Cardiology | Antiarrhythmic Drug Guide | Class III | Amiodarone

Amiodarone

IV Dose 5 mg/kg over 15-30 mins.. Repeat if necessary in 15 minutes. Drip 10-20 mg/kg/day. Must be given by central line in D5W.
Oral dose Loading: 5 mg/kg given BID x 10 days (max 1.2grams/day) Then 5 mg/kg QD for 1-2 months. Attempt to decrease progressively to 2.5 mg/kg in small changes every 4-6 months.
Levels Useful to document gross noncompliance. Therapeutic > 1.0 ug/ml. Toxicity common at > 2.5 ug/ml.
Kinetics Complex and obscure. Extensive rapid uptake by adipose tissue, slow uptake by myocardium, concentrates in both. Elimination half-life about 30 days with chronic oral therapy. (Range 8-107 days) Levels detectable 9 months after stopping Rx. Therapeutic effect seen 1-3 hours after IV dose. Peak serum level at 5 hours after oral dose
Cautions Many. In particular, extreme sinus bradycardia requiring a pacemaker is frequent. 25% incidence of marked hypotension and decreased contractility with IV administration only.
Interactions Potentiates warfarin action. Digoxin levels progressively rise 70-100%. With beta blockers and calcium channel blockers, causes severe sinus bradycardia.Potentiates tendency of quinidine, propafenone and mexiletine to cause Torsades de pointes. Increases levels of quinidine, procainamide, phenytoin, flecainide, and cyclosporin
Preparations Cordarone scored tablets, 200 mg. Cordarone injection, 50 mg/cc, 3 cc ampuls
FDA approval in children no

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