When to administer Amiodarone (antiarrhythmic medication) infusion?

From the Guidelines

Amiodarone infusion should be given for life-threatening ventricular arrhythmias, atrial fibrillation with rapid ventricular response, or other tachyarrhythmias unresponsive to first-line treatments, with a standard loading dose of 150 mg IV over 10 minutes, followed by 1 mg/min for 6 hours, then 0.5 mg/min maintenance infusion, as recommended by the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1.

Indications for Amiodarone Infusion

• Life-threatening ventricular arrhythmias
• Atrial fibrillation with rapid ventricular response
• Other tachyarrhythmias unresponsive to first-line treatments

Dosage and Administration

• Standard loading dose: 150 mg IV over 10 minutes
• Maintenance infusion: 1 mg/min for 6 hours, then 0.5 mg/min
• Total dose over 24 hours should not exceed 2.2 g

Important Considerations

• Cardiac monitoring is required due to potential QT prolongation and hypotension
• Amiodarone works by blocking potassium channels, prolonging action potential duration, and extending the refractory period in cardiac tissue
• It also has sodium and calcium channel blocking properties and noncompetitive beta-blocking effects
• The drug should be administered through a central line when possible, as peripheral administration can cause phlebitis
• Continuous cardiac monitoring is essential during administration, and blood pressure should be checked frequently, especially during loading doses, as supported by studies 1.

From the FDA Drug Label

The recommended starting dose of amiodarone is about 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: After the first 24 hours, continue the maintenance infusion rate of 0. 5 mg/min (720 mg per 24 hours) In the event of breakthrough episodes of VF or hemodynamically unstable VT, use 150 mg supplemental infusions of amiodarone (mixed in 100 mL of D5W and infused over 10 minutes to minimize the potential for hypotension)

Amiodarone infusion should be given as follows:

• Initial dose: 1000 mg over the first 24 hours of therapy
• Maintenance dose: 0.5 mg/min (720 mg per 24 hours) after the first 24 hours
• Supplemental dose: 150 mg infused over 10 minutes in the event of breakthrough episodes of VF or hemodynamically unstable VT 2

From the Research

Amiodarone Infusion Administration

• Amiodarone infusion is effective for the treatment of recurrent, life-threatening ventricular tachyarrhythmias 3.
• The infusion can be given to patients with shock refractory out-of-hospital cardiac arrest and hemodynamically destabilizing ventricular arrhythmia 4.
• The goal of amiodarone infusion is to demonstrate efficacy in patients with refractory, recurrent hemodynamically destabilizing ventricular tachycardia or ventricular fibrillation by determining a dose response among different regimens 3.

Dosage and Administration

• The dosage of amiodarone infusion can range from 125 mg to 1000 mg during the first 24 hours, with supplemental infusions of 150 mg given to treat breakthrough ventricular arrhythmias 3.
• The event rate decreases with increasing doses, with median values of 0.07,0.04, and 0.02 events per hour for the 125-, 500-, and 1000-mg dose groups, respectively 3.
• Amiodarone infusion can be used in combination with other medications, such as beta-blockers, to prevent ICD shocks and treat electrical storm 4.

Clinical Use and Efficacy

• Amiodarone infusion is an effective anti-arrhythmic agent for the acute treatment of life-threatening ventricular arrhythmias and represents an important treatment option for emergency anti-arrhythmic therapy for patients suffering from cardiac arrest 5.
• The efficacy and tolerability of intravenous amiodarone for acute treatment of recurrent and refractory ventricular tachycardia and ventricular fibrillation has been demonstrated in clinical trials 5.
• Amiodarone, either by itself or in combination with conventional antiarrhythmic drugs, has a significant therapeutic effect in high-risk patients with refractory ventricular tachycardia 6.