Cochin Cardiac Club

Health Blog by Dr.Uday Nair

MEDICINES TO HAVE AT HOME



A healthy and hygienic lifestyle can help us avoid major illnesses. But there are always some minor ailments – an accidental fall, a small burn when cooking in a hurry, a cold from getting wet in the rain, a stomach upset from eating something spicy  or something scarier like chest pains– that may occasionally affect our health. Most people aren’t prepared to handle a health problem or medical emergency in their home.Whether it’s a common cut  you need the right items to handle a medical emergency.

Here are the some items that should be within reach in any healthy home. 


1. Plain bar or hand soap




This may seem obvious, but the old-fashioned soap-and-water combo is still the best way to clean minor cuts and scrapes. 


2.Antiseptic Liquid


When someone is wounded, the first step is to wash it with water to remove any dust that may be sticking to the area. Immediately after this, it is important to cleanse the area with an antiseptic liquid that can prevent microorganisms from causing the wound to get infected.  Keep an antiseptic liquid such as Dettol or Savlon at home for use in such situations. Of course, if the wound is a major or deep one, with the inner tissues exposed, it is best to immediately consult a doctor rather than attempting to tackle it yourself.

3.Antibacterial Ointment


After you have cleaned the wound, it is good to apply an antibacterial ointment to reduce the risk of infection. Products such as Soframycin, Neosporin or Betadine are good options and can be applied to wounds in which the skin is not damaged badly.

4.Painkillers


When you have a wound, there is often the possibility of a slight swelling, redness and pain in the area. Sometimes, you may develop a muscle spasm or sprain when you bend or stretch in an unnatural manner. In such cases too, there will be pain and inflammation. People who suffer from fever or a respiratory tract infection accompanied by cough and cold may also find they have a slight pain all over the body. For all such situations, stock up on painkillers that are available over the counter (OTC) such as paracetamol(brand names Crocin and Metacin) and aspirin (brand names ASA and Disprin). However, make sure that you do not give aspirin to someone below 16 years of age; also, do not exceed a dose of 4 grams of paracetamol per day. If there is no relief in the pain even after two days of using a painkiller, it is better to consult a doctor to find out if there is some underlying problem.

5.Anti-inflammatory Cream or Ointment


A muscle pull, sprain or spasm can be quite painful while it lasts and although you may take painkiller medicines, applying a cream to the affected area will help you get better relief more quickly. Products such as Iodex or Tiger Balm contain compounds which have an anti-inflammatory action and when applied to the skin, these rapidly penetrate into the underlying tissues to provide relief from the swelling and pain.

6. An assortment of plain adhesive bandages/Band-Aids 


For minor injuries, the simpler, the better.

7. An elastic wrap 


Also called an ACE bandage (based on the best-known brand name).Just be sure to apply the wrap correctly: If wrapping a foot or ankle, start at the bottom of the foot and wrap it several times around until you reach the ankle, then criss-cross the bandage in a figure-8 pattern behind the heel and secure it at top with some tape.If it’s too loose, it won’t supply helpful compression; if it’s too tight, it can restrict circulation. 
(Remove it if the body part feels numb or tingly, gets cold or turns blue.For minor sprains, also keep an ice pack in your freezer and remember the acronym “RICE”: Rest, Ice, Compression, Elevation.)


8. An accurate thermometer 



You need a good thermometer to monitor fevers, which could indicate infection in a wound or worsening of any illness.Digital thermometers are better as they're easier to read than ones with mercury. 
Remember, it’s not a fever until body temperature goes above 100.5˚. 



9.Antihistamines


Some people are extremely allergic to insect bites or even dust and being bitten by an insect or exposure to dust can trigger off an allergic reaction that manifests as intense itching, severe swelling, a runny nose and watering of the eyes. All these symptoms are a result of the release of chemical called histamine and when you suffer from them, it is useful to take medicines called antihistamines. Medicines such as Avil and Cetzine are antihistamines and can help deal with the symptoms of allergy; however, these tend to cause a slight drowsiness and therefore, it is vital you do not drive or perform any activity that requires you to be alert after taking this medicine.

