Amiodarone and the elderly, >75

Summary from 2019: Aust Prescr 2019 Oct 1;42(5):158–162. Amiodarone in the aged - PMC

Amiodarone in the aged

"Amiodarone is widely considered to be the most effective antiarrhythmic drug available.1 It is commonly used to treat atrial fibrillation and ventricular arrhythmias. Amiodarone, and its active metabolite desethylamiodarone, have multiple effects on cardiac depolarisation and repolarisation. Although it primarily blocks potassium channels, amiodarone potentiates its effect through all four of the classic Vaughan Williams mechanisms of antiarrhythmic action.

Despite its efficacy, amiodarone is a challenging drug to use in clinical practice due to its prolonged half-life, multiple adverse effects and drug interactions. These adverse effects are particularly problematic for older people who are more susceptible to drug toxicities and who have higher rates of polypharmacy. There is also a lack of information regarding the safety of amiodarone in older people.2 A cardiologist’s opinion is recommended before prescribing. 

[Unfortunately, it was prescribed by a cardiologist.]

Amiodarone can have adverse effects in multiple organ systems including the lungs, heart, liver, thyroid, gut, skin, nerves and eyes.3 Its use is also implicated in a range of drug–drug interactions with commonly prescribed cardiovascular drugs.4"

Also read from 2025: The Safety Profile of Amiodarone Among Older Adults (Age ≥75 Years): A Pharmacovigilance Study from the FDA Data. | Read by QxMD

CONCLUSIONS: In this global postmarketing study, interstitial lung disease and bradycardia were more frequently reported in older adults treated with amiodarone. These findings support vigilant monitoring for these adverse events, particularly in older patients.

In our case, there was "no vigilant monitoring."

Dual-chamber leadless pacemaker system

I won't exactly be making medical history, but I might be moving quickly ahead of my dad and siblings, all of whom had/have a conventional pacemaker. I'll be meeting with Dr. Amin about a "revolutionary" dual-chamber leadless pacemaker system, which will coordinate i2i (implant to implant) devices (smaller than a AAA battery) between the heart's atrial and ventricular chambers without traditional leads. I've seen it likened to a "moonshot" or a least a Thomas Edison moment in heart regulation. It was approved by FDA in 2023. I'm a pace setter at age 85!

Of course, I've learned all this in a week, so I'm a little fuzzy on the details--I been reading blogs and product literature and listening to podcasts. It's like trying to learn Mandarin and then having a conversation. It's brand new even to the experts, IMO.

 
In September I was told I was not a candidate for a pacemaker (originally developed in the late 50s) and here I be, now ready for the moon! If you have one of these in your heart, let me know--I've yet to meet anyone who does. And if you're a direct descendant of Grandma Bessie, we might want to talk.

The word on exercise

A quote from my new book, "Outlive," by Dr. Peter Attia (c. 2023).

"So if you adopt only one new set of habits based on reading this book, it MUST be in the realm of exercise. If you currently exercise, you will likely want to rethink and modify your program. And if exercise is not a part of your life at the moment, you are not alone--77% of the US population is like you. Now is the time to change that. Right now. Even a little bit of daily activity is much better than nothing. Going from zero weekly exercise to just 90 minutes per week can reduce your risk of dying from all causes by 14%. It's very hard to find a drug that can do that." p. 218

 
Dr. Attia has a podcast. Interviews interesting people.

Bob had an appointment with his cardiologist this morning and he said something very similar. Although Bob never took a pill before 2020, he now has a handful every morning. His doctor said that his regular exercise program is worth more than all of them.

Physical Exercise as a Preventive or Disease-Modifying Treatment of Dementia and Brain Aging - PMC (nih.gov)