What is the procedure for administering amiodarone (antiarrhythmic medication) 150 milligrams via intravenous (IV) infusion?

From the Guidelines

To administer amiodarone 150mg via IV infusion, the medication should be diluted in 100mL of 5% dextrose solution (D5W) and administered over 10 minutes. The concentration should be 1.5mg/mL, and a glass or polyolefin container should be used since amiodarone can bind to PVC 1.

Key Considerations

• Never use normal saline or other diluents as they can cause precipitation.
• Administer the infusion using an infusion pump for accuracy, at a rate of approximately 10mL/minute.
• Monitor the patient's vital signs, especially blood pressure and heart rate, as amiodarone can cause hypotension and bradycardia 1.
• Also, monitor the IV site closely for signs of phlebitis or infiltration, as amiodarone is highly irritating to veins.

Maintenance Infusion

If the patient requires continued therapy after the initial dose, a maintenance infusion can be prepared at a lower concentration, with 1 mg/min for 6 hours, and then 0.5 mg/min 1.

Mechanism of Action

Amiodarone is a class III antiarrhythmic that works by prolonging the action potential and refractory period in cardiac tissue, making it effective for various arrhythmias, particularly ventricular arrhythmias and atrial fibrillation 1.

Clinical Guidelines

The recommended dosage and administration guidelines are supported by various studies and guidelines, including the American Heart Association and the European Society of Cardiology 1.

From the FDA Drug Label

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)

The procedure for administering amiodarone 150 milligrams via intravenous (IV) infusion is to mix it in 100 mL of D5W and infuse over 10 minutes.

• Key points:
  • Dose: 150 mg
  • Diluent: 100 mL of D5W
  • Infusion time: 10 minutes
  • Purpose: For breakthrough episodes of VF or hemodynamically unstable VT 2

From the Research

Administration Procedure

The administration procedure for amiodarone via intravenous (IV) infusion is as follows:

• The dose of amiodarone can be administered as a bolus or continuous infusion 3, 4, 5.
• A bolus dose of 5 mg/kg can be given over 30 minutes, followed by a continuous infusion of 20 to 30 mg/kg/day for 5 days 3.
• Alternatively, a dose of 150 mg can be given as a supplemental infusion for breakthrough destabilizing tachyarrhythmias 5.
• The infusion rate and dose may vary depending on the patient's response and the specific formulation of amiodarone used 6, 7.

Formulation Considerations

• Different formulations of intravenous amiodarone may have varying effects on blood pressure and cardiac function 6, 7.
• The standard formulation of amiodarone (Cordarone IV) contains vasoactive solvents that can cause hypotension, whereas newer formulations such as Amio-Aqueous and PM101 may be safer and more stable 6, 7.
• The choice of formulation may impact the administration procedure and the patient's response to treatment 6, 7.

Safety Considerations

• Intravenous amiodarone can cause serious adverse events, including hypotension, bradycardia, and sinus arrest 3, 4, 6.
• The risk of adverse events may be related to the dose and rate of infusion, as well as the patient's underlying cardiac condition 3, 4, 5.
• Close monitoring of the patient's vital signs and cardiac function is necessary during administration of intravenous amiodarone 3, 4, 5.