From the Guidelines
The protocol for converting oral amiodarone to intravenous (IV) amiodarone is not directly addressed in the provided evidence, but the conversion from IV to oral amiodarone is described.
- When converting from IV to oral amiodarone, the dosage depends on the duration of IV treatment:
- Patients who received IV amiodarone for less than one week should take 800 to 1,600 mg oral amiodarone per day 1.
- Patients who received IV amiodarone for one to three weeks should take 600 to 800 mg oral amiodarone per day 1.
- Patients who received IV amiodarone for more than three weeks should take 400 mg oral amiodarone per day 1.
- The IV dosing of amiodarone typically starts with a 150-mg IV bolus over 10 minutes, followed by 1 mg per minute for 6 hours, and then 0.5 mg per minute for 18 hours 1.
- It is essential to note that amiodarone can cause significant adverse effects, including hypotension, bradycardia, atrioventricular block, QT prolongation, GI upset, constipation, and rarely, torsades de pointes 1.
- The choice of amiodarone and its dosing should be individualized based on the patient's response and the specific clinical context, considering the potential benefits and risks 1.
From the FDA Drug Label
Patients whose arrhythmias have been suppressed by amiodarone may be switched to oral amiodarone The optimal dose for changing from intravenous to oral administration of amiodarone will depend on the dose of intravenous amiodarone already administered, as well as the bioavailability of oral amiodarone. Table 4 provides suggested doses of oral amiodarone to be initiated after varying durations of amiodarone administration These recommendations are made on the basis of a similar total body amount of amiodarone delivered by the intravenous and oral routes, based on 50% bioavailability of oral amiodarone.
The protocol for converting oral amiodarone to intravenous (IV) amiodarone is not directly addressed in the provided drug labels. However, the protocol for converting IV amiodarone to oral amiodarone is provided.
- The optimal dose for changing from IV to oral administration of amiodarone will depend on the dose of IV amiodarone already administered, as well as the bioavailability of oral amiodarone.
- Table 4 provides suggested doses of oral amiodarone to be initiated after varying durations of amiodarone administration.
- These recommendations are made on the basis of a similar total body amount of amiodarone delivered by the IV and oral routes, based on 50% bioavailability of oral amiodarone 2.
From the Research
Protocol for Converting Oral Amiodarone to Intravenous (IV) Amiodarone
- The protocol for converting oral amiodarone to IV amiodarone is not explicitly stated in the provided studies 3, 4, 5, 6, 7.
- However, study 6 discusses the transition of critically ill patients from IV to oral amiodarone, and found that providing IV and PO overlap of amiodarone for a median of 4 hours did not decrease the rate of early tachyarrhythmia recurrence.
- Study 4 mentions that IV amiodarone has been used as a bolus only or as a bolus followed by a continuous IV infusion until conversion or up to 24 hours, with doses ranging from 3 to 7 mg/kg body weight for the bolus and 900 to 3000 mg/day for the infusion.
- Study 5 notes that high-dose IV or combined IV and oral administration of amiodarone may be effective for acute conversion of atrial fibrillation to normal sinus rhythm in patients with recent-onset atrial fibrillation of <48 hour duration.
Key Considerations
- The dosage and administration of IV amiodarone may vary depending on the specific clinical scenario and patient population 4, 5.
- The use of IV amiodarone should be carefully considered in patients with certain medical conditions, such as structural heart disease or left ventricular systolic dysfunction 4, 5.
- The formulation of IV amiodarone can impact medication safety, with newer formulations such as PM101 potentially reducing the risk of adverse events and pharmaceutical incompatibilities 7.