Amiodarone or Mexiletine

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Colin Pearson
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Amiodarone or Mexiletine

Post by Colin Pearson » August 13th, 2014, 1:54 pm

Evening Folks,

Apologies for creating yet another thread, I seem to be popping up all the place on here at the moment.

As some of you may have read I had yet another whack off the ICD on Sunday, out of the blue, no warning. I collapsed and hit the deck hard, the ICD did its trick and saved my life.

The frequency of my events is becoming more frequent and today there was talk about putting me on something a bit stronger to control my heart events. My heart events are all electrical with the plumbing being in very good shape. I had a failed ablation about 6 weeks ago where they could not induce the arrhythmia so could not actually do anything.

There was talk of me either going onto Amiodarone or Mexilitine, I'll hopefully find out some more on Friday.

I've read a lot about the Amiodarone as having some scary side effects and naturally looked up the side effects of the Mex. I have to say both scare the crap out out of me. I have some questions;

1, What would be your drug of choice out of these two not that I will probably have any choice anyway.

2, Is is true that on going onto either of these two, they should start you whilst in hospital where they can observe you.

3, Are they any good news stories with these two, or is it a case of living with some side effects.

I'll know more on Friday but would like to be informed before I go so I can ask the right questions

Many thanks.

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freckles1880
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Re: Amiodarone or Mexiletine

Post by freckles1880 » August 13th, 2014, 4:13 pm

I have no experience with either. But here is a copy of a link found in the USA. From PUBMED

J Cardiovasc Pharmacol. 2013 Aug;62(2):199-204. doi: 10.1097/FJC.0b013e31829651fe.
Mexiletine as an adjunctive therapy to amiodarone reduces the frequency of ventricular tachyarrhythmia events in patients with an implantable defibrillator.
Gao D1, Van Herendael H, Alshengeiti L, Dorian P, Mangat I, Korley V, Ahmad K, Golovchiner G, Aves T, Pinter A.
Author information
Abstract

The most effective pharmacological management of frequent ventricular tachyarrhythmia events in patients with an implantable defibrillator who failed or did not tolerate amiodarone is unknown. The aim of this retrospective cohort study was to assess the efficacy and tolerability of mexiletine in such patients. The patients served as self-controls. The number of treated ventricular tachyarrhythmia episodes (primary outcome); mortality, shocks from the defibrillator, and electrical storm events (secondary outcomes) during mexiletine therapy was compared with a matched duration of observation just before initiating mexiletine in 29 patients who were treated with a median dose of 300 mg/d of mexiletine and were followed for a median of 12 months. None of the patients had to stop mexiletine due to side effect. There was a significant reduction in the incidence of ventricular tachycardia/fibrillation episodes (median 2 vs. 12 events, P = 0.001) and shocks (median 0 vs. 2 events, P = 0.003) in the first 3 months of treatment, but long-term efficacy was only observed among patients who continued amiodarone therapy. In conclusion, mexiletine, when added to amiodarone in case of amiodarone inefficacy, reduces ventricular tachycardia/fibrillation events and appropriate therapies in patients with an implantable cardioverter defibrillator. A randomized trial should validate the efficacy and safety of mexiletine as an adjunctive therapy to amiodarone.

PMID:
23609328
[PubMed - indexed for MEDLINE]

wavhi
Bob

Medtronic-Visia AF implanted 7-8-2016 stayed with the with 6947 Sprint Quattro Secure lead. Original ICD implant 2-4-2009. ICD turned off 10-6-17 as stage 4 lung cancer taking over.
Major heart attack, carcinogenic shock and quad bypass 10-13-08 post myocardial infarction, old inferior MI complicated by shock and CHF, combined, Atherosclerosis, abdominal aortic Aneurysm, Seroma 7 cm, left leg. Stent in the left main vein 10-7-2014

My "Wardens" are my bride of 54+ years and my daughters.

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David882
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Re: Amiodarone or Mexiletine

Post by David882 » August 13th, 2014, 5:42 pm

Colin:

If you are going onto amiodarone then please discuss a pulmonary function test prior to starting the meds and then at set time intervals for as long as you take the drug. You should also discuss amiodarone blood testing on a regular basis to screen for amiodarone overdose.

