Impact of concurrent amiodarone treatment on the tolerability and efficacyof carvedilol in patients with chronic heart failure

Objective-To assess the safety and efficacy of carvedilol when administered to heart failure patients already receiving amiodarone. Design-Retrospective analysis of the clinical outcome of 230 patients treat ed with carvedilol for chronic heart failure, stratified according to wheth er they were already receiving amiodarone (amiodarone group, 80 patients) o r not (non-amiodarone group, 130 patients) at baseline. Setting-Heart failure clinic at a university affiliated public teaching hos pital. Main outcome measures-Incidence of adverse events; changes in functional st atus and echocardiographic dimensions at three months. Results-Adverse reactions to carvedilol occurred in 33 (41%) of the amiodar one group and 43 (29%) of the non-amiodarone group (p = 0.049). Carvedilol was discontinued in 21 (26%) of the amiodarone group and 37 (25%) of the no n-amiodarone group (NS). The clinical outcome at three months did not diffe r significantly between the two groups; 31 (39%) of the amiodarone group im proved their New York Heart Association status, 28 (35%) were unchanged, an d 21 (26%) deteriorated compared with 67 (45%), 51 (34%), and 32 (21%), res pectively, for the non-amiodarone group (NS). Both groups had highly signif icant decreases in heart rate and left ventricular end systolic dimension, and a significant increase in left ventricular ejection fraction after thre e months of carvedilol treatment, with no significant differences between t he groups. Conclusions-The beneficial effects of carvedilol on left ventricular remode lling, systolic function, and symptomatic status are not affected by concur rent treatment with amiodarone. Adverse reactions necessitating cessation o f carvedilol are no more frequent in patients receiving amiodarone.