Because of the complexity and widespread use of this agent, other treatment decisions often are affected. This drug should be used at the lowest effective dose in order to prevent the occurrence of side effects. A naive look at this scenario gives the impression that the patient has not been started on an oral loading dose of amiodarone. Followed by Slow: 360 mg over the NEXT 6 hours (1 mg/min). PO to IV Amiodarone Switch-Medscape-Apr22,2004. Patients treated with amiodarone should be followed regularly to assess ongoing need for amiodarone, efficacy of the drug, appropriateness of dosage, adverse effects, and potential drug interactions. Optic neuropathy and optic neuritis, sometimes progressing to total blindness, have been described in a small number of patients treated with amiodarone. Patients' on the "floors" may receive once daily IV maintenance doses, however, IV loading regimens (multiple doses) are restricted to pts on a monitor- ICU's. Cordarone I.V. This content is owned by the AAFP. Stop amiodarone; initiate corticosteroid therapy. All Rights Reserved. +*59mQau]pR+T7{vN2{pU[9jY0HR{Ui&IljC,7mh-`}pJ1l!:s(tG$IS|-L[UFrYfFqj9'FPaP9*?&L,?uH`Xp2YdCq1X,Q>Rxw:se2Uk;XuHepn dGB$rRE*17wAp_gCw88lg# wBEaz-EBpzxjcTE)a- WIT INFUSION Duration of Cordarone I.V. Any report from the patient of worsening dyspnea or cough should elicit a prompt assessment for pulmonary toxicity. Advise patients to avoid consumption of grapefruit juice during treatment with this drug. Discontinue this drug if the patient experiences signs or symptoms of clinical liver injury. Cordarone IV Thallium-201 is injected at midpoint (3 minutes) of infusion. The discoloration resolves over several months after amiodarone is discontinued. PULMONARY TOXICITY: This drug has several potentially fatal toxicities, the most important of which is pulmonary toxicity (hypersensitivity pneumonitis or interstitial/alveolar pneumonitis) that has resulted in clinically manifest disease at rates as high as 10% to 17% in some series of patients with ventricular arrhythmias given doses around 400 mg/day, and as abnormal diffusion capacity without symptoms in a much higher percentage of patients. A patient started on oral (PO) amiodarone approximately 1 week ago (400 mg/day). Although significant beta-blockade occurs at oral doses as low as 25 mg, significant Class III effects are seen only at daily doses of 160 mg and above. Although no dosage adjustment for patients with renal, hepatic, or cardiac abnormalities has been defined during chronic treatment with oral amiodarone, close clinical monitoring is prudent for elderly patients and those with severe left ventricular dysfunction. In most instances, the toxicity is reversible. A total of 184 patients were included for analysis. The maintenance infusion of up to 0.5 mg/min can be cautiously continued for 2 to 3 weeks regardless of the patient's age, renal function, or Left-ventricular function. Intravenously administered amiodarone is being used with increasing frequency in the acute treatment of atrial fibrillation. ER Tab: 500 mg, 750 mg, 1000 mg. Injection: 100 mg/ml (10 ml); 500 mg/ml (2 ml). Pacerone, Cordarone (amiodarone) dosing, indications, interactions From in vitro studies, the protein binding of amiodarone is >96%. Because phlebitis may occur, the drug should be given through a central venous line when possible. Not preferred drug for PSVT because it is not rapidly effective (may take up to 60 minutes). 3 mL (150 mg) 10 Single-dose vials per carton (NDC 60505-0722-0). In clinical studies of 2 to 7 days, clearance of amiodarone after intravenous administration in patients with VT and VF ranged between 220 and 440 mL/h/kg. Patients taking amiodarone should not eat grapefruit or drink grapefruit juice because it can inhibit the conversion of amiodarone to an active metabolite. FDA-approved for acute termination of A-flutter/A-fib (may be alternative to cardioversion): 1mg IV over 10min. It is used in patients who have already been treated with other medicines that did not work well. This retrospective, observational, single-center study included cardiothoracic surgery patients who were initiated on IV amiodarone for supraventricular arrhythmia and subsequently transitioned to oral amiodarone. Before Renal impairment does not influence the pharmacokinetics of amiodarone. Abstract The use of amiodarone for postoperative atrial fibrillation (AF) is widespread; however, there is a paucity of data on the optimal duration of overlap when transitioning from intravenous (IV) to oral amiodarone. (If given IVPush-admin over at least 5 min).PSVT: (For patients not on digoxin): 0.25 to 0.5 mg IV. Thyroid abnormalities have been described in up to 10 percent of patients receiving long-term amiodarone therapy.2 Hyperthyroidism may result from an excess of iodine or acute