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 dextrose 5% or sodium chloride 0.9% (1.8 mg/ml)
  • Continuous infusions should be prepared in non-PVC bags to prevent adsorption of amiodarone to bag.
  • Use of a 0.2 or 0.22 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
  • Cardiac Arrest (filter not required for cardiac arrest bolus dose):
    First dose:
    Draw up amiodarone 300 mg (6 mL) into a 30 mL syringe, then draw up 24 mL of D5W.  Administer the 30 mL solution as quickly as possible.
    Second dose: If patient remains in pulseless ventricular tachycardia or ventricular fibrillation 5 minutes after the first dose, give a second dose of amiodarone 150 mg (3 mL). Draw up into a 30 mL syringe, then draw up 27 mL of D5W. Administer  the 30 mL solution as quickly as possible.
Adverse Effects:
  • Acute effects:
  • arrhythmias including radycardia and AV blocks
  • prolonged QT interval (with potential for 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)
    • Amiodarone should not be used in patients with polymorphic ventricular tachycardia as it is associated with a prolonged QT interval which is made worse by antiarrhythmic agents
    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
    • Heart rate
    • QT interval
    • Blood pressure and pulse
    • liver enzymes
    Adult Critical Care Protocol:
    • The first (300 mg) and second (150 mg) doses of amiodarone may be given for pulseless ventricular tachycardia or ventricular fibrillation by Medical Directive by a certified Adult Critical Care Nurse.
    • May be administered by IV infusion by an Adult Critical Care Nurse.
    • Continuous infusions must be administered by infusion device and the pump library must be enabled.


    Lynne Kelly, Pharmacist, CCTC
    Brenda Morgan, Clinical Nurse Specialist, CCTC
    Last Update: August 7, 2006, October 25, 2011, reviewed and updated August 28, 2018

    LHSCHealth Professionals

    Last Updated September 20, 2018 | © 2007, LHSC, London Ontario Canada