What is the recommended rate for increasing the amiodarone (antiarrhythmic medication) infusion rate, and can 0.7 mg/min be administered?

Amiodarone Infusion Rate Recommendations

The recommended maintenance infusion rate for amiodarone is 0.5 mg/min, and 0.7 mg/min exceeds the standard recommended rate. 1, 2

Standard Amiodarone IV Administration Protocol

According to the FDA drug label and major cardiology guidelines, amiodarone IV administration follows a three-stage approach:

1. Initial loading dose: 150 mg over 10 minutes
2. Early maintenance infusion: 1 mg/min for 6 hours
3. Later maintenance infusion: 0.5 mg/min 1, 2

The total dose over 24 hours should not exceed 2.2 g 2.

Rate Increase Considerations

When considering increasing the amiodarone infusion rate:

• Maximum recommended maintenance rate: 0.5 mg/min according to FDA labeling and ACC/AHA/ESC guidelines 1, 2
• Safety concerns: Higher rates increase risk of:
  • Hypotension
  • Bradycardia
  • Heart block
  • Phlebitis (especially with concentrations >2 mg/mL) 2

Clinical Situations Where Rate Adjustments May Be Considered

In breakthrough episodes of ventricular fibrillation or hemodynamically unstable ventricular tachycardia:

• Use 150 mg supplemental infusions over 10 minutes rather than increasing the maintenance rate 1

Important Safety Considerations

• Monitoring: Continuous ECG monitoring is essential during amiodarone administration 2
• Administration route: Use a central venous catheter for concentrations >2 mg/mL 1
• Concentration limits: Do not exceed 2 mg/mL for peripheral infusions lasting >1 hour 1
• Contraindications: Severe sinus node dysfunction, marked bradycardia, second/third-degree AV block without pacemaker 2

Practical Recommendations

If rate control is inadequate at 0.5 mg/min:

1. First option: Administer a supplemental 150 mg bolus over 10 minutes rather than increasing the maintenance rate 1
2. Second option: Consider adding another agent if appropriate
3. If rate increase is absolutely necessary: Close monitoring for hypotension, bradycardia and heart block is essential 2

Conclusion

Based on the most current guidelines and FDA labeling, 0.7 mg/min exceeds the standard recommended maintenance infusion rate of 0.5 mg/min. While some studies have used higher rates in specific circumstances, the standard recommendation should be followed to minimize risk of adverse effects.