Amiodarone: Difference between revisions
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== | ==General== | ||
* | *Type: [[Antiarrhythmics]] | ||
* | *Dosage Forms: injectable solution, tablet | ||
* | *Routes of Administration: IV, PO | ||
*Common Trade Names: Cordarone, Pacerone, Nexterone | |||
* | |||
== Contraindications == | ==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== | |||
==Special Populations== | |||
*[[Drug Ratings in Pregnancy|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 | *Iodine or shellfish allergy | ||
*Pregnancy | *Pregnancy | ||
== | ==Adverse Reactions== | ||
* | {{Amiodarone adverse effects}} | ||
* | |||
* | ==Pharmacology== | ||
*Half-life: 58 days | |||
*Metabolism: Liver extensively | |||
*Excretion: Bile primarily | |||
== Mechanism of Action == | ===Mechanism of Action=== | ||
*Class III - Inhibits potassium channels | *Class III - Inhibits potassium channels | ||
**Impairs SA and AV node conduction | **Impairs SA and AV node conduction | ||
| Line 21: | Line 50: | ||
**Prolongs refractory period in accessory pathways | **Prolongs refractory period in accessory pathways | ||
*Also has class I & II properties | *Also has class I & II properties | ||
==See Also== | ==See Also== | ||
*[[Critical care quick reference]] | *[[Critical care quick reference]] | ||
*[[Amiodarone pulmonary toxicity]] | |||
==References== | |||
<references/> | |||
[[Category: | [[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