Acute disabling epigastric pain during intravenous administration of amiodarone

Abstract

Amiodarone is a Class III antiarrhythmic agent used for cardioversion and prevention of recurrences of 
atrial fibrillation. However, its use is limited due to its side-effects resulting from the drug’s long-term 
administration. The only acute and benign adverse reaction of intravenous amiodarone that has been 
reported is acute low back pain. We describe a patient who suffered an acute disabling epigastric pain, 
following treatment with intravenous amiodarone for atrial fibrillation. When treatment with amiodarone 
was abruptly interrupted, the epigastric pain was completely resolved. To our knowledge, there are no 
cases describing severe epigastric pain as an acute reaction to intravenous amiodarone administration. 
Intravenous, and rarely oral, administration of amiodarone has been related to a series of minor and 
major adverse reactions, indicating other constituents of the intravenous solution as the possible 
cause, possibly polysorbate 80. A possible correlation between acute epigastric pain and intravenous 
amiodarone loading is unproven; however it is of crucial importance for clinicians to be aware of this 
phenomenon, and especially since an acute epigastric pain is implicated in the differential diagnosis of 
cardiac ischemia.