When I was first out of hospital i was on amiodarone and my wife was not happy about that drug treatment. However, she did a bit of research and identified the above testing protocols. We discussed these with the Cardiologist and he concurred as a reasonable precaution.

I was on amiodarone for about a year and then was slowly taken off. There was none of the side effects and the testing provided no evidence of any problems.

If you use the amiodraone your results may vary...much like American Westerns.
With Respect,
David

11 Sept 2012 / Idiopathic Ventricular Fibrillation
At about 2AM I started storming at home, and in the ambulance, and in the ER.
Sometimes I restated and sometimes I had to be defibrillated.
A number of times I went into arrest and stopped breathing.
External defibrillation count exceeded 18 and at some point the team induced a coma.
24 hours later I was revived and have never had another event.
13 Sept 2012 / Medtronic ICD was implanted.
My diagnosis is still idiopathic.

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mrag
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Re: Amiodarone or Mexiletine

Post by mrag » August 13th, 2014, 9:05 pm

I don't know Mexiletine. I've been on amiodarone. It most(!) cases it is a drug of LAST RESORT, but it can be more effective than anything else. Some people tolerate it quite well. Might be worth a try, what can you lose, a few more shocks? I really like David's suggestions. I would clearly and forcefully demand to know Plan B, C and D now if the amiodarone doesn't do the trick.
"The greatest enemy of knowledge is not ignorance, it is the illusion of knowledge" S Hawking

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4EverHopeful
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Re: Amiodarone or Mexiletine

Post by 4EverHopeful » August 13th, 2014, 9:42 pm

Hi Colin,

I've been on Amiodarone for 1 1/2yrs after a failed ablation. I was started on 800mg first week, 600mg second week, then finally 200mg which is my current dosage. It was a last resort for me, but it did worked in getting my PVCs under control. They did not however admit me to the hospital for monitoring when starting dosages.

I did have some side effects at 800mg that first week. Couldn't sleep for 3 nights and painful cramps down both legs. I hung in there and when dropped to 600mg the side effects quit.

Once I settled into the maintenance dosage, I couldn't stand it for I had become so hyper and jittery! I was so fatigue and when trying to rest, I couldn't for I couldn't sit still. It was like I was wrestling with myself, very frustrating. I don't know for sure if that was due only to the amio because at the same time as starting it they also increased by bpm pacing from 60 to 80. I went back to EP and they lowered the pacing to 70bpm but it still took me almost a year to readjust to the hyper feeling even though it had calmed down a bit. I'm pretty much back to my tired self:)

About 7 months into the amio treatment a blood test revealed that I had Amio induced hypothyroidism. I'm now on thyroid meds. With Amio my EP requires me to get blood work every 6 months to check liver, thyroid and other levels. Also a chest xray once a year to check the lungs and an eye exam.

Overall I feel good and best of all am stable. Hadn't been in hospital since starting Amio other than a migraine headache last week that sent me to the ER. Morphine took care of that thankfully!

I hope you can work it out, some can't take Amio and others do fine. If you monitor it closely, any problems would hopefully be discovered early.
Phyllis

God's prescription for the heart:
O LORD, You have examined my heart and know everything about me. You know when I sit
down or stand up. You know my every thought when far away. You chart the path ahead of me
and tell me where to stop and rest. Every moment You know where I am.
Psalm 139:1-3

Non-ischemic DCM 09/11
PVCs, LBBB, leaky mitral valve
St Judes CRT-D (Bubba) 02/12; (Bubba II) 09/17
EF 20% 09/11; 25% 07/12; 35% 02/16
Failed PVC Ablation 11/12
Coreg, Zestril, Asprin, Aldactone, Lasix, Zocor, Levothroid
viewtopic.php?p=87649#p87649

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Suzanne
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Re: Amiodarone or Mexiletine

