Amiodarone

 

Other Names

  Cordarone


Classification

Antiarrhythmic


Action

  1. •Increases the action potential duration (repolarization inhibition)

  2. •Non competitively blocks beta-adrenergic receptors

  3. •No real inotropic effects

  4. •Prolonged therapy increases the refractory period in the atria, ventricles and AV node


Indications

  1. •Recurrent or refractory Ventricular Fibrillation (VF) and hemodynamically unstable Venticular Tachycardia (VT)

  2. •Acute control of Supraventricular Tachyarrhythmia (SVT/PSVT), including recent-onset atrial fibrillation


Contraindications

  1. •Hypersensitivity to the medicatioS

  2. •Severe SA node disease resulting in pre-existing bradycardia

  3. •Heart block

  4. •Bradycardia with associated syncope

  5. •Prolonged QT particularly if hypomagnesemic

  6. •Nausea/vomiting


Precautions

Patients already receiving beta and calcium channel blockers and anti-arrhythmic medication


Adverse Reactions

  1. •Hypotension, respiratory failure (heart failure can occur with rapid IV injection)

  2. •Pain, phlebitis at injection site – Use central line if concentration > 2 mg/ml

  3. •Bradycardia, heart block


Interactions/Compatibility/Stability

  1. •Compatible in NS or D5W at a concentration of 1 - 6 mg/ml

  2. •Stable for 2 hours in PVC bags but for infusions exceeding 2 hours must be mixed in glass bottles

  3. •PVC containing tubing may be used

  4. •Incompatible with heparin, sodium bicarbonate, aminophylline, and some antibiotics


Special Considerations

  1. •A central line should be used for infusions > 2 mg/ml and/or longer than 1 hour (due to phlebitis)

  2. •For supraventricular arrhythmias, mix 5 mg/kg in 20 - 100 ml D5W and administer in 5 - 30 minutes

  3. •Use infusion devices for all infusions


Dosages

Preparation: 150 mg/3 ml (50 mg/ml)

Adult:
Cardiac Arrest (Pulseless VT of VF): Initial bolus of 5 mg/kg to a maximum of 300 mg IV diluted in 20 - 30 ml of NS or D5W. Consider repeat doses of 150 mg IV every 3 - 5 minutes. If defibrillation is successful: 1 mg/min infusion for 6 hours, then reduce slowly to 0.5 mg/min for the next 18 hours, maximum daily dose is 2.2 g IV in 24 hours

Adjunct to cardioversion of stable VT or SVT/PSVT: Loading dose of 150 mg IV bolus over10 minutes at 15 mg/min. After conversion: early maintenance infusion of 360 mg over the next 6 hours at 1 mg/min, then slowly reducing to 0.5 mg/min over the next 18 hours, maximum daily dose is 2 gm IV in 24 hours

Pediatric: Not recommended for children in the intrahospital or prehospital environment


Kinetics

    No documentation found



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