Amiodarone Infusion Dosing Regimen
The recommended dosing regimen for amiodarone infusion is 150 mg given over 10 minutes, which may be repeated if necessary, followed by a 1 mg/min infusion for 6 hours, then 0.5 mg/min for 18 hours, with a total dose over 24 hours not exceeding 2.2 g. 1, 2, 3
Initial Loading Dose
- Administer 150 mg IV over 10 minutes as the initial loading dose 1, 2
- This loading dose may be repeated in 10-30 minutes if necessary for inadequate response 3
- The antiarrhythmic effect begins in less than 30 minutes after administration 3
Maintenance Infusion
- Continue with 1 mg/min infusion for 6 hours (360 mg total) 1, 2, 3
- Reduce to 0.5 mg/min for the next 18 hours (540 mg total) 1, 2, 3
- Total dose over 24 hours should not exceed 2.2 g 1, 2, 4
Administration Considerations
- Use a volumetric infusion pump for administration 4
- For infusions longer than 1 hour, do not exceed amiodarone concentrations of 2 mg/mL unless a central venous catheter is used 4
- Whenever possible, administer through a central venous catheter dedicated to that purpose 4
- Use an in-line filter during administration 4
- Amiodarone infusions exceeding 2 hours must be administered in glass or polyolefin bottles containing D5W 4
Monitoring Requirements
- Continuous ECG monitoring is required during administration 3
- Regular blood pressure monitoring is necessary to detect hypotension 3
- Monitor for bradycardia and AV block during infusion 2, 3
Potential Adverse Effects
- Hypotension, especially with rapid administration, is a common adverse effect 2, 3
- Bradycardia and atrioventricular block may occur 2, 3
- Phlebitis, particularly with concentrations >2 mg/mL, is a potential adverse effect 1, 3
- Higher doses and faster infusion rates than recommended have resulted in hepatocellular necrosis and acute renal failure 4
Special Considerations
- For patients with moderate or severe left ventricular failure, use with caution as amiodarone may cause negative inotropic effects 2
- Amiodarone has a very long half-life (IV: 9-36 days; Oral: 26-107 days), which affects long-term management strategies 2, 3
- Amiodarone has numerous drug interactions due to its effects on multiple ion channels and receptors 2
- Concomitant use of other QT-prolonging medications should be done with caution 2