Amiodarone
Cardiac Therapy · Anti-arrhythmic
Indications
Treatment and prevention of arrhythmias refractory to other anti-arrhythmic agents & life threatening disturbances of cardiac rhythm (both ventricular & supra-ventricular), recurrent ventricular fibrillation & arrhythmias associated with Wolff-Parkinson-White syndrome.
Dosage
Adults: Pulseless ventricular fibrillation or ventricular tachycardia: IV push IO Initial 300 mg rapid bolus, if pulseless VT or VF continues after subsequent defibrillation attempt or recurs, give supplemental dose of 150 mg. Prevention of recurrent life-threatening ventricular arrhythmias: Oral. 800-1600 mg/day in 2-3 divided doses for 1-3 wk, then when adequate control achieved, reduce to 600-800 mg/day in 1-2 divided doses for 1 mth; maintenance 400 mg/day. Lower doses recommended for supraventricular arrhythmias. Children: Under 3 yr, not recommended. Supraventricular and ventricular arrhythmias: 3-12 yr, Oral initially 5-10 mg/kg (max 200 mg) twice daily for 7-10 days, then reduced to maintenance dose of 5-10 mg/kg once daily (max 200 mg daily); 12-18 yr, 200 mg 3 times daily for 1 wk then 200 mg twice daily for 1 wk then usually 200mg daily adjusted according to response. IV…
Administration
IV inf over a period of 20 min to 2 hour. Diluted in 250 mL in 5% DW; may be followed by repeated infusions up to 1200 mg i.e. (approximately 15 mg/kg body wt) in up to 500 mL 5% DW per 24 hour, the rate of infusion based on clinical judgement. May be given by slow IV inj of 150-300 mg in 10-20 mL of 5% DW over 1-2 min. Compatibility: Stable in D5W, KCl. Y-site administration: Drug to Drug IV Compatibility: Amikacin, bumetanide, calcium gluconate, ceftriaxone, ciprofloxacin, diltiazem, dobutamine, dopamine, epinephrine, esmolol, famotidine, fentanyl, fluconazole, gentamicin, insulin regular, labetalol, linezolid, lorazepam, methylprednisolone, midazolam, milrinone, morphine, nitroglycerin, norepinephrine, phenylephrine, tobramycin, vancomycin, vasopressin, vecuronium. Drug to Drug IV Incompatibility: Aminophylline, cefamandole, digoxin, heparin, imipenem, levofloxacin,…
Adverse Effects
Severe bradycardia, headaches, fatigue, nightmares, hallucinations & depression (dose-related), nausea, vomiting, abdominal pain & constipation, corneal deposits, skin changes, ataxia, tremors, pulmonary changes, arthropathies, marked body weight loss. Hypothyroidism, hyperthyroidism, corneal microdeposits, raised serum transaminases, acute liver disorders, extrapyramidal tremor, sleep disorders, photosensitivity, optic neuropathy and neuritis, Stevens Johnson syndrome or toxic epidermal necrolysis.
Risk Factor (Pregnancy/Lactation)
Pregnancy: Positive evidence of risk: Use only when no safer alternative exists for a serious problem. Lactation: Contraindicated or not recommended. Contraindications: Severe arterial hypotension, cardiovascular collapse & shock, all kinds of conduction delays, bradycardia, thyroid disorders, iodine allergy, pulmonary fibrosis, severe liver parenthetic damage, women of child bearing age. Precautions: Prolonged sun or UV exposure is to be avoided during therapy & several months after discontinuation. Reactivity may impair, care is advised for motor driving. Pregnancy should be avoided for the first year after therapy. Monitor thyroid, pulmonary, eye and liver function. Perform ECG and serum potassium measurement before initiating therapy, monitor ECG during therapy. Pacemakers; verify functioning before and regularly during therapy. Perform eye exam promptly if visual disorders occur.…
Interactions
MAO inhibitors, oral anticoagulants, phenytoin, digoxin, trimoxazole, lithium, flecainide, drugs which prolong QT interval, antiarrhythmics, co-trimoxazole, erythromycin, pentamidine, antipsychotics, TCADs, antihistamines, antimalarials, moxifloxacin, other quinolones, B-blockers, calcium channel blockers, diuretics, amphotericin, corticosteroids, tetracosactide, anaesthesia, cyclosporin, stimulant laxatives, statins, lidocaine, tacrolimus, sildenafil, fentanyl, midazolam, ergotamine, colchicine, sofosbuvir + ledipasvir, sofosbuvir + daclatasvir, sofosbuvir + simeprevir, grapefruit juice.
Advice to Patient
Take with or without meals. Recommended daily allowance for Iodine in adults is 150 mcg. If you have GI discomfort, take with meals. Contact prescriber if there is dry cough; shortness of breath; chest pain; palpitations; irregular or slow heartbeat; unusual bruising or bleeding; blood in urine, dark stool, vomitus; warmth, swelling, pain in calves; muscle tremor, weakness, numbness; skin rash; irritation or changes in urinary pattern. Regular blood tests, eye examinations and cardiac tests are required during therapy. Avoid corneal refractive laser surgery during therapy. Avoid grapefruit juice. Be cautious when rising from sitting or lying position. Use sunscreen, wear proper clothes and avoid direct sunlight to prevent photosensitivity.
Pharmacokinetics
Onset of action: Oral: 2 days-3 wks. IV (electrophysiologic effects): Within hrs. Antiarrhythmic effects: 2-3 days to 1-3 wks. Peak effect: 1 wk-5 mths. Duration after discontinuing therapy: Variable, 2 wks- months: Children: Less than a few wks. Adults: Several months. Absorption: Oral: Slow and variable. Metabolism: Hepatic. Bioavailability: Oral: Approx. 50%. Half-life elimination: Note: Half-life is shortened in children vs adults. Single dose: 58 days. Oral chronic therapy: Mean range: 40-55 days. IV single dose: Mean range: 9-36 days. Time to peak, serum: Oral: 3-7 hrs. Excretion: Faeces, urine.
Brands with this active ingredient
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