From the Guidelines
The normal dose of amiodarone varies depending on the clinical situation, but for most cases, a loading dose is not required and a maintenance dose of 100-200 mg daily is typically used, as this dose is effective and associated with fewer side effects 1. For acute life-threatening arrhythmias, a loading dose of 150 mg IV over 10 minutes is typically given, followed by 1 mg/min for 6 hours, then 0.5 mg/min for 18 hours. Some key points to consider when prescribing amiodarone include:
- The drug has a very long half-life (approximately 58 days) due to its lipophilic nature and tissue accumulation, which means it takes time to reach steady-state levels and remains in the body long after discontinuation.
- Patients should be monitored for potential side effects including thyroid dysfunction, pulmonary toxicity, liver abnormalities, and corneal deposits.
- Dose adjustments may be necessary based on patient response, side effects, and drug interactions, as amiodarone inhibits several cytochrome P450 enzymes and can increase levels of many medications including warfarin and digoxin.
- According to the 2016 ACC/AHA/HRS guideline for the management of adult patients with supraventricular tachycardia, the initial daily dose of amiodarone is 400-600 mg in divided doses for 2-4 weeks, followed by a maintenance dose of 100-200 mg daily 1. It's also important to note that amiodarone can interact with many other medications, and its use should be carefully considered in patients with certain medical conditions, such as sinus or AV conduction disease, inflammatory lung disease, or hepatic dysfunction 1.
From the FDA Drug Label
DOSAGE & ADMINISTRATION Amiodarone shows considerable interindividual variation in response. Thus, although a starting dose adequate to suppress life-threatening arrhythmias is needed, close monitoring with adjustment of dose as needed is essential The recommended starting dose of amiodarone HCl injection is about 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: The maintenance infusion rate of 0. 5 mg/min (720 mg/24 hours) should be continued utilizing a concentration of 1 to 6 mg/mL
The normal dose of amiodarone is 1000 mg over the first 24 hours of therapy, followed by a maintenance infusion rate of 0.5 mg/min (720 mg/24 hours) 2.
- The initial infusion rate should not exceed 30 mg/min.
- The maintenance infusion may be increased to achieve effective arrhythmia suppression, but mean daily doses above 2100 mg were associated with an increased risk of hypotension.
From the Research
Normal Dose of Amiodarone
The normal dose of amiodarone can vary depending on the specific condition being treated and the patient's response to the medication.
- For arrhythmias such as supraventricular tachycardia or atrial fibrillation, maintenance doses of amiodarone typically range from 100 to 400 mg/day 3.
- For ventricular arrhythmias, doses can be higher, ranging from 400 to 800 mg/day 3, 4.
- In some cases, a loading dose of 600 mg orally twice a day for 7 days may be used, followed by a maintenance dose of 300 to 400 mg twice daily 4, 5.
- Lower maintenance doses, such as 200 mg/day, may also be effective and have been used in studies comparing amiodarone to other antiarrhythmic medications 6.
Factors Influencing Dose
The dose of amiodarone may need to be adjusted based on the patient's response to the medication and the presence of any side effects.