Amiodarone overdose and its management

A patient taking an overdose of 3.4 g of amiodarone is described. Consciousness and physical examination remained normal throughout. Continuous electrocardiographic monitoring for 48 hours after admission revealed only a self-limiting episode of ventricular tachycardia, despite high serum levels of the drug (serum desethylamiodarone levels 4.4 mg/l). The pharmacokinetic properties of amiodarone and treatment strategies for the overdose situation are discussed. It is suggested that there may be a role for the use of cholestyramine in the treatment of both acute and chronic amiodarone toxicity.