to the editor: I read with interest the excellent article¹ by Dr. Siddoway on the clinical use of the antiarrhythmic drug amiodarone (Cordarone) that appeared in the December 1, 2003, issue of American Family Physician. The author clearly presented the effectiveness and adverse effects related to this therapy that has been used intravenously or orally to convert and prevent recurrences of cardiac arrhythmias. However, there was no mention in the article¹ of thrombophlebitis, a common complication associated with intravenous amiodarone.²

Recent studies³ have reported rates of phlebitis as high as 16 percent with the intravenous administration of amiodarone. A meta-analysis⁴ of 18 randomized controlled trials studying intravenous amiodarone to convert atrial fibrillation reported an 8 percent rate of phlebitis among the 550 patients who received amiodarone. In this systematic review,⁴ phlebitis was the most common adverse effect of the drug, followed by bradycardia (4 percent of patients) and hypotension (2 percent of patients).

Thrombophlebitis usually occurs when high doses of amiodarone are infused over a long period in peripheral veins. Thus, to avoid this side effect, the drug should be administered in a peripheral vein for a maximum of 24 hours. Afterwards, the drug must be used orally or a central vein access should be considered.⁵ By following these precautions, this minor but frequent complication can be avoided.