10.Antitussive Lozenges


A cough or a cold is typically accompanied by an itching or painful sensation in the throat. While you may need antibiotics to treat an underlying infection, it is also important to use something that provides relief from the unpleasant sensations in the throat. Antitussive lozenges such as Strepsils or Vicks are helpful in such situations; however, do not give these to very small kids because they may choke if they are unable to control the lozenge from moving into the throat.

11.Antacids


If you suffer from a burning sensation or pain in the stomach or excessive gas, it is quite likely that the acid normally present in the stomach is causing you problems. In such situations, an antacid is useful because it helps to neutralize the harmful effects of the acid and helps with digestion. Products such as Eno or Gelusil are antacids that can help overcome simple indigestion problems.

12.Oral Rehydration Salts


When something you eat does not agree with your stomach, you are likely to develop either diarrhoea or vomiting or both. When this happens, the body loses a significant amount of water as well as vital minerals and you need to replace these to prevent dehydration from setting in. Oral rehydration salts sold under names such as ORS or Electral are therefore a vital medicine you ought to have at home.

13.Anti-diarrhoeal Medicine


Diarrhoea (or loose motions) is a result of either indigestion or an infection of the gastrointestinal tract. While it is vital to replace the fluids you lose, it is also important to try and reduce the frequency of your visits to the toilet. Therefore, as a first line of treatment, you could try taking the medicine calledloperamide which is sold under the brand name of Eldoper. However, if you do not find any change in status, please consult a doctor who can find out if you are suffering from an infection and need treatment with antibiotics.


14. Aspirin 



Aspirin is also needed in a  medical emergency.Heart attacks can happen any time, and taking aspirin as soon as possible helps reduce the damage. If you take aspirin (and chew it so it enters your system quickly), its blood-thinning properties can help break down the clot and limit the injury to your heart.

If you have chest pain, chew 325 mg of uncoated aspirin.

15.Sorbitrate/Nitrates



During emergency chest pain or discomfort putting this tab under the tongue can reduce damage and can save you from a heart attack.


These are a few of the essential medicines that ought to find a place in every family’s medicine cabinet. However, it is vital to remember that they can only be a first line of treatment and if the ailment persists beyond a couple of days, self-medication is not recommended; instead, you ought to visit a doctor to get a correct diagnosis and the right treatment.



ANTIBIOTICS



Antibiotics, also known as antibacterials, are types of medications that destroy or slow down the growth of bacteria.

Before bacteria can multiply and cause symptoms, the body's immune system can usually destroy them. We have special white blood cells that attack harmful bacteria. Even if symptoms do occur, our immune system can usually cope and fight off the infection. There are occasions, however, when it is all too much and some help is needed.....from antibiotics. 



Each antibiotic is effective only for certain types of infections, and your doctor is best able to compare your needs with the available medicines. Also, a person may have allergies that eliminate a class of antibiotic from consideration, such as a penicillin allergy preventing your doctor from prescribing amoxicillin.


In some cases, laboratory tests may be used to help a doctor make an antibiotic choice. Special strains of the bacteria such as Gram stains, can be used to identify bacteria under the microscope and may help narrow down which species of bacteria is causing infection. Certain bacterial species will take a stain, and others will not. Cultures may also be obtained. In this technique, a bacterial sample from your infection is allowed to grow in a laboratory. The way bacteria grow or what they look like when they grow can help to identify the bacterial species. Cultures may also be tested to determine antibiotic sensitivities. A sensitivity list is the roster of antibiotics that kill a particular bacterial type. This list can be used to double check that you are taking the right antibiotic.

