Letter to the Editor Incompatibility between intravenous amiodarone and heparin in an infant Gabriele Bronzetti a, ⁎ , Cinzia D’Angelo a , Elisabetta Mariucci a , Fernando Maria Picchio a , Giuseppe Boriani b a Pediatric Cardiology and Adult Congenital Unit, University of Bologna, Italy b Institute of Cardiology, University of Bologna, Azienda Ospedaliera S.Orsola-Malpighi, Bologna, Italy Received 12 October 2008; accepted 14 December 2008 Available online 3 February 2009 Abstract Amiodarone is an effective antiarrhythmic agent and represents the drug of choice in the treatment of severe arrhythmias, especially in the setting of ventricular dysfunction. Amiodarone has the potential for interaction with many cardiac and non-cardiac drugs. Nonetheless few incompatibilities have been reported. We report the incompatibility between amiodarone and heparin administrated in the same vein in a case of a one month old baby with atrial flutter. This topic needs more attention, due to the frequent co-administration of these two drugs in tachyarrhytmias with high thromboembolic risk. © 2008 Elsevier Ireland Ltd. All rights reserved. Keywords: Intravenous amiodarone; Heparin; Incompatibility; Atrial flutter 1. Introduction Amiodarone is a powerful antiarrhythmic drug, available for oral and intravenous administration, and is used in the treatment and prevention of both ventricular and supraven- tricular arrhythmias in adults and children [1,2]. Many of these patients have underlying conditions requiring antic- oagulation for the prevention of thromboembolism. Given that amiodarone and its metabolites are inhibitors of the hepatic metabolism of many drugs, potentially harmful drug interactions may result from coadministration. Incom- patibilities with other drugs leading to inactivation are less known but equally important. In the present report we provide an example of the interplay between amiodarone and heparin. 2. Case report A one month-old baby girl, from twin pregnancy at 38 weeks of gestation with birth weight of 2.870 kg and a normal APGAR score, called the parents' attention because of poor feeding. There was no history of flu or other viral illnesses. She was brought to the hospital and clinical examination after admission demonstrated that the patient was alert and responsive; the weight was 3.870 kg, the oxygen saturation was 98% on room air, blood pressure 72/ 50 mm Hg, heart rate 220 beats/min, respiratory rate 70 breaths/min. A pansystolic murmur and gallop were audible on auscultation. A standard electrocardiogram demonstrated an atrial flutter (AFl) with 2:1 conduction (atrial rate 500 beats/min; ventricular rate 250 beats/min) (Fig. 1). Echocardiography showed a moderate biventricular dilation, severely impaired left ventricular function (ejection fraction 15%), biatrial enlargement with “smoke effect”, flattening of the inter- ventricular septum (D-shaped left ventricle), and severe mitral and tricuspid regurgitation. The echo picture was International Journal of Cardiology 145 (2010) e70 – e73 www.elsevier.com/locate/ijcard ⁎ Corresponding author. Institute of Cardiology of Bologna, S. Orsola Hospital, Via, Massarenti 9, 40138 Bologna, Italy. Tel.: +39 51 349858; fax: +39 51 344859. E-mail address: gabronz@hotmail.com (G. Bronzetti). 0167-5273/$ - see front matter © 2008 Elsevier Ireland Ltd. All rights reserved. doi:10.1016/j.ijcard.2008.12.158