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September 24, 1982

Adverse Effects of Amiodarone-Reply

JAMA. 1982;248(12):1448-1449. doi:10.1001/jama.1982.03330120018008

In Reply.—  We appreciate the opportunity of responding to Dr Alves and colleagues regarding adverse reactions during amiodarone therapy. The striking difference between their findings and ours merits clarification.Amiodarone is a compound with unique electrophysiological and pharmacokinetic properties. Its side effects develop slowly and are a function of dose as well as duration of therapy; therefore, they will ultimately develop in every patient given a fixed dose (except the smallest). The fact that the drug elimination half-life is extremely variable (16 to 65 days) in different patients makes the correlation of dose with efficacy or side effects difficult, if not impossible, to determine if duration of therapy and, hence, drug accumulation are not taken into account.1,2 For this reason, the variations in efficacy and side-effect profile of the drug among different investigators is understandable.However, we are intrigued and surprised by the 57% incidence of chemical and clinical