Mode of Action



The body's balance between health and illness is called homeostasis. Homeostasis largely depends on the relationship of the body to the bacteria with which it lives. For example, bacteria are always present on human skin. When the skin is cut, the bacteria are able to enter the body and may cause infection.The invading bacteria are usually destroyed by blood cells called phagocytes and by various actions of the immune system. However, when there are too many bacteria for the system to handle, illness results and antibiotics are needed to help restore homeostasis.
Antiobiotics can be bacteriostatic (prevent bacteria from multiplying) or bactericidal (kill bacteria). For most infections, these two types of antibiotics appear to be equally effective, but if if the immune system is impaired orthe individual has a severe infection, a bactericidal antibiotic is usually more effective. Bactericidal drugs, however, may be bacteriostatic against certain microorganisms, and vice versa.
In most infections, including certain types of pneumonia (pneumococcal) and urinary tract infections, there seems to be no advantage of bactericidal overbacteriostatic drugs. However, bactericidal activity seems to be necessary ininfections in which host (the organism from which the bacteria obtains its nourishment) defense mechanisms are at least partially lacking locally or systemically (in the whole system), for example, endocarditis (inflammation of the lining membrane of the heart), meningitis (inflammation of the membranes ofthe spinal cord or brain), or serious staphylococcal infections.
Each of the various types of antibiotics kill microorganisms in a unique way.Some disturb the structure of the bacterial cell wall; others interfere with the production of essential proteins; and still others interfere with the transformation (metabolism) of nucleic acid (substances found in the cells of all living things).
It is believed that antibiotics interfere with the surface of bacteria cells,causing a change in their ability to reproduce. Testing the action of an antibiotic in the laboratory shows how much exposure to the drug is necessary to decrease reproduction or to kill the bacteria. Although a large dose of an antibiotic taken at one time might kill the bacteria causing an illness, the dose would most likely cause severe side effects. Therefore, antibiotics are given in a series of smaller doses. This method assures that the bacteria are either killed or reduced enough in number so that the body can repel them. On the other hand, when too little antibiotic is taken, bacteria can develop methods to protect themselves against it. Thus the next time the antibiotic is needed against these bacteria, it will not be effective.

Classifications


Although there are several classification schemes for antibiotics, based on bacterial spectrum (broad versus narrow) or route of administration (injectable versus oral versus topical), or type of activity (bactericidal vs. bacteriostatic), the most useful is based on chemical structure. Antibiotics within a structural class will generally show similar patterns of effectiveness, toxicity, and allergic potential.

PENICILLINS

The penicillins are the oldest class of antibiotics, and have a common chemical structure which they share with the cephalopsorins. The two groups are classed as the beta-lactam antibiotics, and are generally bacteriocidal-that is, they kill bacteria rather than inhibiting growth. The penicillins can be further subdivided. The natural pencillins are based on the original penicillin G structure; penicillinase-resistant penicillins, notably methicillin and oxacillin, are active even in the presence of the bacterial enzyme that inactivates most natural penicillins. Aminopenicillins such as ampicillin and amoxicillin have an extended spectrum of action compared with the natural penicillins; extended spectrum penicillins are effective against a wider range of bacteria. These generally include coverage for Pseudomonas aeruginaosa and may provide the penicillin in combination with a penicillinase inhibitor.

CEPHALOSPORINS

Cephalosporins and the closely related cephamycins and carbapenems, like the pencillins, contain a beta-lactam chemical structure. Consequently, there are patterns of cross-resistance and cross-allergenicity among the drugs in these classes. The "cepha" drugs are among the most diverse classes of antibiotics, and are themselves subgrouped into 1st, 2nd and 3rd generations. Each generation has a broader spectrum of activity than the one before. In addition, cefoxitin, a cephamycin, is highly active against anaerobic bacteria, which offers utility in treatment of abdominal infections. The 3rd generation drugs, cefotaxime, ceftizoxime, ceftriaxone and others, cross the blood-brain barrier and may be used to treat meningitis and encephalitis. Cephalopsorins are the usually preferred agents for surgical prophylaxis.

FLUROQUINOLONES

The fluroquinolones are synthetic antibacterial agents, and not derived from bacteria. They are included here because they can be readily interchanged with traditional antibiotics. An earlier, related class of antibacterial agents, the quinolones, were not well absorbed, and could be used only to treat urinary tract infections. The fluroquinolones, which are based on the older group, are broad-spectrum bacteriocidal drugs that are chemically unrelated to the penicillins or the cephaloprosins. They are well distributed into bone tissue, and so well absorbed that in general they are as effective by the oral route as by intravenous infusion.

TETRACYCLINES

Tetracyclines got their name because they share a chemical structure that has four rings. They are derived from a species of Streptomyces bacteria. Broad-spectrum bacteriostatic agents, the tetracyclines may be effective against a wide variety of microorganisms, including rickettsia and amebic parasites.

