Ethamioduroxone, also known as cortisone and amiodarone, is indicated for ventricular and supraventricular tachycardia and premature beats, paroxysmal atrial flutter and fibrillation, and pre-excitation syndrome. In particular, arrhythmias accompanying organic heart disease. Pharmacokinetics Oral absorption is delayed and irregular. It is mainly distributed in adipose tissue and fat-rich organs. This is followed by the heart, kidneys, lungs, liver and lymph nodes. The lowest is in the brain, thyroid and muscle. 4 to 5 days for onset of action, 5 to 7 days for maximum effect, sometimes 1 to 3 weeks for onset. The effect can last for 8-10 days after discontinuation of the drug, and occasionally for 45 days. Therefore, it takes 4-5 days for the efficacy of oral administration to appear. Its effect can be maintained for a period of time after discontinuation, and care should be taken when switching to other antiarrhythmic drugs during this period. Oral dose 200mg per dose, 3 times a day, after meals; after 3 days, switch to maintenance dose, 200mg per dose, 1 or 2 times a day, or every other day, weekly. Follow medical advice. Adverse reactions (1), cardiovascular: less adverse cardiovascular reactions than other antiarrhythmic drugs. (1) sinus bradycardia, sinus arrest or sinus block, atropine can not counteract this reaction; (2) atrioventricular block; (3) occasional Q-T interval prolongation with torsional ventricular tachycardia; mainly seen in hypokalemia and with other drugs to prolong QT; (4) the above adverse reactions are mainly seen in long-term high doses and with hypokalemia, the above cases should be discontinued, the use of antihypertensive drugs, isoproterenol, sodium bicarbonate ( The above adverse reactions should be discontinued and treated with antihypertensive drugs, isoproterenol, sodium bicarbonate (or sodium lactate) or pacemaker. Because of the long half-life of this product, so the treatment of adverse reactions need to last 5-10 days. (2), thyroid: ① hyperthyroidism, can occur during or after discontinuation of the drug, in addition to the proptosis signs can appear typical signs of hyperthyroidism, can also appear new arrhythmias, laboratory T3, T4 are increased, TSH decreased. The incidence of hypothyroidism is about 2%, and it can disappear completely in a few weeks to months after stopping the drug, but a few need to be treated with antithyroid drugs, propranolol or adrenocorticosteroids; ② hypothyroidism, the incidence of 1% to 4%, more common in the elderly, can appear the typical signs of hypothyroidism, increased TSH, can subside in a few months after stopping the drug, but mucinous edema can remain, if necessary, thyroxine treatment. (3), gastrointestinal tract: constipation, a few people have nausea, vomiting, decreased appetite, obvious when the load amount. (4), eye: those who have taken the drug for more than 3 months have yellow-brown pigmentation in the lower 1/3 of the basal layer of the cornea, which is related to the course of treatment and dose, and occurs less frequently in children. Such deposits may occasionally affect vision, but there is no permanent damage. A small number of people may have halos, and rarely discontinue the drug due to ocular side effects. (5), the nervous system: uncommon, related to the dose and the course of treatment, may appear tremor, ataxia, proximal muscle weakness, extra-pyramidal signs, more than 1 year of drug use may have peripheral neuropathy, after reducing or stopping the drug gradually subside. (6), skin: photosensitivity with the course of treatment and dose, skin slate blue pigmentation, after a longer period of time (1 to 2 years) after discontinuation of the drug to gradually recede. Other allergic rash, fading faster after discontinuation of the drug. (7), liver: hepatitis or fat infiltration, increased aminotransferase, related to the course of treatment and dose. (8), lung: pulmonary adverse reactions occur mostly in those who take large amounts of drugs for a long time (0.8 to 1.2g a day). It mainly produces allergic pneumonia, interstitial or alveolar fibrosis pneumonia. Clinical manifestations include shortness of breath, dry cough and chest pain, restrictive pulmonary function changes, increased blood sedimentation and increased blood leukocytes, which can be fatal in severe cases. The drug needs to be stopped and treated with adrenocorticosteroids. (9) Other: Occasionally, hypocalcemia and elevated serum creatinine may occur. Contraindications: (1) Contraindicated in severe sinus node abnormalities; (2) Contraindicated in atrioventricular block of degree II or III; (3) Contraindicated in syncope due to bradycardia; (4) Contraindicated in hypersensitivity to this product. Pregnant women and nursing mothers: It may cause congenital goiter, hyperthyroidism and hypothyroidism in the fetus, so pregnant women should weigh the advantages and disadvantages when using it. This product and its metabolites may be secreted from breast milk. The safety and efficacy of amiodarone in children is not known. The oral administration of Amiodarone to the elderly requires close monitoring of electrocardiogram and pulmonary function. Precautions for use (a) When taking up to dragon, attention should be paid to the combination of other medications as follows: (1) Increase the anticoagulant effect of warfarin, which can last from 4 to 6 days after the addition of this product until several weeks or months after discontinuation of the drug. When combined, the prothrombin time should be closely monitored and the dose of anticoagulant should be adjusted. (2) Combination with beta-blockers (metoprolol, bisoprolol, etc.) or calcium channel blockers (tranylcypromine, isoptin, etc.) may aggravate sinus bradycardia, sinus arrest and atrioventricular block. If this occurs, the dosage of this product or the first two types of drugs should be reduced. (3), increase the concentration of serum digoxin, may also increase the concentration of other digitalis preparations to toxic levels, when starting this product digitalis drugs should be stopped or reduced by 50%, such as the combination of their serum herbal concentrations should be carefully monitored. This product has enhanced the inhibitory effect of digitalis on sinus node and atrioventricular node. (4), combined with potassium-removing diuretics, may increase arrhythmias due to hypokalemia. (5), increase the role of sunlight-sensitive drugs. (2) The following clinical conditions may occur with the use of Kotalon: (1) Allergic reactions, people who are allergic to iodine may be allergic to this product. (2), interference with diagnosis: (1) electrocardiographic changes: for example, prolongation of P-R and Q-T interval, most patients have T-wave hypotension with widening and bidirectional and u-wave after taking the drug, which is not an indication for discontinuation; (2) very few have increased AST, ALT and alkaline phosphatase; (3) thyroid function changes, this product inhibits the conversion of peripheral T4 to T3, resulting in increased T4 and rT3 and a mild decrease in serum T3. Thyroid function tests are usually abnormal, but there is no clinical thyroid dysfunction. Abnormal thyroid function tests may persist until several weeks or months after discontinuation of the drug. (3) The following conditions should be used with caution: (1) sinus bradycardia; (2) Q-T prolongation syndrome; (3) hypotension; (4) hepatic insufficiency; (5) pulmonary insufficiency; (6) severe congestive heart failure. (c) Most of the adverse reactions of Kotarolone are dose-related, so those who need to take the drug for a long time should use the minimum effective maintenance dose as much as possible and should follow up regularly, and should pay attention to the following examinations during the drug use: ① blood pressure; ② electrocardiogram, special attention should be paid to Q-T interval when taken orally; ③ liver function; ④ thyroid function, including T3, T4 and thyroid stimulating hormone, once every 3-6 months; ⑤ lung function, lung X-ray film, once every 6-12 months; ⑥ ～(5) pulmonary function and lung X-ray, once every 6 to 12 months; (6) eye examination.