Amiodarone (Pacerone) to Control Heart Rhythm

Unless otherwise noted, the following information about amiodarone (Nexterone®, Pacerone®) comes from the package insert.1


Amiodarone is an antiarrhythmic medication used for rhythm control (and occasionally rate control). It may be used on an outpatient basis as an oral drug or administered in the hospital intravenously (IV). The IV preparation is typically used to treat sudden onset arrhythmia in critically ill patients (i.e., after surgery, in the intensive care unit, or in the emergency room).2

How to Use

The oral medication is a pill. You should be hospitalized when starting it in case there are any serious side effects. Your doctor will start you on a high dose and gradually decrease it. Take it with food if it upsets your stomach.


Amiodarone is highly toxic because of the iodine used to make it. Long-term use of this oral medication can lead to life-threatening lung and liver damage and new arrhythmias. It should also not be used in those with hypothyroidism unless there is no other option.

Common Side Effects

These are common side effects of amiodarone.If these conditions persist or get worse, talk to your doctor.

  • Nausea
  • Vomiting
  • Constipation
  • Loss of appetite
  • Shaking
  • Tiredness.

Serious Side Effects

Contact your doctor immediately if you experience any of these serious side effects.

  • Easy bruising/bleeding
  • Loss of coordination
  • Tingling or numbness of the hands or feet
  • Uncontrolled movements
  • New or worsening symptoms of heart failure, such as shortness of breath, swelling ankles or feet, unusual tiredness, or unusual or sudden weight gain

Get medical help immediately if you have any of these very serious side effects.

  • Faster, slower, or more irregular heartbeats
  • Severe dizziness
  • Fainting

There are also reports of vision loss, skin sensitivity to the sun, blue-gray skin color, skin lesions, tremors and nerve damage, and thyroid disorders. Your doctor will monitor you for these conditions but let your doctor know if you experience any symptoms.

Drug Interactions

Talk with your doctor if you are taking any of the following with amiodarone:

  • Statins. Amiodarone can increase the risk of muscle pain when used with statins
  • Warfarin (Coumadin®). The two drugs can interact with each other and affect potency.

Also, avoid grapefruit juice, which can affect how your body metabolizes this medication.


When you start amiodarone, you will need certain tests to monitor your lungs, liver, thyroid, and eye health. Talk to your doctor about how often you will need these tests.


The various guidelines have specific recommendations related to amiodarone.

  • US guidelines (AHA/ACC/HRS) recommend amiodarone to maintain sinus rhythm, depending on underlying heart disease and other medical conditions.2 
  • European guidelines (ESC) recommend amiodarone for long-term rhythm control in all afib patients. Other antiarrhythmic drugs should be considered first, whenever possible, due to amiodarone’s toxicity.3
  • Canadian guidelines (CCS) recommend its use for pharmacologic rhythm control only after considering the potential for drug toxicities and when other choices can’t be used or have failed.4