MACROLIDES

The macrolide antibiotics are derived from Streptomyces bacteria, and got their name because they all have a macrocyclic lactone chemical structure. Erythromycin, the prototype of this class, has a spectrum and use similar to penicillin. Newer members of the group, azithromycin and clarithyromycin, are particularly useful for their high level of lung penetration. Clarithromycin has been widely used to treat Helicobacter pylori infections, the cause of stomach ulcers.

OTHERS

Other classes of antibiotics include the aminoglycosides, which are particularly useful for their effectiveness in treating Pseudomonas aeruginosa infections; the lincosamindes, clindamycin and lincomycin, which are highly active against anaerobic pathogens. There are other, individual drugs which may have utility in specific infections.

Antibiotic Resistance


Antibiotics are extremely important in medicine, but unfortunately bacteria are capable of developing resistance to them. Antibiotic-resistant bacteria are germs that are not killed by commonly used antibiotics. When bacteria are exposed to the same antibiotics over and over, the bacteria can change and are no longer affected by the drug.
Bacteria have number of ways how they become antibiotic-resistant. For example, they possess an internal mechanism of changing their structure so the antibiotic no longer works, they develop ways to inactivate or neutralize the antibiotic. Also bacteria can transfer the genes coding for antibiotic resistance between them, making it possible for bacteria never exposed to an antibiotic to acquire resistance from those which have. The problem of antibiotic resistance is worsened when antibiotics are used to treat disorders in which they have no efficacy (e.g. antibiotics are not effective against infections caused by viruses), and when they are used widely as prophylaxis rather than treatment.
Resistance to antibiotics poses a serious and growing problem, because some infectious diseases are becoming more difficult to treat. Resistant bacteria do not respond to the antibiotics and continue to cause infection. Some of these resistant bacteria can be treated with more powerful medicines, but there some infections that are difficult to cure even with new or experimental drugs.


Please Note




Antibiotics do not fight infections caused by viruses, such as
  • Colds
  • Flu
  • Most coughs and bronchitis
  • Sore throats, unless caused by strep
If a virus is making you sick, taking antibiotics may do more harm than good. Each time you take antibiotics, you increase the chances that bacteria in your body will be able to resist them. Later, you could get or spread an infection that those antibiotics cannot cure. Methicillin-resistant Staphylococcus aureus (MRSA) causes infections that are resistant to several common antibiotics.
When you take antibiotics, follow the directions carefully. It is important to finish your medicine even if you feel better. If you stop treatment too soon, some bacteria may survive and re-infect you. Do not save antibiotics for later or use someone else's prescription.

Only your doctor can choose the best class and the best antibiotic from that class for your individual needs.In most cases of antibiotic use, a doctor must choose an antibiotic based on the most likely cause of the infection.


Do also note that some bacteria are harmless, while others are good for us.





FROZEN SHOULDER




Frozen shoulder, or adhesive capsulitis, is a condition that causes restriction of motion in the shoulder joint. The cause of a frozen shoulder is not well understood, but it often occurs for no known reason. Frozen shoulder causes the capsule surrounding the shoulder joint to contract and form scar tissue.

Anatomy



Your shoulder is a ball-and-socket joint made up of three bones: your upper arm bone (humerus), your shoulder blade (scapula), and your collarbone (clavicle).
The head of the upper arm bone fits into a shallow socket in your shoulder blade. Strong connective tissue, called the shoulder capsule, surrounds the joint.
To help your shoulder move more easily, synovial fluid lubricates the shoulder capsule and the joint.

Risks.


Although the exact cause is unknown, certain factors may increase your risk of developing frozen shoulder.
Age and sex
People 40 and older are more likely to experience frozen shoulder. Most of the people who develop the condition are women.
Immobility or reduced mobility
People who have experienced prolonged immobility or reduced mobility of their shoulder are at higher risk of developing frozen shoulder. Immobility may be the result of many factors, including:
  • Rotator cuff injury
  • Broken arm
  • Stroke
  • Recovery from surgery
Systemic diseases
People who have certain medical problems appear to be predisposed to develop frozen shoulder. Examples include:
  • Diabetes
  • Overactive thyroid (hyperthyroidism)
  • Underactive thyroid (hypothyroidism)
  • Cardiovascular disease
  • Tuberculosis
  • Parkinson's disease

Causes.



