Не люблю я разделять, тем более одно лекарство. Тут оно от фибрилляции, а тут только для продления жизни. Некоторые вещи волей не волей экстраполируешь, правда, это чаще в негативе. Тот же хинидин постепенно во всем умирает, т.к. в чем-то одном показал ощутимый негатив. Так же и с соталолом, который вроде наконец тоже стал угасать, не знаю как в РФ.
А про амиодарон под разными углами:
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Цитата:
Lancet. 1997 Nov 15;350(9089):1417-24.
Effect of prophylactic amiodarone on mortality after acute myocardial infarction and in congestive heart failure: meta-analysis of individual data from 6500 patients in randomised trials. Amiodarone Trials Meta-Analysis Investigators.
Prophylactic amiodarone reduces the rate of arrhythmic/sudden death in high-risk patients with recent MI or CHF and this effect results in an overall reduction of 13% in total mortality.
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Цитата:
Circulation. 1997 Nov 4;96(9):2823-9.
Quantitative overview of randomized trials of amiodarone to prevent sudden cardiac death.
Amiodarone reduced total mortality by 10% to 19% in patients at risk of sudden cardiac death. Amiodarone reduced risk similarly in patients after myocardial infarction, with heart failure, or with clinically evident arrhythmia.
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Цитата:
Int J Cardiol. 1998 Sep 1;66(1):1-10.
Overview and meta-analysis of randomised trials of amiodarone in chronic heart failure.
In a meta-analysis of randomised controlled trials the use of amiodarone in heart failure was associated with an approximate 20 to 25% reduction in deaths. However, amiodarone was also associated with a 120 to 124% increase in side effects.
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Цитата:
Pharmacotherapy. 1998 Nov-Dec;18(6 Pt 2):127S-137S.
Clinical efficacy of amiodarone.
Meta-analysis of relevant studies indicated that amiodarone reduces the risk of arrhythmic and sudden death by 29% in high-risk patients with recent myocardial infarction or congestive heart failure. This translates into an overall 13% reduction in total mortality.
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Цитата:
Am J Cardiol. 1999 Mar 11;83(5B):55D-63D.
Amiodarone and "primary" prevention of sudden death: critical review of a decade of clinical trials.
Even accepting that amiodarone might decrease total mortality by 10%
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Цитата:
Am J Cardiol. 1999 Nov 4;84(9A):90R-93R.
Meta-analysis of antiarrhythmic drug trials.
a meta-analysis was performed from the 13 trials of amiodarone in patients after an acute myocardial infarction or with congestive heart failure. The results showed a significant reduction in mortality and in arrhythmic death with amiodarone.
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Цитата:
Expert Opin Pharmacother. 2001 Nov;2(11):1877-90.
Amiodarone -- waxed and waned and waxed again.
Amiodarone reduces sudden death after MI and this benefit is predominantly observed in patients with preserved cardiac function. Sudden cardiac death, predominantly due to ventricular arrhythmias, is also commonly seen in patients with heart failure. The Grupo de Estudio de la Sobrevida en lsuficiencia Cardiaca en Argentina (GESICA) and Estudio Piloto Argentino de Muerte Subita y Amiodarona (EPAMSA) trials showed survival benefit of amiodarone in heart failure, whereas Congestive Heart Failure-Survival Trial of Anti-arrhythmic Therapy (CHF-STAT) did not. Subsequent meta-analysis established a survival benefit of amiodarone in heart failure.
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Цитата:
Crit Care. 2013 Aug 12;17(4):R173. doi: 10.1186/cc12852.
Antiarrhythmia drugs for cardiac arrest: a systemic review and meta-analysis.
Amiodarone (relative risk (RR), 0.82; 95% confidence interval (CI), 0.54 to 1.24), lidocaine (RR, 2.26; 95% CI, 0.93 to 5.52), magnesium (RR, 0.82; 95% CI, 0.54 to 1.24) and nifekalant were not shown to improve the survival to hospital discharge compared with placebo, but amiodarone, lidocaine, and nifekalant were shown to be beneficial to initial resuscitation, assessed by the rate of return of spontaneous circulation and survival to hospital admission, with amiodarone being superior to lidocaine (RR, 1.28; 95% CI, 0.57 to 2.86) and nifekalant (RR, 0.50; 95% CI, 0.19 to 1.31).
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Цитата:
Ann Pharmacother. 2005 Sep;39(9):1409-15. Epub 2005 Jun 28.
Effect of prophylactic amiodarone on clinical and economic outcomes after cardiothoracic surgery: a meta-analysis.
Prophylactic treatment with amiodarone decreases patients' risk of POAF and stroke while reducing LOS.
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Цитата:
Mayo Clin Proc. 2009 Mar;84(3):234-42. doi: 10.1016/S0025-6196(11)61140-3.
Benefits and risks of long-term amiodarone therapy for persistent atrial fibrillation: a meta-analysis.
Amiodarone was more effective than a placebo or rate control drug in achieving sinus rhythm (21.3 vs 9.2 per 100 patient-years in sinus rhythm; relative risk [RR], 3.2; 95% confidence interval [CI], 1.9-5.5), and its use was not associated with an increased risk of long-term mortality (4.7 vs 3.9 per 100 patient-years; RR, 0.95; 95% CI, 0.8-1.1; P=.51; I2=0%). Cessation of amiodarone therapy because of intolerable adverse effects was more common compared with a placebo or rate control drug (10.7 vs 1.9 per 100 patient-years; RR, 3.0; 95% CI, 1.4-6.2; P<.001; I2=70%), but amiodarone was not associated with an increased incidence of hospitalizations (RR, 1.1; 95% CI, 0.6-2.1; P=.77; I2=90%).
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Цитата:
MJ Clin Evid. 2010; 2010: 0216.
Ventricular tachyarrhythmias (out-of-hospital cardiac arrests)
Amiodarone may increase the likelihood of arriving alive at hospital in people with ventricular tachyarrhythmia that has developed outside hospital, compared with placebo or with lidocaine, but has not been shown to increase longer-term survival.
Amiodarone is associated with hypotension and bradycardia.
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Я не обожествляю амиодарон, даже стараюсь назначать только когда припрет. Но другого такого у нас нет и припирает часто, т.к. от остального можно просто умереть...
P.S. Мне тоже очень интересно общаться, картинка получается полнее и качественнее в итоге. Спасибо!