Amiodarone: Difference between revisions
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==General== | ==General== | ||
*Type: [[Antiarrhythmics]] | *Type: [[Antiarrhythmics]] | ||
*Dosage Forms: | *Dosage Forms: injectable solution, tablet | ||
*Common Trade Names: Cordarone | *Routes of Administration: IV, PO | ||
*Common Trade Names: Cordarone, Pacerone, Nexterone | |||
==Adult Dosing== | ==Adult Dosing== | ||
===[[V-fib]]/[[pulseless V-tach]]=== | |||
*Loading dose = 300mg IV bolus followed by 150mg bolus PRN | |||
* | ===Stable [[wide complex tachycardia]] (e.g. V-tach) or [[SVT]]=== | ||
** | *150 mg in 100mL D5W over 10min (15 mg/min), followed by 1 mg/min drip over 6hrs (360 mg total)<ref>Amiodarone. GlobalRPH. http://www.globalrph.com/amiodarone_dilution.htm.</ref> | ||
**Then 0.5 mg/min drip over next 18 hrs (540 mg total) | |||
**Oral dosage after IV infusion is 400 -800 mg PO daily | |||
==Pediatric Dosing== | ==Pediatric Dosing== | ||
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==See Also== | ==See Also== | ||
*[[Critical care quick reference]] | *[[Critical care quick reference]] | ||
*[[Amiodarone pulmonary toxicity]] | |||
==References== | ==References== | ||
<references/> | <references/> | ||
[[Category:Pharmacology]] | [[Category:Pharmacology]] [[Category:Cardiology]] | ||
Latest revision as of 16:54, 19 September 2019
General
- Type: Antiarrhythmics
- Dosage Forms: injectable solution, tablet
- Routes of Administration: IV, PO
- Common Trade Names: Cordarone, Pacerone, Nexterone
Adult Dosing
V-fib/pulseless V-tach
- Loading dose = 300mg IV bolus followed by 150mg bolus PRN
Stable wide complex tachycardia (e.g. V-tach) or SVT
- 150 mg in 100mL D5W over 10min (15 mg/min), followed by 1 mg/min drip over 6hrs (360 mg total)[1]
- Then 0.5 mg/min drip over next 18 hrs (540 mg total)
- Oral dosage after IV infusion is 400 -800 mg PO daily
Pediatric Dosing
Special Populations
- Pregnancy Rating: D
- Lactation Risk Categories: Unsafe
- Renal Dosing- no adjustment
- Adult
- Pediatric
- Hepatic Dosing- caution and consider dose decrease
- Adult
- Pediatric
Indications
- Ventricular and supraventricular arrhythmias
- 1st line for pulseless V-tach/V-fib
- Used for atrial arrhythmias in patients with decreased EF
Contraindications
- Allergy to class/drug
- Iodine or shellfish allergy
- Pregnancy
Adverse Reactions
Amiodarone Adverse Effects
- Bradycardia
- Hypotension with older solvent-based formulation. Uncommon with newer aqueous formulation.
- Prolonged QT
- Thyrotoxicosis[2]
- Between 5-20% of patients treated with amiodarone have thyrotoxicosis (higher in areas of iodine deficiency)
- Iodine-induced hyperthyroidism
- It is thought that the iodine load may unmask hyperthyroidism in patients with multinodular goiter and subclinical Graves’ disease
- Drug-induced destructive thyroiditis
- More commonly, the cytotoxic effects of amiodarone destroy thyroid cells, resulting in a release of preformed hormone.
- Amiodarone pulmonary toxicity
- Hyperpigmentation rash
Pharmacology
- Half-life: 58 days
- Metabolism: Liver extensively
- Excretion: Bile primarily
Mechanism of Action
- Class III - Inhibits potassium channels
- Impairs SA and AV node conduction
- Decreases automaticity
- Prolongs refractory period in accessory pathways
- Also has class I & II properties
See Also
References
- ↑ Amiodarone. GlobalRPH. http://www.globalrph.com/amiodarone_dilution.htm.
- ↑ Rosen's 8th Edition