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Amiodarone

Medical and Pharmacy Editor:

Brand Name: Pacerone, Cordarone, Nexterone

Generic Name: amiodarone

Drug Class: Antidysrhythmics, III

What Is Amiodarone and How Does It Work?

Amiodarone is used to treat certain types of serious (possibly fatal) irregular heartbeat (such as persistent ventricular fibrillation/tachycardia). It is used to restore normal heart rhythm and maintain a regular, steady heartbeat.

Amiodarone is known as an anti-arrhythmic drug. It works by blocking certain electrical signals in the heart that can cause an irregular heartbeat.

Amiodarone is available under the following different brand names: Pacerone, Cordarone, and Nexterone.

Dosages of Amiodarone:

Dosage Forms and Strengths

Injectable solution

  • 50 mg/mL
  • 150 mg/100mL (Nexterone)
  • 360 mg/200mL (Nexterone)

Conventional IV preparation contains polysorbate 80 and benzyl alcohol

Newer IV formulation (Nexterone) does not contain polysorbate 80 or benzyl alcohol

Tablet

  • 100 mg
  • 200 mg
  • 400 mg

Dosage Considerations – Should be Given as Follows:

Stable Monomorphic or Polymorphic Ventricular Tachycardia (VT) (Off-label)

  • 150 mg intravenous (IV) bolus in 10 minutes; may repeat every 10 minutes as necessary, THEN
  • 1 mg/min IV for 6 hours, THEN
  • 0.5 mg/min IV for 18 hours; not to exceed 2.2 g/24 hours
  • For breakthrough episodes of ventricular fibrillation (VF, or V-Fib) or hemodynamically unstable VT, repeat the initial Load
  • Dosing considerations
    • Initiate in hospital with experienced personnel

ACLS, Pulseless Ventricular Fibrillation/Ventricular Tachycardia (Off-label)

  • 300 mg intravenous (IV) or intraosseous push after dose epinephrine if no initial response to defibrillation
  • May follow initial dose with 150 mg IV every 3-5 minutes
  • Dosing considerations
    • Rapid IV push if pulseless/no blood pressure (BP)

Ventricular Arrhythmias

Oral

  • Load: 800-1600 mg orally once/day for 1-3 weeks until response; once adequate arrhythmia control achieved, reduce dose to 600-800 mg/day for 1 month; THEN reduce to maintenance dose
  • Maintenance dose: 400 mg orally once/day

Intravenous (IV)

  • 150 mg over first 10 min (15mg/min), followed by 360 mg over next 6 hours (1 mg/min), THEN 540 mg over remaining 18 hours (0.5 mg/min), for a total of 1000 mg over 24 hours before administering maintenance infusion
  • Maintenance: 0.5 mg/min for a total 720 mg/24hr at a concentration of 1-6 mg/mL (360 mg/200mL), or 1.8 mg/mL Nexterone at rate of 278 mL/min
  • Duration of therapy: May continue to administer 0.5 mg/min for 2-3 weeks regardless of patient's age, renal function or ventricular function

Conversion to oral amiodarone after intravenous (IV) administration

  • Less than 1 week IV infusion: 800-1600 mg/day
  • 1-3 week IV infusion: 600-800 mg/day
  • Greater than 3 week IV infusion: 400 mg/day

Pediatric

Drug Resistant Refractory Cardiac Arrhythmias (Off-label)

Oral

  • Age less than 1 year: 600-800 mg/1.73 mē every 24 hours or divided every 12 hours; continue therapy for 4-14 days and/or until adequate control achieved; if initial treatment effective, decrease dosage to 200-400 mg/1.73 mē every 24 hours or divided every 12 hours
  • Age over 1 year: Until adequate control, 10-15 mg/kg/day orally once/day or divided every 12 hours; if effective, reduce to 5 mg/kg/day orally once/day or divided every 12 hours

Intravenous (IV)

  • Loading dose (limited data): 5 mg/kg IV over 30-60 min
  • Maintenance dose: 0.005 mg/kg/min IV infusion; may increase to 20 mcg/kg/min per 24 hours; consider converting to oral therapy within 24-48 hours

Pulseless Ventricular Tachycardia or Ventricular Fibrillation (PALS dosing) (Off-label)

  • 5 mg/kg intravenous/intraosseus (IV/IO) rapid bolus; not to exceed 300 mg/dose; may repeat twice to maximum 15 mg/kg during acute treatment

Supraventricular Tachycardia (Off-label)

  • Infants/children/adolescents: 5 mg/kg intravenous (IV) over 1 hour initially; follow with 5 mg/kg/day for 47 hours
  • Maintenance: 10-20 mg/kg/day for 7-10 days; follow with 3-20 mg/kg/day

Dosing Considerations, Pediatric

  • In a pediatric trial of 61 patients, aged 30 days to 15 years, hypotension (36%), bradycardia (20%), and atrioventricular block (15%) were common dose-related adverse events and were severe or life-threatening in some cases
  • Injection site reactions were seen in 5 (25%) of the 20 patients receiving amiodarone HCI injection through a peripheral vein, irrespective of dose regimen
  • Conventional IV amiodarone contains the preservative benzyl alcohol; there have been reports of fatal “gasping syndrome” in neonates (children aged less than 1 month) following the administration of IV solutions containing the preservative benzyl alcohol
  • Nexterone does not contain benzyl alcohol

Dosing Considerations, Geriatric

  • Recommended to start dosing at the lower end of the dosing range because elderly may be predisposed to toxicity

Dosing Considerations

Susceptible organisms

Medically Reviewed by a Doctor on 4/18/2017



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