Alternate Name(s):
Cordarone
Classification:
Antiarrhythmic Agent
Original Date:
July 2003
Revised Date:
Dec 2023
Indications:
- Supraventricular arrhythmias such as junctional ectopic tachycardia (JET), atrial flutter, atrial tachycardia
- Management of resistant, life-threatening ventricular arrhythmias
Administration:
- IV loading dose over 60 minutes followed by a continuous infusion
- IV direct, intraosseous: in cardiac arrest only
- PO
Dosage:
- IV:
- Stable Arrhythmias
- Loading dose: 5 mg/kg/dose over 60 minutes followed by an infusion
- Continuous infusion: 5 - 15 mcg/kg/min
- Dilution concentration: 0.6 - 6 mg/mL (use central line if concentration > 2 mg/mL)
- Pulseless VF or VT
- 5 mg/kg rapid IV bolus or intraosseous
- Stable Arrhythmias
- PO:
- Loading dose: 10 mg/kg/day as a single daily dose or divided BID for 7 to 10 days
- Maintenance dose: 5 mg/kg/day as a single daily dose
Side Effects:
- CVS: bradycardia, heart block, hypertension (may be related to infusion rate)
- Endocrine: hypothyroidism, hyperglycemia, increased triglycerides
- Hematologic: coagulation abnormalities, thrombocytopenia
- Hepatic: liver enzymes elevated, severe hepatic toxicity
- Local: phlebitis (concentrations < 2.5 mg/mL may be less irritating)
- Ocular: corneal microdeposits, halos or blurred vision, photophobia, optic neuropathy, optic neuritis
- Respiratory: intersitital pneumonitis, hypersensitivity pneumonitis
Parameters to Monitor:
- HR, BP
- CXR
- CBC, thyroid function tests, liver function tests
- Ophthalmologic exams
Reconstitution and Stability:
- Amidarone 50 mg/mL
- Add 0.4 mL (20 mg) of amiodarone to 19.6 mL of D5W
- Final concentration: 1 mg/mL
- Amiodarone 50 mg/mL
- Add 0.8 mL (40 mg) of amiodarone to 19.2 mL of D5W
- Final concentration: 2 mg/mL (central line only)
- Stability: 24 hours at room temperature in IV syringes or glass bottles
Compatibility:
- Solutions Compatible: D5W
- Y-site Compatible: amphotericin B, dobutamine, dopamine, epinephrine, fentanyl, gentamicin, midazolam, milrinone, morphine, vancomycin
Incompatible: SMOF, TPN
Notes:
May increase serum digoxin levels - reduce digoxin dose by 50% during concurrent therapy
References:
-Taketomo CK, Hodding JH, Kraus DM. Pediatric Dosage Handbook 9th-11th Editions. Hudson: Lexi-Comp Inc.; 2002-2004.
-Trissel LA. Handbook on Injectable Drugs. 12th-13th Editions. Bethesda: American Society of Health-System Pharmacists; 2003-2005.
-King JC. King Guide to Parenteral Admixtures. Internet Edition.
-The Children's Hospital of Eastern Ontario Parenteral Drug Manual. Department of Pharmacy 2003.