thyroiditis.20 Hypothyroidism is two to four times more common than hyperthyroidism.2, In hypothyroid patients with a strong clinical indication for amiodarone, the drug may be continued with appropriate thyroid hormone supplementation. IV: Peak concentrations after 10-minute infusions of 150 mg intravenous amiodarone in patients with ventricular fibrillation (VF) or hemodynamically unstable ventricular tachycardia (VT) range between 7 and 26 mg/L. A reduction of the resting heart rate due to the beta-blocking effect of sotalol is observed at daily doses >/=90 mg/m2 in children. HONcode standard for trust- worthy health, Skeletal Muscle Index And Ovarian Cancer Prognosis: A Meta-Analysis, 7 Natural Remedies for Rheumatoid Arthritis. In early studies, the frequency of pulmonary toxicity in amiodarone therapy was 2 to 17 percent.2 More recent studies have shown a lower incidence in patients receiving dosages of 300 mg per day or less. of vials = level (ng/mL) x body weight (kg) divided by 100, Digitoxin: No. Supplied: 200 mg, 300 mg tab (sulfate). If the starting dose was 250 mcg twice daily, then adjust to 125 mcg twice daily. May give by bolus injection if cardiac arrest is imminent. Gastrointestinal side effects of amiodarone include nausea, anorexia, and constipation. PROARRHYTHMIC EFFECTS: Like other antiarrhythmics, this drug can exacerbate the arrhythmia, e.g., by making the arrhythmia less well tolerated or more difficult to reverse. On the other hand, it is possible that this is a very lightweight, elderly woman, and the physician is being extremely cautious on the loading or there are other comorbid conditions that could increase the risk of amiodarone toxicity. Amiodarone exhibits complex disposition characteristics after intravenous administration. If patient is < 60kg give 0.01 mg/kg over 10 minutes. Intravenous 324 mg extended release tab (gluconate). Copyright 2023 American Academy of Family Physicians. If intravenous amiodarone is administered during pregnancy, the patient should be apprised of the potential hazard to the fetus. <> (900 mg) to 500 mL D5W (conc = 1.8 mg/mL). The time at which a previously controlled life-threatening arrhythmia will recur after discontinuation or dose adjustment is unpredictable, ranging from weeks to months. Cordarone IV is a prescription medicine used to treat the symptoms of irregular heart rhythm (Ventricular Arrhythmias). Contraindications: V-fibrillation; hypokalemia; WPW syndrome with wide complex. The antisympathetic action and the block of calcium and potassium channels are responsible for the negative dromotropic effects on the sinus node and for the slowing of conduction and prolongation of refractoriness in the atrioventricular (AV) node. The patient is obviously at great risk during this time and may need prolonged hospitalization. So I would first investigate the appropriateness of amiodarone use and its dose, and if indeed no loading approach is appropriate, I would just convert the patient to an equipotent IV dose while he/she is NPO. Amiodarone: I.V. This has occurred in 2% to 5% of patients in various series, and significant heart block or sinus bradycardia has been seen in 2% to 5%. Do Not Copy, Distribute or otherwise Disseminate without express permission. Crcl <10 ml/min: Individualize dose. Oral Loading - Half-life elimination: 40-55 days (range: 26-107 days); Cordarone I.V is not intended for maint therapy. /QU+(R% $Kh=c6cL`bv!w? Conversion from oral to IV: Decrease IV dose by 20 to 25%. Adverse reactions: Severe hypotension; bradycardia; ventricular standstill in digitalized patients; asystole; respiratory failure. Such patients should not be given dronedarone. Available for Android and iOS devices. However, the drug has many other effects: it slows heart rate and atrioventricular nodal conduction (via calcium channel and beta-receptor blockade), prolongs refractoriness (via potassium and sodium channel blockade), and slows intracardiac conduction (via sodium channel blockade). The affinity of DIGIBIND for digoxin is in the range of 109 to 1011 M-1, which is greater than the affinity of digoxin for (sodium, potassium) ATPase, the presumed receptor for its toxic effects. WebAmiodarone (Cordarone) 150 mg IV over 10 minutes, then 30 to 60 mg IV per hour; 200 to 400 mg orally every day as a maintenance dose after loading: 43 to 68: 8 to 24 hours: 55 to Ocular: Ophthalmic examination, including fundoscopy and slit-lamp examination, Respiratory: History, physical exam, chest X-ray, and pulmonary function tests, including diffusion capacity. Administration of Cordarone in divided doses with meals is suggested for total daily doses of 1,000 mg or higher, or when gastrointestinal intolerance occurs.) In clinical trials, treatment-emergent, drug-related hypotension was reported as an adverse effect in 288 (16%) of 1836 patients treated with intravenous amiodarone. After a single dose of intravenous amiodarone in cirrhotic patients, significantly lower Cmax and average concentration values are seen for DEA, but mean amiodarone levels are unchanged. 