Name: AMIODARONE (CordaroneR)
Classification: antiarrhythmic: Class III
prolongs refractory period in atria and ventricles thus effective for arrhythmias of various origins
  • decreases SA automaticity and conduction through AV node
Dose:
  • Multiple dosing regimes in literature; RECOMMEND:
  • Bolus Dose:
    • 150-300 mg IV (maximum infusion rate 30 mg/min)
  • Continuous Infusion:
    • 900-1200 mg over 24 hours (37.5-50 mg per hour)
  • Breakthrough arrhythmias:
    • 150 mg IV (maximum infusion rate 30 mg/min)
Administration:
  • 900 mg/500 ml D5W or NS
  • Continuous infusions should be prepared with EXCEL bags (non-PVC) to prevent adsorption of amiodarone to bag.
  • Use of a 0.2 micron filter is recommended for intermittent and continuous infusions.
  • Bolus doses:  in 100 ml D5W over 10 min (maximum infusion rate 30 mg/min)
  • Continuous infusion:  in 500 ml D5W EXCEL bag over 24 hours
Adverse Effects:
  • Acute effects:
  • bradycardia, AV block, arrhythmias including Torsades des pointes
  • hepatitis, elevation of liver function tests
  • peripheral myopathy or tremors, headache, sleep disturbances
  • nausea, anorexia, constipation
  • Long term effects:
    • corneal microdeposits, photophobia, visual blurring, halovision
    • interstitial pneumonitis
    • blue-grey skin discoloration
    • hypo or hyperthyroidism
    Contraindications:
    • in complete heart block or type II second degree heart block unless functional pacemaker in place (can suppress a ventricular escape rhythm)
    Drug Interactions:
    • amiodarone + digoxin = increased digoxin levels
    • amiodarone + warfarin = increased warfarin effect
    • amiodarone + beta blockers = increased effects of both drugs
    • amiodarone + calcium channel blockers = increased effects of both drugs
    • amiodarone + procainamide = increased procainamide effect
    Monitoring Therapy:
    • ECG, rhythm, QT interval
    • cardiac index
    • breath sounds, chest xray
    • liver enzymes
    CCTC Protocol:
    • May be administered as 300 mg in 30 ml D5W IV direct without a physician's order by a certified nurse in CCTC for pulseless ventricular tachycardia or ventricular fibrillation.
    • May be administered by IV infusion by an approved RN in CCTC.
    • Must be administered as a continuous infusion by an infusion pump.


    Lynne Kelly, Pharmacist, CCTC
    Brenda Morgan, Clinical Nurse Specialist, CCTC
    Last Update: August 7, 2006, October 25, 2011

    LHSCHealth Professionals

    Last Updated October 26, 2011 | © 2007, LHSC, London Ontario Canada