Critical Care Trauma Centre

AMIODARONE (Cordarone)

 

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