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Amiodarone drug-induced pigmentation
See also in: External and Internal Eye
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Amiodarone drug-induced pigmentation

See also in: External and Internal Eye
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Contributors: Michael D. Tharp MD, Neil Shear MD
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Synopsis

Amiodarone is a class III antiarrhythmic, iodine-rich drug that is commonly used for a wide variety of cardiac arrhythmias. Amiodarone causes a wide range of adverse effects including skin pigmentation, corneal deposits, and complications of the liver and lungs. There can also be alterations of thyroid function.

Skin effects – Blue-gray pigmentation of sun-exposed skin is common. Skin effects also include vasculitis and photosensitivity (30%-50% of patients on amiodarone). Skin pigmentation can develop 6 months to 5 years after beginning therapy.

Ocular effects – Amiodarone will induce mitochondrial deposits in the deep epithelial layer of the cornea. These deposits will form a whorl-like epitheliopathy called "corneal verticillata," or vortex keratopathy. The deposits are barely visible without the aid of a slit lamp and rarely result in any reduction in vision or ocular discomfort. The corneal verticillata are typically found on routine eye exam and are not an indication for discontinuation of the medication. Most patients using amiodarone will develop corneal deposits. Upon discontinuation of the medication, the deposits typically resolve.

Thyroid effects – Adverse events include either hypothyroidism or hyperthyroidism with skin manifestations of myxedema.

Codes

ICD10CM:
T50.995A – Adverse effect of other drugs, medicaments and biological substances, initial encounter

SNOMEDCT:
110284009 – Drug-induced pigmentation

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Diagnostic Pearls

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Differential Diagnosis & Pitfalls

Best Tests

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Management Pearls

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Therapy

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Drug Reaction Data

Below is a list of drugs with literature evidence indicating an adverse association with this diagnosis. The list is continually updated through ongoing research and new medication approvals. Click on Citations to sort by number of citations or click on Medication to sort the medications alphabetically.

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References

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Last Updated: 02/21/2018
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Amiodarone drug-induced pigmentation
See also in: External and Internal Eye
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Amiodarone drug-induced pigmentation : amiodarone, Corneal opacities, Eye, Forehead, Hyperpigmented patch, Lips, Nose, Vision loss, Sun-exposed distribution, Blurry vision, Cheeks
Clinical image of Amiodarone drug-induced pigmentation
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