Frozen shoulder is caused when the flexible tissue that surrounds the shoulder joint, known as the capsule, becomes inflamed and thickened.

It is not fully understood why this happens, although there are a number of things that make developing a frozen shoulder more likely. These include having:
  • a shoulder injury or shoulder surgery
  • diabetes 
  • Dupuytren's contracture - a condition where small lumps of thickened tissue form in the hands and fingers
  • other health conditions, such as heart diseaseand  stroke

Symptoms



The typical symptoms are pain, stiffness, and limitation in the range of movement of a shoulder. The symptoms typically have three phases:
  • Phase one - the 'freezing', painful phase. This typically lasts 2-9 months. The first symptom is usually pain. Stiffness and limitation in movement then also gradually build up. The pain is typically worse at night and when you lie on the affected side.
  • Phase two - the 'frozen', stiff (or adhesive) phase. This typically lasts 4-12 months. Pain gradually eases but stiffness and limitation in movement remain and can get worse. All movements of the shoulder are affected. However, the movement most severely affected is usually rotation of the arm outwards. The muscles around the shoulder may waste a bit as they are not used.
  • Phase three - the 'thawing', recovery phase. This typically lasts between one and three years. The pain and stiffness gradually go and movement gradually returns to normal, or near normal.
Symptoms often interfere with everyday tasks such as driving, dressing, or sleeping. Even scratching your back, or putting your hand in a rear pocket, may become impossible. Work may be affected in some cases.
There is great variation in the severity and length of symptoms. Untreated, on average the symptoms last 2-3 years in total before going. In some cases, it is much less than this. In a minority of cases, symptoms last for several years.

Diagnosis



A frozen shoulder is suggested during examination when the shoulder range of motion is significantly limited, with either the patient or the examiner attempting the movement. Underlying diseases involving the shoulder can be diagnosed with the history, examination, blood testing, and X-ray examination of the shoulder.
If necessary, the diagnosis can be confirmed when an X-ray contrast dye is injected into the shoulder joint to demonstrate the characteristic shrunken shoulder capsule of a frozen shoulder. This X-ray test is called arthrography. The tissues of the shoulder can also be evaluated with an MRI scan.
Treatment.



If nothing is done most frozen shoulders improve significantly over 2-4 years after onset. However the pain and limitations of the stiff shoulder generally require treatment. The treatment required depends on the severity of the pain and stiffness. These include:
  1. Physiotherapy - to prevent any further stiffness and regain range of motion
  2. Painkillers and anti-inflammatories
  3. Injections - reduce inflammation and provide pain relief
  4. Hydrodilatation Procedure - more effective than simple injections in relieving severe pain and improving range of motion
  5. Surgery - Surgery has been shown to be of benefit in both the early and later stages of a Frozen Shoulder. This may involve an arthroscopic Capsular Release or Manipulation Under Anaesthetic (MUA). We prefer the Capsular Release procedure. It is excellent for both pain relief and restoring movement, with a success rate of 96% at 6 months. Intensive physiotherapy is essential after the surgery.

Please Note



When the shoulder pain is severe:

  • Avoid using the affected side to lift heavy objects.
  • Avoid overuse of the same side. Use both shoulders alternatively.
  • Avoid twisting movement of the joint or sleeping on the affected side.
  • Avoid using the affected hand to do self-care activities.
  • Gentle mobilization exercise like "Pendular exercise" can be performed to improve circulation, relax muscle and relief pain. When performing the exercise, the hand should not carry any weight and the arm should move according to the level of pain.

When pain is relieved, but movement of shoulder is still restricted, we should:
  1. Use the affected side more and perform stretching exercise to decrease stiffness.
  2. Consult health professional for maintenance exercise.





