What is the appropriate dose of Amiodarone (amiodarone hydrochloride) for an adult with ventricular tachycardia (VT) with a pulse?

From the Guidelines

For adult ventricular wide complex tachycardia with a pulse, amiodarone should be administered as a 150 mg IV bolus over 10 minutes, followed by a continuous infusion of 1 mg/min for 6 hours, then 0.5 mg/min for the next 18 hours, as recommended by the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. The maximum cumulative dose should not exceed 2.2 grams over 24 hours. If the arrhythmia persists, an additional 150 mg bolus can be considered after the initial dose.

Key Considerations

• Amiodarone works by blocking multiple ion channels (sodium, potassium, and calcium) and has alpha and beta-adrenergic blocking properties, making it effective for various arrhythmias.
• During administration, continuous cardiac monitoring is essential, and blood pressure should be monitored frequently as hypotension can occur.
• The infusion should be administered through a central venous line when possible to avoid phlebitis.
• Patients should also be monitored for QT prolongation, bradycardia, and heart block.
• Amiodarone has a long half-life, so effects may persist for weeks after discontinuation.
• Liver and thyroid function should be assessed before initiating long-term therapy.

Comparison with Other Guidelines

Although the 1996 ACC/AHA guidelines for the management of patients with acute myocardial infarction also recommend amiodarone for ventricular tachycardia, the dosing regimen is similar to the 2010 guidelines 1. However, the 2010 guidelines provide more specific recommendations for the management of ventricular wide complex tachycardia with a pulse.

Monitoring and Side Effects

• Bradycardia, hypotension, and phlebitis are potential side effects of amiodarone therapy.
• Monitoring for these side effects is crucial to ensure safe and effective treatment.
• The benefits of amiodarone therapy in reducing morbidity and mortality in patients with ventricular wide complex tachycardia with a pulse outweigh the potential risks, as supported by the 2010 American Heart Association guidelines 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: Initial Load: 150 mg in 100 mL (in D5W) infused over 10 minutes Followed by: 1 mg/min for 6 hours Followed by: 0.5 mg/min thereafter For breakthrough episodes of VF or hemodynamically unstable VT, repeat the Initial Load

The recommended dose of amiodarone for adult ventricular wide complex tachycardia with a pulse is about 1000 mg over the first 24 hours of therapy. The infusion regimen is as follows:

• Initial Load: 150 mg in 100 mL (in D5W) infused over 10 minutes
• Followed by: 1 mg/min for 6 hours
• Followed by: 0.5 mg/min thereafter For breakthrough episodes of VF or hemodynamically unstable VT, repeat the Initial Load 2, 2.

From the Research

Amiodarone Dose in Adult Ventricular Wide Complex Tachycardia with a Pulse

• The optimal dose of amiodarone for adult ventricular wide complex tachycardia with a pulse is not explicitly stated in the provided studies 3, 4, 5, 6, 7.
• However, the studies suggest that amiodarone is a commonly used and effective treatment for ventricular tachycardia and ventricular fibrillation 4, 5, 6, 7.
• A study published in 2018 found that amiodarone was relatively safe and moderately effective for the treatment of sustained stable ventricular tachycardia in the prehospital setting, with approximately half of the patients treated with amiodarone reverting from ventricular tachycardia while under paramedic care 7.
• Another study published in 2023 compared the effectiveness of amiodarone and lidocaine for the treatment of in-hospital cardiac arrest and found that lidocaine was associated with statistically significantly higher odds of return of spontaneous circulation, 24-hour survival, survival to hospital discharge, and favorable neurologic outcome compared to amiodarone 6.
• The American Heart Association Advanced Cardiac Life Support (ACLS) guidelines support the use of either amiodarone or lidocaine for cardiac arrest caused by ventricular tachycardia or ventricular fibrillation, but the optimal dose of amiodarone is not specified 6.

Key Findings

• Amiodarone is a commonly used and effective treatment for ventricular tachycardia and ventricular fibrillation 4, 5, 6, 7.
• The optimal dose of amiodarone for adult ventricular wide complex tachycardia with a pulse is not explicitly stated in the provided studies 3, 4, 5, 6, 7.
• Lidocaine may be associated with better outcomes compared to amiodarone for the treatment of in-hospital cardiac arrest 6.
• Amiodarone is relatively safe and moderately effective for the treatment of sustained stable ventricular tachycardia in the prehospital setting 7.