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"Calcium-channel blockers (eg verapamil and diltiazem) and beta-blockers are contraindicated in cardiac amyloidosis (Gertz et al, 1985). Digoxin may cause toxicity at therapeutic levels (Rubinow et al, 1981) but is not necessarily contraindicated in the management of patients with cardiac amyloidosis and supraventricular tachyarrhythmias." (from Guidelines on the diagnosis and management of AL amyloidosis, British Journal of Haematology, 2004 - pdf file, or for html)http://pmj.bmjjournals.com/cgi/content/full/77/913/686. This article by Khan & Falk, (Postgrad Med J 2001;77:686-693, November), has some useful advice on medications used in treating Amyloidosis, under the heading 'Supportive Management'. "The mainstay of the treatment of amyloid cardiomyopathy is salt restriction and careful administration of diuretics, such as furosemide (Lasix), scrupulously avoiding aggravation of intravascular volume contraction (due to concomitant nephrotic syndrome) and postural hypotension. If furosemide becomes ineffective in controlling edema, the addition of metolazone or spironolactone can be beneficial. Patients with reduced stroke volume can benefit from afterload reduction with angiotensin-converting enzyme inhibitors. However, these agents should be used with great caution, starting at the lowest effective dose, escalating carefully and withdrawing if postural hypotension develops. Digoxin is not generally helpful, with the possible exception in patients with atrial fibrillation and rapid ventricular response. Calcium channel blockers can aggravate the congestive heart failure. Patients with recurrent syncope may require permanent pacemaker implantation. Menacing ventricular arrhythmias benefit from treatment with amiodarone. " AL AMYLOIDOSIS: THERAPEUTIC STRATEGIES 2004 :Giampaolo Merlini, MD http://www.asheducationbook.org/cgi/content/full/2004/1/257 Hiccups/Hiccoughs Hiccups/Hiccoughs are an often distressing side-effects of treatment for Amyloidosis Patients. We hope the following points may be of some use:If hiccoughs are persistent or intractable, then an underlying organic cause should always be considered. Non-drug treatments for hiccoughs all rely on attempting to interrupt the hiccough reflex arc. Common examples include: Breath holding Rebreathing from paper bag Valsalva manoeuvre Hyperventilation Sneezing Sipping iced water Drinking water rapidly Pressure on eyeballs Gasping with sudden fright Drug therapy works on the hiccough reflex arc by blocking transmitting nerve impulses, counter stimulating impulses or affecting the cause. Most of the evidence for these is from case reports. (Friedman, 1996) Persistent or intractable hiccoughs usually justify an attempt with drug therapy. Chlorpromazine and haloperidol are both licensed for the treatment of intractable hiccoughs. Other (non-licensed) options are metoclopramide ('Maxalon'), nifedipine, valproic acid, and baclofen. ( DTB, 1990; Friedman, 1996; Regnard and Tempest, 1998; Cersosimo and Brophy, 1998)
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