AMIODARONE vs DRONEDARONE



AMIODARONE
Amiodarone is an antiarrhythmic medication that affects the rhythm of heartbeats.
Amiodarone is used to help keep the heart beating normally in people with life-threatening heart rhythm disorders of the ventricles (the lower chambers of the heart that allow blood to flow out of the heart). Amiodarone is used to treat ventricular tachycardia or ventricular fibrillation.

PHARMACOKINETICS



Amiodarone is an iodine-containing compound with some structural similarity to thyroxine. The drug's high iodine content likely is a factor in its effects on the thyroid gland. The bioavailability of amiodarone is variable but generally poor, ranging from 22 to 95 percent.Absorption is enhanced when the drug is taken with food.Amiodarone is highly lipid soluble and is stored in high concentrations in fat and muscle, as well as in the liver, lungs, and skin. Amiodarone crosses the placenta and reaches measurable levels in breast milk.
The major metabolite of amiodarone is desethylamiodarone (DEA), which is known to have antiarrhythmic properties. Grapefruit juice can inhibit amiodarone metabolism and lead to elevated drug levels, but the impact of this interaction on the long-term efficacy and toxicity of amiodarone is not known.
The elimination half-life of amiodarone is highly variable and unusually long, averaging about 58 days. The long half-life is thought to be a result of the drug's slow release from lipid-rich tissues.
ELECTROPHYSIOLOGIC EFFECTS



Amiodarone is considered to be a class III drug (Vaughan Williams classification), which indicates that it prolongs the QT interval. However, the drug has many other effects: it slows heart rate and atrioventricular nodal conduction (via calcium channel and beta-receptor blockade), prolongs refractoriness (via potassium and sodium channel blockade), and slows intracardiac conduction (via sodium channel blockade).
The relationship between plasma amiodarone concentrations and effect, as well as the contribution of the metabolite DEA, is not well established.Routine monitoring of the amiodarone plasma level is not recommended. [Evidence level C, consensus/expert guidelines]

Unusual features of amiodarone


Amiodarone has several characteristics that make it unique.
First, the drug takes weeks to achieve its maximum effectiveness. This is because amiodarone is stored in most of the tissues of the body, and to "load" the body with the drug, all the tissues need to be saturated. The typical "loading" regimen of amiodarone, therefore, is to use very large doses for a week or two, then taper the dosage over the next month or so. It is not unusual to give patients 1200 or 1600 mg per day at first, and then maintain them on as little as 100 or 200 mg per day chronically.
Second, amiodarone leaves the body very, very slowly. It is not excreted (like most drugs) by the liver or the kidneys. It is lost when amiodarone-containing human cells are lost - such as skin cells or cells from the GI tract, which are shed by the millions each day. Thus, if it is decided that one needs to stop amiodarone, the drug remains in the body in measurable quantities for months and months. The "half life" of the drug, in contrast to most other drugs, is measured in weeks instead of hours.
Third, because amiodarone is stored in many different kinds of tissues, it can produce side effects affecting many different organs. Some of these side effects take months or years to develop, so it is never true that one can stop being vigilant.
Fourth, amiodarone works through many different mechanisms, unlike most drugs. It fits into two separate categories of antiarrhythmic drugs (Class I and Class III). It acts as a beta blocker and also as a calcium blocker. It dilates blood vessels, and and it often acts to "block" the effect of thyroid horomone.

INDICATIONS


Because of its life-threatening side effects and the substantial management difficulties associated with its use, Cordarone is indicated only for the treatment of the following documented, life-threatening recurrent ventricular arrhythmias when these have not responded to documented adequate doses of other available antiarrhythmics or when alternative agents could not be tolerated.
  1. Recurrent ventricular fibrillation.
  2. Recurrent hemodynamically unstable ventricular tachycardia.
As is the case for other antiarrhythmic agents, there is no evidence from controlled trials that the use of Cordarone Tablets favorably affects survival.
Cordarone should be used only by physicians familiar with and with access to (directly or through referral) the use of all available modalities for treating recurrent life-threatening ventricular arrhythmias, and who have access to appropriate monitoring facilities, including in-hospital and ambulatory continuous electrocardiographic monitoring and electrophysiologic techniques. Because of the life-threatening nature of the arrhythmias treated, potential interactions with prior therapy, and potential exacerbation of the arrhythmia, initiation of therapy with Cordarone should be carried out in the hospital.
Dosage : 

Oral:Ventricular arrhythmias- Adult: 800-1,600 mg/day in 1-2 divided doses for 1-3 week until initial therapeutic response is achieved then reduce dose to 600-800 mg/day in 1-2 divided doses for 1 month. Maintenance: 400 mg/day; lower doses may be used for supraventricular arrhythmias. Close monitoring of the patient is recommended. Use the minimum effective dose. Liver impairment: Dosage reduction may be necessary. 

