Increased acute mucosal and cutaneous radiation toxicity in two patients taking amiodarone

International Journal of Radiation OncologyBiologyPhysics (Impact Factor: 4.26). 02/1992; 22(1):224. DOI: 10.1016/0360-3016(92)91008-B
Source: PubMed
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    ABSTRACT: The aim of curative radiation therapy is to achieve uncomplicated local tumor control, that is to destroy all clonogenic tumor cells without producing major damage to surrounding normal tissue. This principle was illustrated by Hermann Holthusen, who used data on control of skin carcinoma and development of telangiectasia as an indicator of late-occurring normal tissue damage (Fig. 1). Both the probability of local tumor control and the development of normal tissue damage increased as sigmoid functions of radiation dose. The probability of uncomplicated local tumor control at each dose level was given as the product of the probability to achieve local tumor control and the probability of preventing normal tissue damage (Holthusen 1936; Busch 1987).
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    ABSTRACT: With the aging of our population, amiodarone, a cardiac antiarrhythmic, is being used with increasing frequency. Anecdotal reports have appeared describing unexpected mucosal as well as cutaneous toxicity in patients treated concurrently with external beam radiotherapy and oral amiodarone. We retrospectively reviewed 12 years of experience at the University of Iowa Hospitals and Clinics and found 10 cases wherein amiodarone was taken concurrently with external beam radiation therapy. In our series, there were no missed treatment fractions because of unexpected acute sequelae. We conclude that amiodarone use does not preclude the delivery of therapeutic radiotherapy.
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    ABSTRACT: This chapter discusses several positive inotropic drugs and drugs used in dysrhythmias. Plasma potassium concentrations normally rise during exercise. In the study discussed in the chapter, in nine patients with atrial fibrillation during exercise at 75 W in the absence of digoxin, the peak serum potassium concentration was 4.6 mmol/L; when the serum digoxin concentration was 1.1 nmol/L, it was 4.8 mmol/L, and when the serum digoxin concentration was 2.5 nmol/L, it was 5 mmol/L. This greater increase in plasma potassium concentration during exercise in patients taking digoxin might increase its dysrhythmogenic effects. The most common presentation of digitalis toxicity in therapeutic use is with gastrointestinal adverse effects, commonly anorexia, nausea, vomiting, and diarrhea. This is also the case when poisoning occurs because of traditional medicines containing cardiac glycosides. The adverse effects of antidigoxin antibody fragments are discussed in the context of the management of digitalis toxicity. The frequency of adverse events was low (7%) and included allergic responses, possible recurrence of digitalis toxicity after treatment, and some effects attributable to the withdrawal of digitalis, such as worsening of heart failure. Amrinone can cause vasodilatation and hypotension after intravenous administration. This was reported in patients who were given intravenous amrinone rapidly during cardiopulmonary bypass. In the study discussed in the chapter, amrinone reportedly further increased intracranial pressure in a 13-year-old girl with pre-existing cerebral damage.
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