[AF-FORUM] 86E 可达龙治疗. Dr. Poreba

[AF Symposium]

各位同事

首先介绍一下FDA的一些内容，随后提出我的问题

“患者副作用发生的影响并没有合适的监测，可达龙 
应给只有那些对治疗致命性心律失常治疗经验丰富的 
医生应用，而且这些医生应该熟知可达龙的益处和风 
险，并且能够有能够监测药物有效性以及治疗副作用 
的实验室条件”

以及

“在负荷剂量时要严密监测，尤其要检测到室性心律 
失常甚至是产的作用减弱消失之后，用药需要在医院 
进行。负荷剂量800-1600mg/天，并需要维持1-3周（有时 
更长）直至治疗效用开始。（可达龙随三餐服用时推 
荐全天剂量1,000mg甚至更高，或者当胃肠道不适发 
生）”

我的问题：
1．          通常您怎样起始病人的口服治疗（病人之 
前无静脉应用）？对于门诊病人最佳的服药计划如 
何？这样可以使患者最容易接受

2．          多长时间检查一次甲功，是应该等到可疑 
症状出现时再查吗？其他相关试验呢？

3．          对于一名病窦安装DDDR起搏器患者，伴阵发 
性房颤，阵发性室上速，而血压、射血分数以及左房 
均在正常范围的患者，现在可达龙治疗已经起效，我 
应该应用多长时间？


个人认为我倾向于消融治疗，而不是可达龙。但不幸 
的是，不是每个患者都有这样的条件。很多服用可达 
龙的患者是因为它的医生喜欢这个药物而且认为它是 
有效的。

但我还是很担心副作用的问题。

给所有才会人员问好

Malgorzata Poreba MD
Wroclaw Medical University
波兰
---------------------------------------------------------
AF-FORUM] 86E Amiodarone therapy. Dr. Poreba
Dear colleagues
After a short intruduction from FDA pages I will ask several questions:
"SEVERITY OF THE SIDE EFFECTS IF PATIENTS ARE IMPROPERLY MONITORED,
AMIODARONE SHOULD BE ADMINISTERED ONLY BY PHYSICIANS WHO ARE EXPERIENCED
IN THE TREATMENT OF LIFE-THREATENING ARRHYTHMIAS, WHO ARE THOROUGHLY
FAMILIAR WITH THE RISKS AND BENEFITS OF AMIODARONE THERAPY, AND WHO HAVE
ACCESS TO LABORATORY FACILITIES CAPABLE OF ADEQUATELY MONITORING THE
EFFECTIVENESS AND SIDE EFFECTS OF TREATMENT"
   and
"Close monitoring of the patients is indicated during the loading phase,
particularly until risk of recurrent ventricular tachycardia or
fibrillation has abated. Because of the serious nature of the arrhythmia
and the lack of predictable time course of effect, loading should be
performed in a hospital setting. Loading doses of 800 to 1,600 mg/day
are required for 1 to 3 weeks (occasionally longer) until initial
therapeutic response occurs. (Administration of amiodarone in divided
doses with meals is suggested for total daily doses of 1,000 mg or
higher, or when gastrointestinal intolerance occurs)."

My  questions are:
1. How you usually start amiodarone orally in your patients (when it was
not given intravenously earlier)? What is or could be the best schedule
in out-patient clinic conditions? Not to bother a patient  too much and
not ordering too many visists.
2. How often should I check TSH, should I wait until any suspected
symptoms occur? Other lab. tests etc. E-ray ?
3. How long should I treat a patient with amiodarone that was started
(not by me) in a patient with DDDR pacemaker, Sick sinus syndrome, cont.
AF, and paroxysm. supr. tachycardias, arterial hypert, EF and left
atrium -within normal range, moderate IVS hypertrophy, patient on
Betaloc Zok 100mg? Now the treatment is effective.

Personally I would treat a patient rather with ablation than amiodarone
for years. Unfortunatelly not all my patients will be that lucky to have
the procedure.A large number of patients take amiodarone beacause
doctors like that drug and think it is effective.
I am always afraid about side effects.

Greetings to all participants

Malgorzata Poreba MD
Wroclaw Medical University
Poland

--
Dr. Sergio Dubner
President of Scientific Committee

Dr. Edgardo Schapachnik
President of Steering Committee