Parenteral Manual

Amiodarone

Disclaimer: Official controlled document is the CHEO online copy. It is the responsibility of user to ensure that any paper copy version is the same as the online version before use.

Alternate Name(s): 
CORDARONE
Classification: 
Antiarrhythmic
Original Date: 
August 2005
Revised Date: 
September 2011
Indications: 
  • Management of resistant, life-threatening ventricular arrhythmias
  • Supraventricular arrhythmias such as junctional ectopic tachycardia (JET) unresponsive to conventional therapy
Reconstitution and Stability: 
  • Available as a 50 mg/mL solution
  • Protect from light (light protection is not necessary during administration)
  • Stable for  24 hours in syringe
  • Stable for 2 hours in PVC bags
Compatibility: 

- Solutions Compatible:  D5W only

- Additives/Above Cassette Compatible: potassium chloride ( up to 40 mmol/L), dobutamine, dopamine, lidocaine, procainamide, verapamil

-Y-site Compatible: ciprofloxacin, fluconazole, metronidazole, midazolam, morphine

- Incompatible: heparin, SMOF lipid 20%

Administration: 

(For approved routes of administration by nursing personnel, refer to Policy for the Administration of Intravenous Medications.)

SC NO
IM NO
IV Direct YES
Infusion time: 0.5-3 minutes (emergency treatment)
IV Intermittent Infusion YES
Usual dilution: 1 mg/mL,
                    Central line only: 2 mg/mL, 6 mg/mL
Infusion time: 30-60 minutes
IV Continuous Infusion

YES
Standard Concentration in ER/OR/PICU:  1 mg/mL,
                   Central line only 2 mg/mL, 6 mg/mL and infusion greater than 1 hour

 

Click here to access SDC Drug Infusion Sheet

 

 

Dosage: 

(For neonatal dosages, refer to Neonatal IV Drug Manual.)

Pediatric:

  • Loading dose: 5 mg/kg/dose IV over 30 - 60 minutes followed 15 minutes later by an infusion
  • Continuous infusion: 5 - 15 mcg/kg/minute IV (or 10 - 20 mg/kg/day)
  • The usual duration of infusion is 5 days.
  • No dosage adjustment in renal impairment.

Adult:  Loading dose: 1000 mg over 24 hours as follows:

  • 150 mg given over 10 minutes (15 mg/min)
  • follow with 360 mg given over 6 hours (1 mg/min)
  • follow with a maintenance dose: 540 mg given over next 18 hours (0.5 mg/min)
  • after 24 hours the maintenance dose is continued at 0.5 mg/min
  • Supplemental doses of 150 mg over 10 minutes may be given for breakthrough arrhythmias
    For maintenance and supplemental doses: the combined daily dose should not exceed 2 g/day
Potential hazards of parenteral administration: 
  • Hypotension (may be related to infusion rate)
  • Bradycardia, heart block
  • Phlebitis and pain at injection site (concentrations <2.5 mg/mL may be less irritating)
  • Slate blue discoloration of skin, rash, photosensitivity
  • Increased liver enzymes, severe hepatic toxicity
  • Halos, blurred vision, corneal deposits
  • Pulmonary fibrosis, interstitial pneumonitis
  • Hypothyroidism (or hyperthyroidism - less common)
Notes: 
  • Monitor HR, blood pressure, EKG, pulmonary function tests, chest X-ray, thyroid function tests, liver enzymes, ophthalmologic exams
  • Inhibits P-450 enzymes and may increase levels of digoxin, lidocaine, cyclosporine, theophylline, procainamide, warfarin, phenytoin.  Dosage reductions may be required

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