Select a medication above to begin.
amiodarone
generic
Black Box Warnings .
Appropriate Use
restrict use to indicated life-threatening arrhythmias due to drug-assoc. toxicity; initiate tx in a clinical setting with available continuous ECG and cardiac resuscitation
Pulmonary Toxicity
hypersensitivity pneumonitis or interstitial/alveolar pneumonitis in 10-17% of pts; abnormal diffusion capacity w/o sx more common; fatal in 10% of pts; obtain baseline chest x-ray and PFTs, incl. diffusion capacity; repeat hx, physical exam, and chest x-ray q3-6mo
Hepatotoxicity
common but usually mild w/ only elev. LFTs; overt hepatic failure can occur w/ few fatal cases; obtain baseline and periodic LFTs; D/C or decr. dose if LFTs >3x normal or is 2x elev. baseline; D/C if liver injury s/sx
Proarrhythmic Effects
arrhythmias worsened, significant heart block, or sinus bradycardia in 2-5% of pts; effects prolonged vs. other antiarrhythmics
Adult Dosing .
Dosage forms: TAB: 100 mg, 200 mg, 400 mg; INJ: various
ventricular arrhythmias, malignant
- [IV route]
- Dose: 150 mg IV x1 over 10min, then 1 mg/min IV x6h, then 0.5 mg/min IV x18h
- [PO route]
- Dose: 400 mg PO qd; Start: load 800-1600 mg PO qd x1-3wk until response, then 400-600 mg PO qd x4wk; Info: divide loading doses >1000 mg/day bid-tid w/ meals; divide maint. doses bid w/ meals if GI intolerance
ACLS, VF/pulseless VT
- [300 mg IV/IO x1]
- Info: may give 150 mg IV/IO x1 prn if VF/pulseless VT persists or recurs; see ACLS: VF/Pulseless VT table
ACLS, wide complex tachycardia
- [150 mg IV x1 over 10min, then 1 mg/min IV x6h, then 0.5 mg/min IV x18h]
- Max: 2.2 g/24h; Info: may repeat 150 mg IV q10min prn; see ACLS: Tachycardia table
atrial fibrillation/flutter (off-label)
- [cardioversion]
- Dose: 300 mg IV over 1-2h, then 10-50 mg/h IV x24h; Alt: 5-7 mg/kg/dose IV over 1-2h, then 10-50 mg/h IV x24h; Max: 1200-3000 mg total dose/24h
- [immediate rate control]
- Dose: 150-300 mg IV over 1h, then 10-50 mg/h IV x24h
- [maintenance rate control]
- Dose: 100-200 mg PO qd; Info: give w/ meals if GI intolerance
- [maintenance rhythm control]
- Dose: 200 mg PO qd; Start: 400-800 mg/day PO divided bid-qid x1-4wk; Info: give w/ meals if GI intolerance
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [see below]
- hepatic impairment: consider decr. usual dose
Peds Dosing .
- Dosage forms: TAB: 100 mg, 200 mg, 400 mg; INJ: various
supraventricular arrhythmia (off-label)
- [5-10 mg/kg/dose PO qd]
- Start: load 10-20 mg/kg/dose PO qd x7-10 days; Alt: load 5 mg/kg/dose IV over 5-60min then 5-15 mcg/kg/min IV; Info: use lowest effective dose
PALS, VF/pulseless VT (off-label)
- [5 mg/kg/dose IV/IO x1]
- Max: 300 mg/dose; Info: may repeat 5 mg/kg/dose IV/IO x2 prn up to 15 mg/kg/total dose if VF/pulseless VT persists or recurs; see PALS: VF/Pulseless VT table
PALS, SVT (off-label)
- [5 mg/kg/dose IV/IO x1]
- Max: 300 mg/dose; Info: may repeat 5 mg/kg/dose IV/IO x2 prn up to 15 mg/kg/total dose; see PALS: Tachycardia table
PALS, VT (off-label)
- [5 mg/kg/dose IV/IO x1]
- Max: 300 mg/dose; Info: may repeat 5 mg/kg/dose IV/IO x2 prn up to 15 mg/kg/total dose; see PALS: Tachycardia table
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [not defined]
- hepatic impairment: consider adult hepatic dosing for guidance