Amiodarone-Related Lung Injury: Diagnosis and Management

Baseline Evaluation and Monitoring

• The American Academy of Family Physicians recommends comprehensive baseline evaluation, including chest radiograph, pulmonary function tests, and complete history and physical examination focused on pulmonary symptoms, before starting amiodarone therapy 1, 2, 3
• Structured monitoring every 6 months is recommended, including history and physical examination directed at detecting pulmonary adverse effects, and chest radiograph and pulmonary function tests should be performed if any suspected pulmonary toxicity develops 1, 4, 5, 3

Clinical Presentation and Diagnosis

• The most common presentation of amiodarone-related lung injury is subacute cough and progressive dyspnea, with patchy interstitial infiltrates on chest radiograph and reduced diffusing capacity on pulmonary function testing 2, 6
• Amiodarone pulmonary toxicity is a diagnosis of exclusion, and congestive heart failure can mimic amiodarone pneumonitis and must be ruled out early 6

Management and Treatment

• Primary treatment consists of immediate discontinuation of amiodarone, if clinically safe, and corticosteroid therapy for severe cases or when amiodarone cannot be safely withdrawn 6