What is the recommended infusion protocol for Cordarone (amiodarone)?

Recommended Infusion Protocol for Cordarone (Amiodarone)

The recommended infusion protocol for Cordarone (amiodarone) is a 150 mg loading dose infused over 10 minutes, followed by a constant infusion of 1.0 mg/min for 6 hours, and then a maintenance infusion of 0.5 mg/min. 1, 2

Standard Infusion Protocol

Initial Loading Dose

• Administer 150 mg IV over 10 minutes 2, 3
• May be repeated in 10-30 minutes if necessary for inadequate response 3

Maintenance Infusion

• First 6 hours: 1.0 mg/min (360 mg total) 1, 2
• Next 18 hours: 0.5 mg/min (540 mg total) 1, 2
• Total dose over 24 hours should not exceed 2.2 g 2, 4

Administration Guidelines

• Use a volumetric infusion pump for administration 4
• For infusions longer than 1 hour, do not exceed amiodarone concentrations of 2 mg/mL unless using a central venous catheter 4
• Administer through a central venous catheter whenever possible, especially for concentrations >2 mg/mL 4
• Use an in-line filter during administration 4
• Infusions exceeding 2 hours must be administered in glass or polyolefin bottles containing D5W 4

Monitoring Requirements

• Continuous cardiac monitoring during administration 2, 3
• Regular blood pressure monitoring to detect hypotension 2, 3
• Monitor for bradycardia and AV block 2, 3
• Monitor heart rate, blood pressure, and ECG during administration 1

Important Precautions

• Higher concentrations (>3 mg/mL) have been associated with peripheral vein phlebitis 4
• Rapid administration of standard formulations may cause hypotension, though newer aqueous formulations may have less risk 5
• Do not use evacuated glass containers for admixing due to potential precipitation 4
• Amiodarone adsorbs to PVC tubing and can leach plasticizers from IV tubing 4

Special Considerations

• Knowledge of pharmacokinetics is important as dosing varies with age, weight, hepatic and renal function 1
• Amiodarone has a very long half-life (IV: 9-36 days; Oral: 26-107 days) 2, 3
• For patients transitioning to oral therapy, dosing should account for the 50% bioavailability of oral amiodarone 4
• Infusions of antiarrhythmic drugs should generally be discontinued after 6 to 24 hours and the need for further arrhythmia management assessed 1

Potential Adverse Effects

• Hypotension, especially with rapid administration of standard formulations 5, 6
• Bradycardia and atrioventricular block 2, 3
• QT prolongation with longer-term use 3
• Hepatocellular necrosis and acute renal failure with much higher concentrations and faster rates of infusion than recommended 4