Amioderone

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Generic Name: AMIODARONE

Brand Name:

Class: Antiarrhythmic Agent Mechanism of Action:

Multiple effects on sodium, potassium and calcium channels. Prolongs action potential, refractory
period. Ventricular automaticity (potassium channel blockade). Slows membrane depolarization and impulse conduction (sodium channel blockade). Negative chronotropic activity in nodal tissue, rate reduction, and antisympathetic activity (calcium channel and
β$-blockade). Dilatescoronaryarteriesduetocalciumchannelanda"lpha- adrenergicblockingaction.

Indications for use:

Treatment of: defibrillation-refractory VF/pulseless VT, polymorphic VT, and wide complex tachycardia of uncertain origin. Control hemodynamically stable ventricular tachycardia when cardioversion unsuccessful. Adjunct to cardioversion of SVT and PSVT.

Rate control in atrial fibrillation or flutter. Contraindications:

Bradycardia Second or third degree heart block unless a functioning pacemaker is present Cardiogenic
shock Hypotension Pulmonary congestion

Adverse Reactions:

Cardiovascular: bradycardia, hypotension, asystole/cardiac arrest, atrio-ventricular block Torsades de Pointes (prolongs

QTc interval), congestive heart failure GI & Hepatic: nausea, vomiting, abnormal liver function tests Skin: slate-blue pigmentation

Other: fever, headache, dizziness, flushing, abnormal salivation, photophobia

NOTES ON ADMINISTRATION

Incompatibilities/Drug Interactions:

Beta blockers, calcium channel blockers, and other antiarrhythmics are additive and can be proarrhythmic when given in combination with Amiodarone due to similar mechanisms of action. Amiodarone precipitates at certain concentrations when mixed at a Y-site with sodium bicarbonate, furosemide, and heparin.

Adult Dosage:

VF/Pulseless VT

300 mg IV push over 30 – 60 seconds, may repeat in 3-5 minutes with 150 mg IV push

Wide-Complex Tachycardias, Atrial Flutter, Atrial Fibrillation, SVT with cardioversion 150 mg IV over 10 minutes (mix in 50 mL bag of D5W) may repeat every 10 minutes

Maintenance Infusion Post Resuscitation/Conversion

After successful defibrillation, follow with up to 1mg/min IV infusion for 6 hours, then up to 0.5 mg/min IV infusion for up to 18 hours, maximum daily dose is 2.2 grams Mix 450 mg in 250 mL of D5W (special polyolefin bag), concentration 1.8 mg/mL, and run at 33.3 mL/hr for 1 mg/min or 16.7

mL/hr for 0.5 mg/min

For Other Maintenance infusion

Rates range from 0.5 mg/min to 1mg/min. Maximum daily dose is 2.2 grams Pediatric Dosage:

VF/Pulseless VT

5 mg/kg IV push (max 300 mg single dose), may repeat every 5 minutes two times to a total maximum of 15 mg/kg/day

Probable VT with pulse

5 mg/kg IV administered over 20 minutes may repeat two more times to a total of 15 mg/kg/day

Route of Administration:

IV/IO bolus, IV/IO infusion

Onset of Action:

Variable

Peak effects:

Variable

Duration of Action:

Half-life may exceed 40 days.

Dosage Forms/Packaging:

150 mg/3mL, 450 mg/9 mL, 900 mg/18 mL vials/ampules/syringes

Arizona Drug Box Standard Supply:

300 mg

Special Notes:

Amiodarone is mixed in a soap-like vehicle in glass or special plastic and is subject to excessive foaming. Draw from ampule with at least an 18 ga. needle. Mix with 20 – 30 mL of D5W prior to administration.

Use with caution if hepatic failure is present or if administered in combination with other drugs.

Patient must be on a cardiac monitor–monitor heart rate and rhythm.

Must be administered on an IV infusion pump during interfacility transports.

Temperature control is required to carry this drug. Temperature may not exceed 77 degrees F. where the drug is stored.

Special polyolefin bag is required for maintenance infusion. Regular bags will absorb Amiodarone.

Amiodarone may not be given via ET Tube. Amiodarone is an optional drug. 

© Matt Dillard 2012