Drug interactions
Amiodarone + Perhexiline
Severity: Major
Amiodarone and Perhexiline: major interaction.
Last updated
For healthcare professionals — reference only. This page is a brief summary, not medical advice and not a substitute for official labeling or clinical judgement. Always verify before prescribing or dispensing.
Summary
Perhexiline has a narrow therapeutic index and is cleared mainly by CYP2D6. Amiodarone inhibits CYP2D6 and may raise perhexiline levels, increasing risk of hepatotoxicity and peripheral neuropathy; both drugs also share these toxicities.
What this interaction means in plain words
Amiodarone and Perhexiline can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for.
Why it happens
Inhibition of CYP2D6 reduces perhexiline clearance, with additive toxicity.
What to do
Avoid the combination if possible; otherwise reduce perhexiline dose and guide it by plasma concentration monitoring. Monitor liver function and neurological symptoms.
What to ask your pharmacist
- Does the benefit of taking both outweigh the risk in my case?
- Do I need any blood test, ECG or other check while on both?
- What early warning signs should I watch for, and what should I do if they appear?
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Other interactions of Amiodarone
- Amiodarone + Amisulpride Contraindicated
- Amiodarone + Arsenic trioxide Contraindicated
- Amiodarone + Dofetilide Contraindicated
- Amiodarone + Dronedarone Contraindicated
- Amiodarone + Droperidol Contraindicated
- Amiodarone + Eliglustat Contraindicated
Frequently asked questions
Can I take Amiodarone with Perhexiline?
MediHelp rates the interaction as major. Amiodarone and Perhexiline can interact in a way that may be serious. Using them together is sometimes necessary, but it needs a deliberate decision by the prescriber, a plan for monitoring, and clear advice on the warning signs to watch for. Perhexiline has a narrow therapeutic index and is cleared mainly by CYP2D6. Amiodarone inhibits CYP2D6 and may raise perhexiline levels, increasing risk of hepatotoxicity and peripheral neuropathy; both drugs also share these toxicities.
How serious is the interaction between Amiodarone and Perhexiline?
MediHelp rates it major, on a four-level scale (minor, moderate, major, contraindicated) based on published labels and references. What to do, in brief: Avoid the combination if possible; otherwise reduce perhexiline dose and guide it by plasma concentration monitoring. Monitor liver function and neurological symptoms.
What other medicines interact with Amiodarone?
MediHelp also lists interactions of Amiodarone with, for example, Amisulpride, Arsenic trioxide, Dofetilide. The full list is on the Amiodarone page.
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