Post by Suzanne » August 13th, 2014, 10:04 pm

Colin, I too only had electrical issues.
After my first ablation, VT continued and it was suggested I start Amiodarone, but I refused. Instead, I was given Sotalol but about 4 weeks later I had an 8 shock storm. Then Mexiletine was added, along with Sotalol. That combination kept me VT free only for about three months.
As far as side effects, I don't know if I had any. I was suffering terribly with anxiety (PTSD due to ICD related events) by the time Mexiletine was added and I was consumed with fear. Maybe the Mexiletine made my anxiety worse, maybe not...I don't know.
I was admitted in the hospital for 5 days when Mexiletine was started. I had an ECG every four hours to monitor.
~ Suzanne ~

St Jude ICD and Lead Implanted Feb.20/09
8 Shock Storm March 21/09
Lead Dislodged, so Replaced with Medtronic Lead June 16/09
ICD and Lead Explanted Nov.23/09
Medtronic Reveal XT (Cardiac Monitor) Implanted Jan.25/10...explanted and new one reinserted on July 21/11

Cardiac Monitor explanted Sept.9/14

Smalley
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Re: Amiodarone or Mexiletine

Post by Smalley » August 14th, 2014, 4:25 am

Colin
Started on Amiodarone a year before ICD implantation after re-occuring VT. Took myself off it after 6 years due to side effects including Hypothyroidism, increasing mental problems and restlessness. Noted about 17 physical and mental changes at the time. Within 6 months of stopping everything back to normal apart from hand tremor (slight). I now have a CRT-D and had no shocks but some ATP and AF after 7 years of no Amiodarone. Hypothroidism is almost gone , take very low dose of Levothyroxine. Need to monitor your condition if on it long term as others recommend. Told at start that I should only be on it for a year but subsequent Cardio Docs resisted stopping it due to my condition. I know some take to it well others not so. Hope this helps.
Bob

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Colin Pearson
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Re: Amiodarone or Mexiletine

Post by Colin Pearson » August 14th, 2014, 4:31 am

Thanks everyone,

I'm relatively young at 43 and am in otherwise good shape. I keep quite fit and exercise a lot when I'm not consumed with anxiety. As I had my latest whack only on Sunday that is where I am now, full of anxiety.

I am getting lots of runs of re-entrant VT and for the last shock it was a 3 beat run that led to VF. Apparently the 3rd beat landing in the re-polarisation phase and caused me to go into VF.

I've done a lot of searching on here and read up on these two as much as I could tolerate. I say tolerate as it seems to be mainly bad news.

The "last resort" bit kept coming up in what I was reading. I don't think I'm anywhere near needing a last resort as I'm otherwise completely healthy except for the odd time my heart tries to kill me.

I have a profound fear of any medication let alone any that have known and accepted side effects and think I'd go into an anxious meltdown knowing that I was taking one that had very serious side effects.

On the other hand, randomly dropping dead at increasingly shorter intervals and getting zapped back also creates severe anxiety as well.

This is going to be a tough one.

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Colin Pearson
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Re: Amiodarone or Mexiletine

Post by Colin Pearson » August 14th, 2014, 4:34 am

Smalley,

Thanks for that, I note you are also in the UK.

Having read your reply I think even more that going onto either of these would cause more harm than good. I'm already on the edge as it is!

I think going down the Mrag route of manning up and riding the lightning every now and then is preferable.

Smalley
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Location: Chichester UK

Re: Amiodarone or Mexiletine

Post by Smalley » August 14th, 2014, 5:15 am

You can only come to a definitive answer by trial. It is a drug that does what it is supposed to do, stops VT's but to some side effects are bad. I am a 77 year old with many health problems, as a younger, fitter man you may tolerate it much better. Personally I would give it a year then review the position. I found sensitivity to sunlight and a blue tinge to the face quite hard initially. All the best to you.
Bob

Chrisg
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Re: Amiodarone or Mexiletine

Post by Chrisg » August 14th, 2014, 5:31 am

Hi Colin I understand your dilemma.

I too have an electrical problem and like you without any other hearth related issues.

After my shock storm I refused outright Amio because of the side effects.

I had 3 ablations but the EP could’nt say he “GOT IT” so I was put on Mexitilion 200mg (3times a day plus a beta-blocker).

