Dangerous Drug: Amiodarone Hydrochloride(a mee o’ da rone)
Apo-Amiodarone (CAN), Cordarone, Gen-Amiodarone (CAN), Nexterone, Novo-Amiodarone (CAN), Pacerone, PMS-Amiodarone (CAN), ratio-Amiodarone (CAN)
PREGNANCY CATEGORY D
Drug Classes
Adrenergic blocker (not used as sympatholytic drug)
Antiarrhythmic
Therapeutic Actions
Type III antiarrhythmic: Acts directly on cardiac cell membrane; prolongs repolarization and refractory period; increases ventricular fibrillation threshold; acts on peripheral smooth muscle to decrease peripheral resistance.
Indications
Only for treatment of the following documented life-threatening recurrent ventricular arrhythmias that do not respond to documented adequate doses of other antiarrhythmics or when alternative agents are not tolerated: Recurrent ventricular fibrillation, recurrent hemodynamically unstable ventricular tachycardia. Serious and even fatal toxicity has been reported with this drug; use alternative agents first; very closely monitor patient receiving this drug
Unlabeled uses: Treatment of refractory sustained or paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia; postoperative conversion of atrial fibrillation, atrial flutter
Contraindications and Cautions
Contraindicated with hypersensitivity to amiodarone; sinus node dysfunction, heart block, cardiogenic shock, severe bradycardia; hypokalemia; lactation; sensitivity to iodine.
Use cautiously with thyroid dysfunction, pregnancy.
Available Forms
Tablets—100, 200, 400 mg; injection—1.5 mg/mL, 1.8 mg/mL, 50 mg/mL
Dosages
Careful patient assessment and evaluation with continual monitoring of cardiac response are necessary for titrating the dosage. Therapy should begin in the hospital with continual monitoring and emergency equipment on standby. The following is a guide to usual dosage.
Adults
Oral
Loading dose, 800–1,600 mg/day PO in divided doses for doses of 1,000 mg or more or with GI intolerance, for 1–3 wk; reduce dose to 600–800 mg/day in divided doses for 1 mo; if rhythm is stable, reduce dose to 400 mg/day in one to two divided doses for maintenance dose. Adjust to the lowest possible dose to limit side effects.
IV
1,000 mg IV over 24 hr—150 mg loading dose over 10 min (15 mg/min), followed by 360 mg over 6 hr at rate of 1 mg/min, then 540 mg at 0.5 mg/min over the next 18 hr. After the first 24 hr, a maintenance infusion of 0.5 mg/min (720 mg/24 hr) or less can be cautiously continued for 2–3 wk. Switch to oral form as soon as possible.
Converting from IV to PO
IV dose of 720 mg/day at 0.5 mg/min: Convert to PO dose based on duration of IV therapy. Less than 1 wk—initial oral dose 800–1,600 mg; 1–3 wk—initial oral dose 600–800 mg; more than 3 wk—initial oral dose 400 mg.
Pediatric patients
Safety and efficacy not established.
Pharmacokinetics
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