What is the protocol for administering an Amiodarone (antiarrhythmic medication) drip for arrhythmia management?

Amiodarone Drip Protocol for Arrhythmia Management

The recommended amiodarone drip protocol consists of a 150 mg IV bolus over 10 minutes, followed by 1 mg/min for 6 hours, then 0.5 mg/min for maintenance, with a total dose not exceeding 2.2 g over 24 hours. 1, 2

Initial Administration Protocol

Loading Dose

• First stage: 150 mg IV bolus administered over 10 minutes
  • May be repeated in 10-30 minutes if necessary for life-threatening arrhythmias 1
• Second stage: Early maintenance infusion of 1 mg/min for 6 hours (360 mg)
• Third stage: Later maintenance infusion of 0.5 mg/min (720 mg per 24 hours) 1, 2

Administration Requirements

• Use a volumetric infusion pump (not drop counter infusion sets)
• Administer through a central venous catheter when possible, especially for concentrations >2 mg/mL
• Use an in-line filter during administration
• For infusions >2 hours, use glass or polyolefin bottles containing D5W 2

Concentration Guidelines

• For peripheral IV: Do not exceed 2 mg/mL to minimize phlebitis risk
• For central venous access: Concentrations up to 6 mg/mL can be used 2
• Avoid concentrations >3 mg/mL in D5W due to high incidence of peripheral vein phlebitis 2

Monitoring Requirements

• Continuous cardiac monitoring is mandatory
• Monitor blood pressure frequently during administration
• Watch for bradycardia, AV block, and hypotension
• Have defibrillator immediately available 1

Special Considerations

Breakthrough Arrhythmias

• For breakthrough episodes of VF or hemodynamically unstable VT:
  • Administer 150 mg supplemental infusion mixed in 100 mL D5W over 10 minutes 2

Transitioning to Oral Therapy

When switching from IV to oral amiodarone:

• If IV therapy <1 week: Start oral dose at 800-1,600 mg/day
• If IV therapy 1-3 weeks: Start oral dose at 600-800 mg/day
• If IV therapy >3 weeks: Start oral dose at 400 mg/day 1

Potential Adverse Effects

• Cardiovascular: Hypotension, bradycardia, AV block
• QT prolongation: Monitor for torsades de pointes
• Phlebitis: Common with peripheral administration 1

Contraindications and Cautions

• Avoid in: Severe sinus node dysfunction, marked sinus bradycardia, second/third-degree AV block without pacemaker
• Use with caution in: Heart failure, hepatic dysfunction
• Do not use in combination with other QT-prolonging drugs without expert consultation 1

Incompatibilities

• Amiodarone forms precipitates with many drugs
• Use separate IV lines when co-administering other medications 2

Critical Pitfalls to Avoid

1. Never exceed initial infusion rate of 30 mg/min to prevent hepatocellular necrosis and acute renal failure 2
2. Do not use plastic containers in series connections (risk of air embolism)
3. Always inspect solution for particulate matter (should be clear)
4. Avoid administering through PVC tubing when possible due to leaching of plasticizers 2

Amiodarone is particularly valuable for life-threatening ventricular arrhythmias refractory to other treatments, but requires careful administration and monitoring due to its complex pharmacology and potential for serious adverse effects.