Escolar Documentos
Profissional Documentos
Cultura Documentos
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
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
amiodarone.wpd/page1
12.97, revised 6/02, 9/04 (prep)
Contraindications
Adverse Reactions
1.
2.
3.
4.
5.
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.
amiodarone.wpd/page2
12.97, revised 6/02, 9/04 (prep)
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
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
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)