CYP3A4 and lung disorder: Patients with preexisting pulmonary disease are particularly vulnerable to amiodarone, with reports of diffuse alveolar hemorrhage syndrome [82]. Sotalol can induce vasculitis [81]. Dofetilide is primarily excreted through the kidneys, while approximately 20- 30% is metabolized in the liver via the CYP3A4 enzyme pathway. Therefore, dose adjustments are necessary for RA patients with impaired kidney function [83]. There are no reports of Ibutilide on RA disease activity.