IV Recommended starting dose is approximately 1,000 mg over the first 24 h administered as follows: rapid administration of 150 mg over first 10 min (15 mg/min), followed by 360 mg over next 6 h (1mg/min), then 540 mg over remaining 18 h (0.5 mg/min). After first 24 h, continue maintenance infusion rate of 0.5 mg/min (720 mg/24 h).

Side Effects : 
Heart- Abnormal heart rhythm, heart failure, heart attack, low blood pressure, sinus arrest.
Central Nervous System- Abnormal gait/ lack of coordination, dizziness, fatigue, uneasiness, tingling, tremor/abnormal involuntary movement, headache, sleep disturbances, confusion, delirium, disorientation, pseudotumor cerebri( increased pressure inside the skull).
Skin- Sensitivity to sunlight, flushing, redness, severe allergic reactions, itching, blue-gray discoloration, skin cancer.
Eye and ENT- Visual disturbances, abnormal smell sensation, ringing in the ears, may lead to blindness.
Gastrointestinal- Nausea, vomiting, loss of appetite, constipation, abdominal pain, abnormal salivation, abnormal taste, inflammation of pancreas.
Genitourinary- Acute kidney failure, inflammation of testis, impotence, decreased sexual activities.
Blood- Blood clot abnormalities, anemia, and decrease in blood cells.
Liver- Abnormal liver function tests, liver disorders, jaundice.
Local- Swelling, redness, necrosis, pain, inflammation , blood clot.
Musculoskeletal- Muscle weakness, muscle pain, muscle damage.
Respiratory- Cough, difficulty in breathing, lung infiltrates, wheezing, lung inflammation, fibrosis.
Miscellaneous- It may cause severe allergic reactions, leg swelling , fever and increased secretion of antidiuretic hormone. It interferes with thyroid function and may increase or decrease thyroid hormone levels.

Drug interactions with amiodarone.

There are a number of important drug interactions with amiodarone. This agent appears to have a marked effect on the kinetics of some commonly used cardiovascular drugs, such as warfarin, digoxin, quinidine, and procainamide, and has dynamic interactions with others, such as the beta blockers and some calcium antagonists. Bleeding has been reported, apparently caused by a potentiation of the anticoagulant effect of warfarin by amiodarone. Torsades de pointes has been observed when quinidine, propafenone, or mexiletine is given together with amiodarone. Furthermore, amiodarone may interact with beta-blocking agents and some of the calcium antagonists to produce symptomatic sinus bradycardia and sinus arrest, especially in a latent or overt sick sinus syndrome. During surgery, amiodarone may induce hypotension and an atropine-resistant bradycardia, possibly by interacting with anesthetic agents. A knowledge of the time of onset, extent, duration, and possible mechanisms of the interactions of amiodarone with other cardioactive drugs is still incomplete, but further studies are of great therapeutic importance.

WARNING: 

Though this medication often gives great benefits to people with irregular heartbeat, it may infrequently worsen an irregular heartbeat or cause serious (sometimes fatal) side effects. When starting treatment with this drug, your doctor may have you stay in the hospital for proper monitoring.
Amiodarone may take 2 weeks or longer to have an effect in your body. Also, this drug stays in your body for weeks to months, even after you are no longer taking it. Therefore, serious side effects may occur weeks to months after taking amiodarone. Serious side effects may include lung or liver problems. Tell your doctor immediately if you notice any symptoms of lung or liver problems such as cough, shortness of breath, chest pain, coughing up blood, persistent nausea/vomiting, dark urine, severe stomach/abdominal pain, or yellowing eyes/skin.