I’m now weaned down to .25mg (1/2 tablet) twice per day and a .25 (1/2 tablet) beta-blocker).

It works for me with no side effect after initial tiredness (low energy)

Mexitilion is an old drug and can be difficult to source at times.

My tablets are made in Japan; there doesn’t seem to be a European supplier.

Best of Luck.

Trust me once they sort out your Meds you’ll be fine again.

Chris

:snoball:
Idiopathic Ventricular Tachycardia
1st Medtronic ICD Dec 07; 2nd August 09; 3rd on right side Sept, 2011
14 Shock Storm July 09; 5 days induced coma
Sprint Fidelis Lead and ICD Explanted July 09
3 Ventricle Ablations July 2009
Lead Erosion; Leads and ICD Explanted August 2011
Medtronic ICD Re-implanted Right side Sept, 2011
Fractured Lead ; Lead left in and new Medtronic Lead and ICD implanted August 2017
Drugs: Mexiletine .50mg 2 daily; Metoprolol .25mg 2 daily. Omacor

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Colin Pearson
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Re: Amiodarone or Mexiletine

Post by Colin Pearson » August 14th, 2014, 6:09 am

Thanks Chris.

Bag of nerves at the moment. I don't even want to think about this yet alone discuss it but obviously have to.

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ricatlga
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Re: Amiodarone or Mexiletine

Post by ricatlga » August 14th, 2014, 12:34 pm

I was initially on amiodarone (along with the emergency ICD implant). However, after about a year and a half, I was switched to a different EP (my first one retired). When he saw me (about age 61) said I was too young to be using amiodarone if I did not have to. He switched me over to Sotalol. I had not noticed any untoward effects of amiodarone until I went off it. All of a sudden my energy levels went way up. Now Sotalol was not a cure-all for ICD therapies. I was still having one about every 6 months. Finally May of 2012 after two therapies 45 minutes apart they did an ablation that was successful. I'm off sotalol now.

Like others have said, I think they will probably have to try it out on you to see what works best.

Regards,
Raymund
Replaced ICD 8/30/18 with Medtronic Visia AF SureScan MRI ICD
Ablation May 2012 - Sotalol discontinued in September
VF unknown cause 1/19/2010, Medtronic Secura-VR 1-22-10
Mitral valve repair Dec 2007

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David882
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Re: Amiodarone or Mexiletine

Post by David882 » August 14th, 2014, 6:56 pm

Colin:
It takes real courage to face something one fears.
While this is clearly difficult, you may care to consider that you are living courageously.
Perhaps that is worth something, i suggest that you are demonstrating something of real value.
With Respect,
David

11 Sept 2012 / Idiopathic Ventricular Fibrillation
At about 2AM I started storming at home, and in the ambulance, and in the ER.
Sometimes I restated and sometimes I had to be defibrillated.
A number of times I went into arrest and stopped breathing.
External defibrillation count exceeded 18 and at some point the team induced a coma.
24 hours later I was revived and have never had another event.
13 Sept 2012 / Medtronic ICD was implanted.
My diagnosis is still idiopathic.

LibraBaby
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Joined: September 18th, 2011, 7:12 pm

Re: Amiodarone or Mexiletine

Post by LibraBaby » August 20th, 2014, 12:19 am

Hey folks it's been awhile just stopping to in to check on everybody. As far as AMIO, I have been on 200mg for almost 3 years. I'm 51 so the EP says I should I stop it, he keeps telling me there's a possibly it's FIXED itself, plus I'm quite young,and I'm not wild about the ablation, while my cardio says "You have no signs of any liver,, pulmonary or tyroid issues at this time, and left the decision up to me. I get my blood checked every 4 months and see the cardio 3 times a year and the EP twice. Amio doesn't hurt every person that takes it, since Sotolol didn't work for me I'll wait another blood test or two and see if I can get up enough courage to risk another shock, I not fully convinced ventricular tachycardia fixes itself. Maybe I'm one of the lucky ones. Whatever you decide good luck and prayers. smilebounce

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