Adult Dosing
Life-threatening arrhythmias
First 24 hrs
- Loading Dose: 150 mg (15 mg/min) IV over 10 mins followed by 360 mg IV (1 mg/min) over 6 hrs
- Maintenance dose: 540 mg (0.5 mg/min) over remaining 18 hrs
After first 24 hrs
- Maintenance: 720 mg/24 hrs (0.5 mg/min) IV
Cardiac arrest secondary to pulseless VT/VF (ACLS guidelines)
- 300 mg IV/IO x 1; an additional dose of 150 mg IV/IO may be considered
VF/ Hemodynamically unstable VT
- Supplemental infusions of 150 mg (15 mg/min) IV over 10 minutes are recommended. Max: 2100 mg/24 hours; 30 mg/min
- Note: Based on experience from clinical trials of IV amiodarone hydrochloride, a maintenance infusion of up to 0.5 mg/minute can be administered for 2-3 weeks
IV to oral transition
- If duration of IV infusion < 1 wk: 800-1600 mg/day PO
- If duration of IV infusion 1 to 3 wk: 600-800 mg/day PO
- If duration of IV infusion >3 wks: 400 mg/day PO
Note:
- IV loading infusions at higher concentrations and faster rates of infusions than recommended have resulted in hepatocellular necrosis and acute renal failure
- Conc. > 3 mg/mL have caused peripheral vein phlebitis. For infusions longer than 1 hr, do not exceed conc. > 2 mg/mL, unless a central venous catheter used
Pediatric Dosing
Ventricular arrhythmias [Not FDA approved]
- 5 mg/kg IV over 20-60 mins; additional doses in 5 mg/kg increments up to a total dose of 15 mg/kg/24 hrs may be required if arrhythmia control not achieved
- MAX: 300 mg/dose; 15 mg/kg/24 hrs
Supraventricular Arrhythmias [Not FDA approved]
- 5 mg/kg IV over 20-60 mins; additional doses in 5 mg/kg increments up to a total dose of 15 mg/kg/24 hrs may be required if arrhythmia control not achieved
- MAX: 300 mg/dose; 15 mg/kg/24 hrs
Pulseless VT/VF [PALS guidelines]
- 5 mg/kg IV/IO push x 1; may repeat 5 mg/kg IV/IO push after 3-5 mins [Up to 15 mg/kg IV total, Max: 300 mg/dose]
[Outline]
See Supplemental Patient Information
- Amiodarone should be administered only by physicians experienced in the treatment of life-threatening arrhythmias having knowledge about risks and benefits of therapy and have access for monitoring the effectiveness/adverse events of treatment
- Hypotension is the most common adverse event of IV amiodarone therapy which may be treated by slowing the infusion or with vasopressors/positive inotropic agents, and volume expansion. Monitor the initial rate of infusion closely and do not exceed the recommended rate
- Risk of bradycardia and A-V block. Bradycardia may be treated by slowing infusion rate or discontinuing therapy; insertion of temporary pacemaker may be required
- Elevation of hepatic enzymes may occur. Acute centrolobular hepatocellular necrosis leading to hepatic coma, acute renal failure and death has occurred in patients on IV amiodarone at a much higher loading dose concentration and faster infusion rate. Monitor the initial rate of infusion closely and do not exceed the recommended rate
- Risk of worsening of existing arrhythmias or precipitation of new arrhythmias. QTc prolongation leading to torsade de pointes may occur, avoid use with other antiarrhythmics that prolong the QTc. Reserve combination of amiodarone with other antiarrhythmics that prolong the QTc to patients with life-threatening ventricular arrhythmias who are incompletely responsive to a single agent
- There have been post-marketing reports of acute-onset pulmonary toxicity manifesting as pulmonary fibrosis or ARDS
- Risk of hyperthyroidism/thyrotoxicosis/thyroid nodules/thyroid cancer; monitor thyroid function at baseline and periodically thereafter. Due to the slow elimination of amiodarone and its metabolites, high plasma iodide levels, altered thyroid function, and abnormal thyroid-function tests may persist for several weeks or even months following withdrawal
- Congenital goiter/hypothyroidism and hyperthyroidism has occurred in infants of mothers treated with IV amiodarone
- Limited experience with IV therapy >3 wks
- Closely monitor patients undergoing general anesthesia as they may be more sensitive to the myocardial depressant and conduction defects of halogenated inhalational anesthetics
- Monitor LFTs, BP, ECG, electrolytes at baseline and periodically thereafter
- Perform chest x-ray, PFTs including diffusion capacity at baseline, then q3-6 months
- Perform fundoscopy and slit-lamp evaluation at baseline and periodically thereafter
Cautions: Use cautiously in
- Hepatic impairment
- History of CHF
- Thyroid disorders
- Severe pulmonary disease
- Concurrent other antiarrhythmics
- Concurrent QT prolonging agents
- Implantable cardiac device
- Hypokalemia
- Hypomagnesemia
- Surgery
- Elderly patients
Supplemental Patient Information
- Avoid grapefruit juice while on therapy with amiodarone
Pregnancy Category:D
Breastfeeding: Possibly unsafe, amiodarone and its active metabolites, desethylamiodarone (DEA), are excreted in human milk. Even when the drug is discontinued at birth, amiodarone is excreted in breast milk for days to weeks. If used during breastfeeding, periodic monitoring of infant cardiac and thyroid function status is recommended. This information is (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 30 September 2010). Manufacturer advises discontinuation of breastfeeding.
