ANNE ARUNDEL MEDICAL CENTER

CRITICAL CARE MEDICATION MANUAL

DEPARTMENT OF NURSING AND PHARMACY
Guidelines for Use of Intravenous
Amiodarone (Cordarone1)
Major Indications

Life threatening ventricular arrhythmias. According to the ACLS 2000 Guidelines, amiodarone is
now recommended ahead of other traditional antiarrhythmics in many cases.
Refractory sustained paroxysmal atrial fibrillation and paroxysmal supraventricular tachycardia

Mechanism of Action
Amiodarone increases the cardiac refractory period without influencing the resting membrane potential.
Amiodarone relaxes vascular smooth muscle, reduces peripheral vascular resistance, and slightly
increases cardiac index.
Pharmacokinetics

IV
PO

Onset of Effect
15 mins
3-6 weeks

Peak Effect*
15 mins after load
Several months

Duration of Effect
1 month after discontinuation
1 month after discontinuation

Dosage and Administration

Note: A final filter is required on amiodarone infusions.
Initial 24 hours:
Loading Dose:

Infuse 150 mg IV over 10 mins followed by 360 mg IV over 6 hours (1 mg/min)

Maintenance Infusion: Drip is initiated at 0.5 mg/min IV after the loading period delivering 540 mg over
the next 18 hours. If breakthrough arrhythmias occur, supplemental
infusions of 150 mg given IV over 10 mins may be used to control the
event.
Subsequent hours:
Maintenance Infusion: Intravenous drip is maintained at 0.5 mg/min. It may be necessary to continue
the infusion for 48-96 hours. If breakthrough arrhythmias occur, supplemental
infusions of 150 mg given over 10 mins may be used to control the event.
Monitoring

Continuous EKG
Blood Pressure (Continuously during initial loading period)
Liver function tests

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12.97, revised 6/02, 9/04 (prep)

Contraindications

Hypokalemia, Hypomagnesemia (need to be corrected prior to Amiodarone use)

Cardiogenic Shock
Sinus Bradycardia
2nd or 3rd degree AV Block

Adverse Reactions
1.
2.
3.
4.
5.

Cardiac: Hypotension, bradycardia, AV block, arrhythmias

Resp: Interstitial pneumonitis, ARDS
CNS: Malaise, muscle fatigue, ataxia, dizziness, and paresthesias.
Hepatic: Elevated liver function tests
GI: Nausea, vomiting, constipation

Overdose/Toxicity
Excessive doses may produce sinus bradycardia +/- block (may be resistant to atropine & require pacing
with isoproterenol or temporary pacer), hypotension, and Q-T prolongation.
Drug Interactions
1. Amiodarone is incompatible with the following medications: Aminophylline, Cefazolin, Heparin, and
Sodium Bicarbonate.
2. Concommitant use of Amiodarone with Digoxin may lead to elevated serum digoxin levels and
digoxin toxicity. Digoxin dosage adjustments should be considered and frequent monitoring of
digoxin levels is recommended.
3. Concomitant use of procainamide or quinidine with amiodarone may lead to elevated procainamide
and quinidine levels.
4. Prolonged prothrombin times have been reported in patients receiving amiodarone and warfarin.
Close monitoring and dosage adjustments are recommended.
5. Amiodarone should be used cautiously in patients also receiving calcium channel blockers or betablockers since potentiation of bradycardia, sinus arrest, or AV Block may occur.
6. Two to three fold increases in phenytoin levels have been reported in patients receiving amiodarone
in combination with phenytoin.
Comments
1.

Conversion to oral Amiodarone:

IV Amiodarone Duration
<1 week
1-3 weeks
>3 weeks

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12.97, revised 6/02, 9/04 (prep)

Daily Dose of PO Amiodarone

800-1600 mg
600-800 mg
400 mg

ANNE ARUNDEL MEDICAL CENTER

CRITICAL CARE MEDICATION MANUAL
DEPARTMENT OF NURSING AND PHARMACY
IV Additive Services
Medication Name

Storage Requirements

Amiodarone

Room Temperature

Preparation
Initial Bolus (150 mg over 10 mins):
Add 150 mg amiodarone (3 ml of Amiodarone 50
mg/ml) to 100 ml D5W Baxter viaflex bag.
Yields: 150 mg/ 100 ml

Resulting
Concentration
1.5mg/ml

Stability
2 hours at
room
temperature

Supplemental Bolus ( 360 mg over 6 hours):

Withdraw 81 ml from Excel brand 250 ml D5W
plastic bag to get 192 ml. Add 200 mg amiodarone
(8 ml of amiodarone 50 mg/ml) to 192 ml D5W for
final volume 200 ml.
Yields: 400 mg/200 ml.

2 mg/ml

24 hours at
room
temperature

Maintenance Infusion:
Add 15 ml of D5W to Excel brand 250 ml D5W
plastic bag, then add 600 mg Amiodarone (12 ml of
amiodarone 50 mg/ml) for final volume 300 ml..
Yields: 600 mg/ 300 ml

2 mg/ml

24 hours at
room
temperature

Trade Name: Cordarone

Notes:
1. Initial bolus in infused over 10 mins (600 ml/hr)
2. Supplemental infusion is infused over 6 hours (30 ml/hr)
3. Maintenance infusion is to deliver 0.5 mg/min (15 ml/hr) ~ see Dosing and Administration section.
4. Supplemental boluses of 150 mg over 10 mins if breakthrough arrhythmias occur; no adjustment in the maintenance infusion is made.

amiodarone.wpd/page3
12.97, revised 6/02, 9/04 (prep)