Adult Dosing
Ventricular arrhythmias
- Loading dose: 800-1,600 mg PO qd x 1-3 wks until response; for doses >1000 mg/day, divide bid/tid with meals
- Maintenance dose: 200-600 mg PO qd. Divide maintenance dose bid with meals if GI intolerance
Note:
- Restrict use to indicated life-threatening arrhythmias due to drug-associated toxicity
- Should be administered by physicians experienced in the treatment of life-threatening arrhythmias. Hospitalize and monitor while administering loading dose, at the time of dose changes/discontinuation/switching to alternate therapy due to variable amiodarone absorption and prolonged elimination
Supraventricular arrhythmias (Not FDA approved)
- Loading dose: 800-1,600 mg PO qd x 1-3 wks until response; for doses >1000 mg/day, divide bid/tid with meals
- Maintenance dose: 200-600 mg PO qd. Divide maintenance dose bid with meals if GI intolerance
Pediatric Dosing
- Safety and effectiveness in pediatric population have not been established
[Outline]
See Supplemental Patient Information
- Use only in indicated life-threatening arrhythmias due to substantial drug-associated toxicity [US Black Box Warning]
- Amiodarone has significant potential toxicities, including hepatotoxicity and pulmonary toxicity. Pulmonary toxicity manifesting as hypersensitivity pneumonitis or interstitial/alveolar pneumonitis has occurred in 10-17% of patients. Hepatotoxicity is common but usually mild with only elevated LFTs [US Black Box Warning]
- Risk of worsening of existing arrhythmias; avoid concurrent use of other antiarrhythmics
- Risk of hyperthyroidism/throtoxicosis/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
- Cases of optic neuropathy and/or optic neuritis, usually resulting in visual impairment, have been reported
- Amiodarone can cause fetal harm when administered to a pregnant woman. Congenital goiter/hypothyroidism and hyperthyroidism has occurred in infants of mothers treated with amiodarone
- In patients with implanted defibrillators or pacemakers, assess pacing and defibrillation thresholds prior to starting therapy
- 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
- Monitor effectiveness in long-term prevention of ventricular tachycardia and ventricular fibrillation using ambulatory monitoring, programmed electrical stimulation, or a combination of both
Cautions: Use cautiously in
- Hepatic impairment
- Hx of CHF
- Thyroid disorders
- Severe pulmonary disease
- Concurrent other antiarrhythmics
- Concurrent QT prolonging agents
- Hypokalemia
- Hypomagnesemia
- Surgery
- Concurrent beta-blockers
- Concurrent calcium channel blockers
- 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 week. If used during breastfeeding, periodic monitoring of infant cardiac and thyroid function status is recommended. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 30 September 2010). Manufacturer advises discontinuation of breastfeeding.
Pricing data from www.DrugStore.com in U.S.A.
- Pacerone 100 MG TABS [Bottle] (UPSHER-SMITH)
30 mg = $150.99
90 mg = $400 - Cordarone 200 MG TABS [Bottle] (WYETH)
60 mg = $269.98
100 mg = $429.95
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.
