a pharmacy student (yet!), but I noticed something strange here. I am in need of your expertise.

A doc had changed the SIG on one of a patient's medication after she was admitted into the ER. Amiodarone 200mg was originally written for a-fib, and later was changed to 100mg 1po qAM for hypertension. While doing so, doc then recommended baby aspirin 81mg 2po qd for a-fib. Pt already has lisinopril for hypertension.

I sort of understand the a-fib & aspirin connection, but not really the amiodarone part. Does amiodarone have some off-label use as a true antihypertensive? According to Facts & Comparisons, amiodarone has a slight ß-adrenergic activity... Could this be the reason why it would be used that way? 😕

 

[Carboxide]

Hi guys.

I'm not a pharmacy student (yet!), but I noticed something strange here. I am in need of your expertise.

A doc had changed the SIG on one of a patient's medication after she was admitted into the ER. Amiodarone 200mg was originally written for a-fib, and later was changed to 100mg 1po qAM for hypertension. While doing so, doc then recommended baby aspirin 81mg 2po qd for a-fib. Pt already has lisinopril for hypertension.

I sort of understand the a-fib & aspirin connection, but not really the amiodarone part. Does amiodarone have some off-label use as a true antihypertensive? According to Facts & Comparisons, amiodarone has a slight ß-adrenergic activity... Could this be the reason why it would be used that way? 😕

The aspirin is...well, I'd probably prefer warfarin for a-fib, to be honest. The reason why we use an anti-clotting drug for a-fib is that the condition can cause blood to pool in the chambers of the heart, which then clots and then can be ejected FROM the heart into the lungs or circulatory system. We're trying to prevent this.

Edited for stupidity.

 

[EBT12]

.

 

[npage148]

Doctor just put down the wrong indication when changing the dose.

 

[rxlea]

Are you sure you're not mixing amiodarone up with amlodipine? I am not aware of any labeled or unlabeled indications for amiodarone for hypertension. There are certainly other medications without black box warnings and as many serious drug interactions and side effects (etc) for hypertension.

Amiodarone MOA: Class III antiarrhythmic agent which inhibits adrenergic stimulation (alpha- and beta-blocking properties), affects sodium, potassium, and calcium channels, prolongs the action potential and refractory period in myocardial tissue; decreases AV conduction and sinus node function

Amlodipine MOA: Inhibits calcium ion from entering the "slow channels" or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization, producing a relaxation of coronary vascular smooth muscle and coronary vasodilation; increases myocardial oxygen delivery in patients with vasospastic angina. Amlodipine directly acts on vascular smooth muscle to produce peripheral arterial vasodilation reducing peripheral vascular resistance and blood pressure.

What happens when you block alpha and beta activity? What about calcium?

Sent from my DROID3 using Tapatalk

 

[All4MyDaughter]

Doctor just put down the wrong indication when changing the dose.

I think so too.

 

[Carboxide]

Are you sure you're not mixing amiodarone up with amlodipine? I am not aware of any labeled or unlabeled indications for amiodarone for hypertension. There are certainly other medications without black box warnings and as many serious drug interactions and side effects (etc) for hypertension.

Amiodarone MOA: Class III antiarrhythmic agent which inhibits adrenergic stimulation (alpha- and beta-blocking properties), affects sodium, potassium, and calcium channels, prolongs the action potential and refractory period in myocardial tissue; decreases AV conduction and sinus node function

Amlodipine MOA: Inhibits calcium ion from entering the “slow channels” or select voltage-sensitive areas of vascular smooth muscle and myocardium during depolarization, producing a relaxation of coronary vascular smooth muscle and coronary vasodilation; increases myocardial oxygen delivery in patients with vasospastic angina. Amlodipine directly acts on vascular smooth muscle to produce peripheral arterial vasodilation reducing peripheral vascular resistance and blood pressure.

Blah. You're totally right. Can you tell I slept horribly last night? I promise I got an A on our hypertensive meds exam...😳

 

[SWSF]

Blah. You're totally right. Can you tell I slept horribly last night? I promise I got an A on our hypertensive meds exam...😳

prove it! 👍

 

[Carboxide]

prove it! 👍

Quiz me!

 

[Quiksilver]

Hi guys.

I'm not a pharmacy student (yet!), but I noticed something strange here. I am in need of your expertise.

A doc had changed the SIG on one of a patient's medication after she was admitted into the ER. Amiodarone 200mg was originally written for a-fib, and later was changed to 100mg 1po qAM for hypertension. While doing so, doc then recommended baby aspirin 81mg 2po qd for a-fib. Pt already has lisinopril for hypertension.

I sort of understand the a-fib & aspirin connection, but not really the amiodarone part. Does amiodarone have some off-label use as a true antihypertensive? According to Facts & Comparisons, amiodarone has a slight ß-adrenergic activity... Could this be the reason why it would be used that way? 😕

I don't know why anyone would only use aspirin for someone in a fib. Especially since this seems to be an acute problem where the risk of thrombosis is especially high. If he was newly diagnosed with a fib, he is at a very high risk.

 

[007rx]

I thought aspirin was legitimate for AF in patients with a CHADS2 (CHF, hypertension, > 75 yo, diabetes, stroke hx) score of 0 or 1? All we know right now is the patient has HTN (+1). My AF lecture was last year, has there been an update in the guidelines frowning upon aspirin for AF since then (that I am unaware of)?

 

[Daiphon]

I thought aspirin was legitimate for AF in patients with a CHADS2 (CHF, hypertension, > 75 yo, diabetes, stroke hx) score of 0 or 1? All we know right now is the patient has HTN (+1). My AF lecture was last year, has there been an update in the guidelines frowning upon aspirin for AF since then (that I am unaware of)?

007rx is right. If you have a low CHADS2 (0 or 1), then ASA alone is appropriate therapy to minimize risk of developing clot & subsequent embolization. That being said, new-onset AF is typically anticoagulated with heparin/warfarin until an echo can be done to prove/disprove presence of atrial clot. If no clot, & if CHADS2 is low, then can d/c the anticoagulation and proceed with antiplatelet therapy alone.

All that being said, treatment of AF waxes & wanes, with the "next big thing" (dabigatran) possibly becoming the "next bad thing" (which, IMHO, it is...)... many internists & cardiologists have been trained in different protocols & approaches over the years, and depending on how well they stay up on the literature (and whether or not they believe it) results in a much varied picture.

Cheers!
-d