Amiodarone

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VENTRICULAR ARRHYTHMIAS

VF or hemodynamically unstable VT:

  • Oral: 800 to 1600 mg daily in 1 to 2 doses x 1-3 weeks,
  • then 600 to 800 mg daily in 1 to 2 doses x 1 month;
  • then maintenance: 400 mg daily

Pulseless VT or VF :

  • IV push, I.O.: Initial: 300 mg rapid bolus; if pulseless VT or VF continues after subsequent defibrillation attempt or recurs, administer supplemental dose of 150 mg.
  • ROSC –> 1 mg/minute x 6 hours, then 0.5 mg/minute for 18 hours .

Stable VT:

  • IV: 150 mg over 10 minutes, then 1 mg/minute x 6 hours, then 0.5 mg/minute; x 18 hours
  • Breakthrough stable VT: 150 mg supplemental doses in 100 mL D5W or NS over 10 minutes

 

SUPRAVENTRICULAR ARRHYTHMIAS

Atrial fibrillation:

Pharmacologic cardioversion (off-label):

  • Oral: 600 to 800 mg daily in divided doses until 10 g total,
  • then 200 mg daily maintenance
  • maintenance 100 mg daily commonly used for elderly or low BMI
  • Other regimens
    • 800 mg daily x 14 days, then 600 mg daily x 14 days, then 300 mg daily x 1 year, then 200 mg daily thereafter
    • 10 mg/kg/day x 14 days, then 300 mg daily x 4 weeks, then maintenance 200 mg daily
  • IV: 150 mg over 10 minutes,
  • then 1 mg/minute x 6 hours,
  • then 0.5 mg/minute x 18 hours or change to oral maintenance dosing (eg, 100 to 200 mg once daily)

Maintenance of sinus rhythm (off-label):

  • Oral: 400 to 600 mg daily in divided doses x 2-4 weeks
  • then maintenance 100 to 200 mg once daily

Prevention of post-op Afib and flutter with cardiothoracic surgery (off-label):

  • Oral: 200 mg TID x 7 days prior to surgery, then 200 mg daily until discharge
  • IV:
    • Preoperative: 150 mg load then 0.4 mg/kg/hour x 3 days prior to surgery and x 5 days postoperative
    • postoperative regimen: Starting at postop recovery, 1000 mg infused x 24 hours for 2 days

Rate control (off-label):

  • IV: 300 mg over 1 hour,
  • then 10 to 50 mg/hour x 24 hours
  • then oral maintenance 100 to 200 mg once daily.

 

Supraventricular tachycardia (eg, AVNRT, AVRT): 

Pharmacologic cardioversion (off-label):

  • Oral: 600 to 800 mg daily in divided doses until 10 g total,
  • then 200 mg daily as maintenance
  • IV: 150 mg over 10 minutes,
  • then 1 mg/minute x 6 hours,
  • then 0.5 mg/minute x 18 hours or change to oral

 

PDF file for Amiodarone table

Doc file for Amiodarone table

Reference:

Uptodate: Amiodarone: Drug information.  Accessed 1/13/2016.

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