AMIODARONE (Cordarone)

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)

• 450 mg/250 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  into 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 (in non PVC bag) over 24 hours
• Cardiac Arrest: 
  First dose: Give 300 mg (6 mL) IV direct UNDILUTED. A filter is not required for IV direct administration.
  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). 

• Adverse events:
  • arrhythmias including bradycardia 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

• 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.