Amiodarone and the "Dizzy" Patient

Beware of neurotoxicity, among other side effects, when treating patients with amiodarone. Patients will typically complain of tremor, but also “dizziness” as an umbrella term for an unsteady gait. There are various levels of the nervous system where amiodarone can impair ambulation: (1) optic neuropathy, (2) distal-symmetric polyneuropathy, (3) cerebellar toxicity, (4) peripheral vestibulopathy, and (5) myopathy. As a rule of thumb, neurotoxicity has become rarer as lower amiodarone maintenance doses are in use (≤5%). But there is a degree of idiosyncrasy regarding neurotoxicity, so one should always be on the look-out for pertinent signs and symptoms. This review will discuss a few easy to use clinical tests to detect potential neurotoxicity. In most cases, neurotoxicity will resolve when amiodorone is discontinued, but as a result of its long half-life this can be a waiting game.