<unk>  is extensively metabolized in the liver by cytochrome P450 3A4 and can affect the metabolism of numerous other drugs. It interacts with digoxin, warfarin, phenytoin, and others. The major metabolite of<unk>  is desethylamiodarone (DEA), which also has antiarrhythmic properties. The metabolism of<unk>  is inhibited by grapefruit juice, leading to elevated serum levels of<unk> . On 8 August 2008, the FDA issued a warning of the risk of rhabdomyolysis, which can lead to kidney failure or death, when simvastatin is used with<unk> . This interaction is dose-dependent with simvastatin doses exceeding 20 mg. This drug combination especially with higher doses of simvastatin should be avoided. Excretion Excretion is primarily via the liver and the bile duct with almost no elimination via the kidney and it is not dialyzable. Elimination half-life average of 58 days (ranging from 25 to 100 days Remington: The Science and Practice of Pharmacy 21st edition) for<unk>  and 36 days for the active metabolite, desethylamiodarone (DEA). There is 10-50% transfer of<unk>  and DEA in the placenta as well as a presence in breast milk. Accumulation of<unk>  and DEA occurs in<unk> ipose tissue and highly perfused organs (i.e. liver, lungs), therefore, if an individual was taking<unk>  on a chronic basis, if it is stopped it will remain in the system for weeks to months.
Amiodarone
Ibutilide
Colestilan
Flecainide
Verapamil
Acecainide
Sotalol
Dofetilide