NAME OF DRUG
amiodarone

CLASSIFICATION

Antiarrhythmic agent

ALTERNATE NAMES

CORDARONE

INDICATIONS

• treatment of life-threatening ventricular tachycardia and supraventricular arrhythmias where conventional antiarrhythmic agents are ineffective
• first-line therapy for ventricular fibrillation/pulseless ventricular tachycardia as per 2000 ACLS guidelines

RECONSTITUTION AND STABILITY

• stable at room temperature

COMPATIBILITY

• compatible with D5W
• compatible with NS at concentrations of 1.8-4 mg/mL ONLY

• compatible via Y-site with amikacin, clindamycin, dobutamine, dopamine, erythromycin, gentamicin, insulin regular, isoproterenol, labetalol, lidocaine, metronidazole, midazolam, morphine, nitroglycerin, norepinephrine, penicillin G, potassium chloride, procainamide, tobramycin, vancomycin, vasopressin, verapamil

• do not mix with other drugs
• amiodarone is physically and chemically stable in a polyvinyl chloride (PVC) container for up to 2 hours
• for infusions lasting greater than 2 hours, must dilute in a glass intravenous container; may use PVC tubing for administration
• for non-arrest use, PVC tubing with 0.2 or 0.22 micron in-line filter should be used for administration of infusions

ROUTES OF ADMINISTRATION

• IV direct 
  • for treatment of ventricular fibrillation or pulseless ventricular tachycardia as per 2000 ACLS guidelines 
  • 300mg rapid IV bolus followed by bolus of 20mL D5W or NS 
• IV intermittent (< 2 hours)
  • Initial Loading Dose: 150 mg in 100 mL D5W administered over 10 minutes (may dilute in minibag); maximum rate 30 mg/minute 
  • larger loading doses (up to 5mg/kg) should be diluted in 250mL D5W and administered over 20 minutes to 2 hours 
  • may dilute to a concentration of 1-6 mg/mL in D5W (1.8-4 mg/mL in NS); concentrations greater than 2 mg/mL should be administered via a central line 
• IV infusion (> 2 hours)
  • dilute 450 mg or 600 mg in 250 mL D5W or NS (1.8 or 2.4mg/mL, respectively); dilute in glass container 
  • may dilute to a concentration of 1-6 mg/mL; concentrations greater than 2 mg/mL should be administered via a central line

VH & HSC ADMINISTRATION POLICY

Restricted to Critical Care Areas  and SICU for non-arrest use.

Continuous ECG monitoring required

B - Direct IV route restricted to nurses from critical care areas and SICU. In all other cases, the direct IV route must be administered by a physician.

H - The IV infusion administration rate must be controlled by an automated infusion control device.

Ventricular fibrillation or pulseless ventricular tachycardia:  300mg IV bolus.

Ventricular tachycardia and supraventricular arrythmias:

*For breakthrough arrythmias, may give supplemental boluses of 150mg IV over 10 minutes to a maximum of 2200mg/day.  The maintenance infusion may be increased to achieve effective arrhythmia suppression (10-20mg/kg/day).
Oral maintenance therapy should be initiated as soon as possible.

Alternatively, for supraventricular arrythmias:

• 5 mg/kg IV over 20 minutes to 2 hours.
• Maintenance dose: 10-20 mg/kg/day IV infusion (average 600-800 mg/24 hours)
• Breakthrough arrythmias: boluses of 150mg IV over 10 minutes.

POTENTIAL HAZARDS OF PARENTERAL ADMINISTRATION

• hypotension, cardiovascular collapse, and congestive heart failure from too rapid administration
• hot flushes, sweating or nausea can occur from too rapid administration
• pain and phlebitis at injection site - concentrations greater than 2 mg/mL should be administered via a central line

IMPORTANT IMPLICATIONS

• may cause worsening of atrioventricular conduction in patients with pre-existing conduction defects
• may cause moderate and transient lowering of blood pressure
• use caution in presence of hypotension, cardiomyopathy and severe heart failure
• may cause prolongation of the QTc interval
• early and usually moderate rise in serum transaminases may occur; rarely accompanied by frank cholestasis with jaundice
• serum digoxin levels may double after the start of amiodarone
• amiodarone potentiates the pharmacological effects of warfarin, phenytoin, procainamide, lidocaine and cyclosporine
• may potentiate sinus bradycardia if used in conjunction with beta blockers or calcium channel blockers

Rev. April 2005