What are the uses of Amiodarone (antiarrhythmic medication) in situations other than Supraventricular Tachycardia (SVT)?

From the Guidelines

Amiodarone is a highly effective antiarrhythmic medication that can be used beyond supraventricular tachycardia (SVT) for various cardiac rhythm disorders, including ventricular arrhythmias and atrial fibrillation, with a recommended dosage of 150 mg IV bolus over 10 minutes, followed by an infusion of 1 mg/min for 6 hours, then 0.5 mg/min for 18 hours, as supported by 1.

Key Points

• Amiodarone is effective for ventricular arrhythmias, including ventricular tachycardia and ventricular fibrillation, with a dosage of 150 mg IV bolus over 10 minutes, followed by an infusion of 1 mg/min for 6 hours, then 0.5 mg/min for 18 hours, as stated in 1.
• For long-term management, oral dosing typically begins with a loading dose of 800-1600 mg daily for 1-2 weeks, followed by 600-800 mg daily for 1 month, then a maintenance dose of 200-400 mg daily, as outlined in 1.
• Amiodarone is also used for atrial fibrillation, particularly when rate control is inadequate or when cardioversion is planned, with a dosage of 600-800 mg per day in divided doses until a total of 10 g has been given, then 200 mg per day, as recommended in 1.
• The drug works by blocking multiple ion channels (sodium, potassium, calcium) and has alpha and beta-blocking properties, providing broad antiarrhythmic effects, as explained in 2.
• However, amiodarone requires careful monitoring due to potential serious side effects, including pulmonary toxicity, thyroid dysfunction, liver abnormalities, and corneal deposits, as warned in 3.
• Baseline and periodic assessments of pulmonary, thyroid, and liver function are essential during treatment, as emphasized in 4.
• Amiodarone may be particularly beneficial in patients with rapid ventricular rates or impaired renal function, as suggested in 1.
• The use of low-dose amiodarone (200 mg daily or less) may be effective and may be associated with fewer side effects, as noted in 5.

From the FDA Drug Label

Amiodarone HCl injection is indicated for initiation of treatment and prophylaxis of frequently recurring ventricular fibrillation and hemodynamically unstable ventricular tachycardia in patients refractory to other therapy. Amiodarone HCl injection also can be used to treat patients with VT/VF for whom oral amiodarone is indicated, but who are unable to take oral medication

The usage of amiodarone is indicated for ventricular fibrillation and hemodynamically unstable ventricular tachycardia in patients refractory to other therapy, and for patients with VT/VF who cannot take oral medication. Key points are:

• Ventricular fibrillation: amiodarone can be used for initiation of treatment and prophylaxis.
• Ventricular tachycardia: amiodarone can be used for initiation of treatment and prophylaxis, specifically for hemodynamically unstable cases.
• Transfer to oral therapy: patients can be transferred to oral amiodarone therapy after treatment with amiodarone HCl injection 6. There is no information about the use of amiodarone in situations other than SVT, ventricular fibrillation, or ventricular tachycardia.

From the Research

Amiodarone Usage Beyond SVT

Amiodarone is used in various clinical settings beyond the treatment of supraventricular tachycardia (SVT). Some of these uses include:

• Treatment and prevention of ventricular fibrillation and ventricular tachycardia 7
• Prevention of life-threatening ventricular arrhythmias in patients at high risk 7
• Treatment of electrical storm in patients with implantable cardioverter defibrillators (ICDs) 7
• Management of atrial fibrillation and atrial flutter 8, 9

Clinical Efficacy and Safety

The efficacy and safety of amiodarone in these situations have been demonstrated in several studies:

• Amiodarone has been shown to be effective in terminating and preventing ventricular arrhythmias in patients with shock refractory out-of-hospital cardiac arrest and hemodynamically destabilizing ventricular arrhythmia 7
• The drug has a high therapeutic index and is safe for use in pharmacologic cardioversion of supraventricular tachyarrhythmias 8, 9
• However, amiodarone can cause several side effects, including thyroid abnormalities, pulmonary fibrosis, and transaminitis, which require routine monitoring 10

Dosage and Administration

The dosage and administration of amiodarone vary depending on the clinical setting:

• For ventricular tachyarrhythmias, amiodarone can be administered intravenously in a dose of up to 2400 mg in 24 hours 7, 11
• For supraventricular tachyarrhythmias, a single infusion of amiodarone up to 2 hours after the restoration of a stable sinus rhythm or up to a maximum dose of 2400 mg in 24 hours can be effective 8, 9
• Careful preparation and delivery of amiodarone are necessary to achieve safe and effective outcomes 11