Amiodarone-induced angioedema: report of two cases.

Amiodarone-induced angioedema: Amiodarone-induced angioedema: Amiodarone-induced angioedema: Amiodarone-induced angioedema: Amiodarone-induced angioedema: Report of two cases Report of two cases Report of two cases Report of two cases Report of two cases Sir, Amiodarone, a class II long-acting anti-arrhythmic, capable of blocking both α and β-adrenoceptors is an iodine-containing highly lipophilic benzofuran derivative. [1,2] Adverse reactions are common and are duration-dependent. Frequent reactions include nausea and other GI symptoms. Ten percent of patients may develop photosensitization (possibly due to phototoxicity) and bluish skin pigmentation, but allergic skin reactions are rare. [3-6] The most serious side-effect related to amiodarone is pulmonary alveolitis and fibrosis. [4] Only a single case of amiodarone-induced angioedema has been reported in the literature. [2] We came across two unrelated cases of angioedema triggered by the use of amiodarone in the last couple of years. A 65-year-old lady was admitted with pericardial effusion and after a positive pericardial tap antitubercular drugs (ATD) were started (isoniazid 300 mg, rifampin 600 mg, ethambutol 800 mg and pyrazinamide1500 mg). She developed atrial fibrillation and an alteration in the ventricular rate. She was put on amiodarone 800 mg twice daily for 15 days and then the dose was tapered to once daily. Facial angioedema appeared within a couple of weeks and she complained of anorexia. Chest roentgenogram was done and was non-contributory. Laboratory evaluation was normal (blood analysis and serum chemistry, stool examination for parasites, IgE, thyroid tests (T3, T4 and TSH), and urinalysis). Liver function tests yielded a mild rise in liver enzymes like ALT, AST and serum alkaline phosphatase; which were 93, 97 and 371 respectively. She was anicteric. Fundoscopy was normal. Symptoms of angioedema were unrelated to any physical activity, stress or ingestion of any particular food. She was not an atopic and had no clinical history of nasal polyps, chronic rhinitis, sinusitis, asthma or chronic and chronically relapsing dermatitis. After another four weeks ATD were stopped. Then they were again started one by one. No improvement was noticed. Angioedema persisted. All medicines were stopped and she was put on prednisolone in a reducing dosage. Within another four weeks that was also completely tapered off. She improved dramatically and was completely symptom-free within 10 days. ATD were started again. No angioedema was noticed then but it appeared within a day when she was given a single dose (400 mg) of oral amiodarone. Again this symptom improved when amiodarone was taken …