Vol. 2 No. 3 (2023): infermieristica journal: your heart, our beat

Amiodarone induced lung toxicity: a radiological overview that simulating COVID19 infection disease

Marco Umberto Scaramozzino
MD Pulmonologist Director Ambulatory of Pulmonology “La madonnina” Reggio Calabria (RC), Italy
Giovanni Sapone
Head of Nursing Department of Cardiology Polyclinic M.d.c. Reggio Calabria (RC), Italy
Ubaldo Romeo Plastina
MD, Radiologist in ECORAD radiology and ultrasound study, Reggio Calabria (RC), Italy
Guido Levi
Pulmonology department, ASST Spedali Civili Brescia, Italy, Department of clinical and experimental sciences, University of Brescia, Brescia, Italy
Mariacarmela Nucara
Department of Clinical and Experimental Medicine, Section of Cardiology, University of Messina, Italy

Published 2023-10-31


  • Amiodarone-Induced Pulmonary Toxicity,
  • Amiodarone,
  • Hyper-Reactivity,
  • OCS,
  • Ground Glass Opacity


Amiodarone-induced pulmonary toxicity (AIPT) is among the most serious adverse effects and is one of the leading causes of death associated with its use. It is a clinical pathology that is conditioned by dose, patient’s age, and pre-existent pulmonary pathologies. Those effects reach a plateau at a cumulative dose bigger than 150g. Patient’s comorbidities; oxygen therapy, invasive procedures or surgical interventions can trigger the pulmonary symptoms induced by amiodarone toxicity. The increased risk of developing amiodarone-induced pulmonary fibrosis is directly related to the dose and the duration of the intake. Despite significant advances in the understanding of AIPT, its aetiology and pathogenesis remain incompletely understood. The role of steroids in the management of pulmonary toxicity from amiodarone is debatable, however, most reports of improvement after amiodarone withdrawal di"er little from those in which concomitant steroid therapy was employed. Therefore, the addition of therapeutic doses of corticosteroids in amiodarone induced pneumopathy may be indicated. Typically, prednisone is started in doses of 40 to 60 mg/day orally and slowly reduced. Again, the pharmacodynamics of amiodarone dictate a treatment period of four to 12 months. The case report describes a patient with AIPT who after therapy with Prednisone at a dosage of 50mg/day by gradually scaling down the doses as reported in the above clinical studies, had a clinical, functional and CT radiological picture that was markedly improved with disappearance of most of the scattered ground glass areas and the previously reported thickening with associated bi-apical fibrotic outcomes.


