||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
- 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)
- 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.
|| 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
- 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
- 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
- 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.