Influence of concomitant medication on plasma concentration of amiodarone in patients with atrial fibrillation - a pilot study.

BACKGROUND: Although amiodarone is a drug with many side effects, it is one of the most commonly used drugs in the treatment and prophylaxis of supraventricular and ventricular arrhythmias. AIM: The purpose of this pilot study was to evaluate plasma concentrations of amiodarone in patients with atrial fibrillation (AF) and to identify possible drug-drug interactions between amiodarone and concomitant medications. METHOD: A prospective observational study was conducted in 27 consecutive patients treated with amiodarone from May to July 2017 in a Clinical University Hospital. The patients included met our inclusion criteria. HPLC-UV was the device used to determine the plasma concentration of amiodarone. RESULTS: Only 51.8% of the patients had amiodarone plasma concentration within therapeutic interval (500-2500 ng/ml). The drugs associated to amiodarone in the therapeutic plan were diuretics, beta blockers, statins, antiplatelets, fluoroquinolones, non-steroidal anti-inflammatory drugs. We observed a statistically significant difference between the plasmatic concentrations of amiodarone in patients treated with furosemide vs. patients concomitantly treated with other drugs. Interactions between other mentioned drugs and amiodarone were not registered. We can report an underuse of amiodarone for more than 50% of the patients. Also, we found a significant interaction between furosemide and amiodarone, most likely through the interaction with MDR. CONCLUSION: Furosemide may influence the pharmacokinetics of P-gp-interfering drugs. However, the relevance of these findings needs to be confirmed and further research is needed to characterize the interaction between amiodarone and furosemide.

[Fibromyalgia: from public issue to the patient experience]. / La fibromyalgie: du problème public à l'expérience des patients.

Fibromyalgia is a health condition characterized by significant tiredness and pain. Its contours are not clearly specified, either from a biological point of view or from a clinical point of view. In this context of uncertainty, the prevalence of fibromyalgia is estimated at more than 1% of the population. This article draws on qualitative data to explore in sociological terms the relationship between the dynamics of public debate about fibromyalgia, which has been recurring since the 1980s, and the patient experience. The linking of these two types of elements, both collective and individual perspectives, highlights the difficulties associated with management and care of fibromyalgia.