endobj Data sources include IBM Watson Micromedex (updated 1 May 2023), Cerner Multum (updated 17 Apr 2023), ASHP (updated 10 Apr 2023) and others. ER Tab: 500 mg, 750 mg, 1000 mg. Injection: 100 mg/ml (10 ml); 500 mg/ml (2 ml). Bethesda, MD 20894, Web Policies Pharmacokinetics Do Not Copy, Distribute or otherwise Disseminate without express permission. Half-life: 38-48 hrs. Cordarone IV may be used alone or with other concentrations should not exceed 2 mg/mL unless a central venous catheter is used. Renal impairment does not influence the pharmacokinetics of amiodarone. Steady-state amiodarone concentrations of 1 to 2.5 mg/L have been associated with antiarrhythmic effects and acceptable toxicity following chronic oral amiodarone therapy. Amiodarone is considered to be a class III drug (Vaughan Williams classification), which indicates that it prolongs the QT interval. If neither amount ingested nor drug level are known, dose empirically as follows: For acute toxicity: 20 vials, administered in 2 divided doses to decrease the possibility of a febrile reaction, and to avoid fluid overload in small children. Routine screening for adult respiratory distress syndrome is of limited value, because pulmonary toxicity can develop rapidly with no antecedent abnormalities on chest radiographs or pulmonary function tests. Because a typical oral amiodarone loading dose for ventricular arrhythmia starts with 800-1600 mg/day and for atrial fibrillation starts with 600-800 mg/day, I would assume that for one reason or another a decision was made not to load this patient. Clipboard, Search History, and several other advanced features are temporarily unavailable. You will receive email when new content is published. Intravenous Amiodarone Drugs for Conversion of Atrial Fibrillation | AAFP Renal Dosing: CRCL >60 ml/min: Administer 500 mcg twice daily. and transmitted securely. These conditions often are dosage related and improve when the dosage is reduced. After absorption, the drug undergoes extensive enterohepatic circulation. infusion over >/= 30 minutes is preferred. In children, a Class III electrophysiological effect can be seen at daily doses of 210 mg/m2 body surface area (BSA). 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 .gov means its official. Advise patients to avoid consumption of grapefruit juice during treatment with this drug. Initiate antithyroid drug therapy; consider stopping amiodarone. The patient is now taking nothing by mouth (NPO), and the physician would like to switch to intravenous (IV) amiodarone. 3 mL (150 mg) 10 Single-dose vials per carton (NDC 60505-0722-0). Time to steady state: 5-7 days (average) ESRD: 15-20 days. Webbetween PO and IV (64% vs. 68%, respectively; p=NS) 223 patients with symptomatic atrial fibrillation on digoxin PO amiodarone 600 mg in3 divided doses vs. IV amiodarone 5mg/kg Despite such measures, bradycardia was progressive and terminal in 1 patient during the controlled trials. 4i$h>B/>tJ1g'nS-84]h9L\\: Amiodarone 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. Crcl 40-60 ml/min: Administer every 24 hours. 2 0 obj See labeling for oral amiodarone. Its vasodilatory action can decrease cardiac workload and consequently myocardial oxygen consumption. <> Overt liver disease can occur, however, and has been fatal in a few cases. Bradycardia should be treated by slowing the infusion rate or discontinuing amiodarone. of vials = level (ng/mL) x body weight (kg) divided by 100, Digitoxin: No. Dose Adjustments. The bioavailability of amiodarone is variable but generally poor, ranging from 22 to 95 percent.1 Absorption is enhanced when the drug is taken with food.2 Amiodarone is highly lipid soluble and is stored in high concentrations in fat and muscle, as well as in the liver, lungs, and skin. Reconstitution: Dissolve each vial with 4 ml sterile water (do not shake). In patients with extended and recurrent sun exposure, bluish skin discoloration may develop in exposed areas. J Am Coll Cardiol. May be administered once a day; twice a day dosing is recommended for total daily doses of 1000 mg or more or in patients who experience gastrointestinal tolerance. Please confirm that you would like to log out of Medscape. Dosing (adults): IVPB: 0 to 1 mg/50 ml D5W or NS over 10 minutes. For control of postoperative hypertension, as many as one-third of patients may require higher doses (250-300 mcg/kg/minute) to control blood pressure; the safety of doses >300 mcg/kg/minute has not been studied.