  1. Feduska ET, Thoma BN, Torjman MC, Goldhammer JE. Acute Amiodarone Pulmonary Toxicity. J Cardiothorac Vasc Anesth. 2021 May;35(5):1485-1494. doi: 10.1053/j.jvca.2020.10.060. Epub 2020 Nov 5. PMID: 33262034.
  2. Heisel A, Berg M, Stopp M, Ukena D, Schieffer H. Amiodaroninduzierte Lungenveränderungen [Amiodarone-induced pulmonary toxicity]. Med Klin (Munich). 1997 Dec;92 Suppl 5:33-6. German. doi: 10.1007/BF03041977. PMID: 19479394.
  3. Papiris SA, Triantafillidou C, Kolilekas L, Markoulaki D, Manali ED. Amiodarone: review of pulmonary effects and toxicity. Drug Saf. 2010 Jul 1;33(7):539-58. doi: 10.2165/11532320-000000000-00000. PMID: 20553056.
  4. Wolkove N, Baltzan M. Amiodarone pulmonary toxicity. Can Respir J. 2009 Mar-Apr;16(2):43-8. doi: 10.1155/2009/282540. PMID: 19399307; PMCID: PMC2687560.
  5. Pitcher WD. Amiodarone pulmonary toxicity. Am J Med Sci. 1992 Mar;303(3):206-12. doi: 10.1097/00000441-199203000-00012. PMID: 1595783.
  6. Rakita L, Sobol SM, Mostow N, Vrobel T. Amiodarone pulmonary toxicity. Am Heart J. 1983 Oct;106(4 Pt 2):906-16. doi: 10.1016/0002-8703(83)90015-7. PMID: 6310979.
  7. Schwaiblmair M, Berghaus T, Haeckel T, Wagner T, von Scheidt W. Amiodarone-induced pulmonary toxicity: an under-recognized and severe adverse effect? Clin Res Cardiol. 2010 Nov;99(11):693-700. doi: 10.1007/s00392-010-0181-3. Epub 2010 Jul 10. PMID: 20623129.
  8. Jessurun GA, Boersma WG, Crijns HJ. Amiodarone-induced pulmonary toxicity. Predisposing factors, clinical symptoms and treatment. Drug Saf. 1998 May;18(5):339-44. doi: 10.2165/00002018-199818050-00003. PMID: 9589845.
  9. Colby R, Geyer H. Amiodarone-induced pulmonary toxicity. JAAPA. 2017 Nov;30(11):23-26. doi: 10.1097/01.JAA.0000524713. 17719.c8. PMID: 29064934.
  10. Budin CE, Cocuz IG, Sab?u AH, Niculescu R, Ianosi IR, Ioan V, Cotoi OS. Pulmonary Fibrosis Related to Amiodarone-Is It a Standard Pathophysiological Pattern? A Case-Based Literature Review. Diagnostics (Basel). 2022 Dec 19;12(12):3217. doi: 10.3390/diagnostics12123217. PMID: 36553223; PMCID: PMC9777900.
  11. Haverkamp W, Israel C, Parwani A. Klinische Besonderheiten der Therapie mit Amiodaron [Clinical aspects of treatment with amiodarone]. Herzschrittmacherther Elektrophysiol. 2017 Sep;28(3):307-316. German. doi: 10.1007/s00399-017-0516-0. PMID: 28643175.
  12. Richeldi L, Collard HR, Jones MG. Idiopathic pulmonary fibrosis. Lancet. 2017 May 13;389(10082):1941-1952. doi: 10.1016/S0140-6736(17)30866-8. Epub 2017 Mar 30. PMID: 28365056.
  13. Malaviya R, Kipen HM, Businaro R, Laskin JD, Laskin DL. Pulmonary toxicants and fibrosis: innate and adaptive immune mechanisms. Toxicol Appl Pharmacol. 2020 Dec 15;409:115272. doi: 10.1016/j.taap.2020.115272. Epub 2020 Oct 5. PMID: 33031836.
  14. Meter M, Prusac IK, Glavaš D, Meter D. Acute respiratory failure on a low dose of amiodarone - is it an underdiagnosed and undertreated condition? Respir Med Case Rep. 2021 Sep 5;34:101500. doi: 10.1016/j.rmcr.2021.101500. PMID: 34527509; PMCID: PMC8429964.
  15. Borthwick LA. The IL-1 cytokine family and its role in inflammation and fibrosis in the lung. Semin Immunopathol. 2016 Jul;38(4):517-34. doi: 10.1007/s00281-016-0559-z. Epub 2016 Mar 21. PMID: 27001429; PMCID: PMC4896974.
  16. Baron E, Mok WK, Jayawardena M, Reall G, Elfaki H, Thirumaran M, Dwarakanath A. Amiodarone lung: under recognised but not forgotten. J R Coll Physicians Edinb. 2021 Mar;51(1):61-64. doi: 10.4997/JRCPE.2021.115. PMID: 33877138.
  17. Mankikian J, Favelle O, Guillon A, Guilleminault L, Cormier B, Jonville-Béra AP, Perrotin D, Diot P, Marchand-Adam S. Initial characteristics and outcome of hospitalized patients with amiodarone pulmonary toxicity. Respir Med. 2014 Apr;108(4):638-46. doi: 10.1016/j.rmed.2014.01.014. Epub 2014 Feb 10. PMID: 24565600.
  18. Kumar S, Bangalore S, Kumari R, Grosu H, Jean R. Amiodarone-induced acute respiratory distress syndrome masquerading as acute heart failure. J Emerg Med. 2012 Nov;43(5):e311-4. doi: 10.1016/j.jemermed.2010.07.024. Epub 2011 Apr 2. PMID: 21459542.
  19. Dharmarajan TS, Shah AB, Dharmarajan L. Amiodarone-induced pulmonary toxicity: potentially fatal, recognize early during life! J Am Geriatr Soc. 2008 Jul;56(7):1363-5. doi: 10.1111/j.1532-5415.2008.01715. x. PMID: 18774973.
  20. Baumann H, Fichtenkamm P, Schneider T, Biscoping J, Henrich M. Rapid onset of amiodarone induced pulmonary toxicity after lung lobe resection - A case report and review of recent literature. Ann Med Surg (Lond). 2017 Jul 19; 21:53-57. doi: 10.1016/j.amsu.2017.07.034. PMID: 28794867; PMCID: PMC5537372.
  21. Chen YF, Avery AJ, Neil KE, Johnson C, Dewey ME, Stockley IH. Incidence and possible causes of prescribing potentially hazardous/contraindicated drug combinations in general practice. Drug Saf. 2005;28(1):67-80. doi: 10.2165/00002018-200528010-00005. PMID: 15649106.
  22. Andrade JG, Connolly SJ, Dorian P, Green M, Humphries KH, Klein GJ, Sheldon R, Talajic M, Kerr CR. Antiarrhythmic use from 1991 to 2007: insights from the Canadian Registry of Atrial Fibrillation (CARAF I and II). Heart Rhythm. 2010 Sep;7(9):1171-7. doi: 10.1016/j.hrthm.2010.04.026. Epub 2010 Apr 27. PMID: 20430112.
  23. Skeoch S, Weatherley N, Swift AJ, Oldroyd A, Johns C, Hayton C, Giollo A, Wild JM, Waterton JC, Buch M, Linton K, Bruce IN, Leonard C, Bianchi S, Chaudhuri N. Drug-Induced Interstitial Lung Disease: A Systematic Review. J Clin Med. 2018 Oct 15;7(10):356. doi: 10.3390/jcm7100356. PMID: 30326612; PMCID: PMC6209877.