2 Patients who received intravenous Hypotension Amiodarone has a variable oral bioavailability. David McAuley, Pharm.D. WebLowest effective dose, ideally 200 mg or less orally once per day or in divided doses. The initial rate of infusion should be monitored closely and should not exceed that prescribed in DOSAGE AND ADMINISTRATION. (Must use 0.22 micron filter) Improvement in signs and symptoms usually begins in 30 minutes or less.Stability: Use promptly after mixing (may refrigerate up to 4 hours). endobj Accessibility Infusion*: <1 week Initial Daily Dose of Oral Cordarone : 800-1600 mg, Duration of Cordarone I.V. Use carton to protect contents from light until used. There is limited experience in patients receiving Cordarone I.V. Adenosine may also lessen vascular tone by modulating sympathetic neurotransmission. Amiodarone is eliminated primarily by hepatic metabolism and biliary excretion and there is negligible excretion of amiodarone or DEA in urine. AF recurrence occurred in 24.5% of patients (n = 45). Like class I drugs, amiodarone blocks sodium channels at rapid pacing frequencies, and like class II drugs, it exerts a noncompetitive antisympathetic action. Clinical effects of intravenous to oral amiodarone transition 4i$h>B/>tJ1g'nS-84]h9L\\: Organophosphate or carbamate poisoning: 2 mg IV, followed by 2 mg every 15 minutes until adequate response (initial doses of up to 6 mg may be used in life-threatening cases). <> Obtain first level within 24 hours of digitalization. Cordarone I.V. If the measured QTc is >500 msec (550 msec in patients with ventricular conduction abnormalities) dofetilide should be stopped. Lidocaine (xylocaine ) Ventricular arrhythmia: 1-1.5 mg/kg IV bolus over 2-3 minutes; may repeat doses of 0.5-0.75 mg/kg in 5-10 minutes up to a total of 3 mg/kg; Studies on the use of amiodarone for the primary prevention of sudden death in high-risk patients have had mixed results. (900 mg) to 500 ml D 5 W (conc = 1.8 mg/ml). Its vasodilatory action can decrease cardiac workload and consequently myocardial oxygen consumption. Drugs for Conversion of Atrial Fibrillation | AAFP If you log out, you will be required to enter your username and password the next time you visit. Duration of Cordarone I.V. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. National Institutes of Health, U.S. National Library of Medicine, DailyMed Database. Therefore, for infusions longer than 1 hour, Cordarone I.V. (an inline 0.22 micron filter should be used). Please confirm that you would like to log out of Medscape. If the starting dose was 125 mcg twice daily, then adjust to 125 mcg every day. Long-Term Use All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Disclosure: Reza Taheri, PharmD, has no significant financial interests or relationships to disclose. This article reviews the pharmacology, indications, adverse effects, and drug interactions of amiodarone, and outlines a strategy for surveillance of patients who are taking this drug. In addition to blocking sodium channels, amiodarone blocks myocardial potassium channels, which contributes to slowing of conduction and prolongation of refractoriness. RECOMMENDATIONS FOR ORAL DOSAGE AFTER I.V. Various practice guidelines recommend amiodarone as a second-line drug in the long-term treatment of atrial fibrillation in patients with structural heart disease and in highly symptomatic patients without heart disease.10 Several smaller studies have shown that amiodarone is similar to quinidine and sotalol in the treatment of atrial fibrillation in these patients.11,12 In one randomized controlled trial (RCT),12 sinus rhythm was maintained successfully for 16 months in 65 percent of patients treated with amiodarone, compared with 37 percent of patients treated with sotalol or propafenone (ARR, 28 percent; NNT, 3.6). Amiodarone dosing in adults by indication - UpToDate A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. All Rights Reserved. <> Ann Thorac Surg. Intraoperative tachycardia and/or hypertension (immediate control): Initial bolus: 80 mg IV (~1 mg/kg) over 30 seconds, followed by a 150 mcg/kg/minute infusion, if necessary. After absorption, the drug undergoes extensive enterohepatic circulation. INFUSION, Recommendations for conversion to intravenous amiodarone after oral administration, HONcode standard for trust- worthy health, Skeletal Muscle Index And Ovarian Cancer Prognosis: A Meta-Analysis, 7 Natural Remedies for Rheumatoid Arthritis. Amiodarone therapy is contraindicated in patients with second- or third-degree heart block who do not have a pacemaker.