Amiodarone Dilution for 6-Hour Infusion
Dilute 350 mg of amiodarone in 175 mL of 5% dextrose (D5W) to achieve a concentration of 2 mg/mL for the 6-hour maintenance infusion. 1
Standard Dilution Protocol
The concentration of amiodarone for continuous infusion should not exceed 2 mg/mL unless administered through a central venous line. 2 For a 6-hour infusion of 350 mg:
- Total volume needed: 175 mL of D5W
- Final concentration: 2 mg/mL (350 mg ÷ 175 mL)
- Infusion rate: Approximately 29 mL/hour over 6 hours
This follows the American Heart Association's recommendation that amiodarone must be diluted with D5W specifically, not normal saline or other solutions. 2
Critical Administration Requirements
Use a central venous catheter whenever possible. 1, 3 Peripheral vein phlebitis occurs frequently with concentrations exceeding 2 mg/mL, making central access strongly preferred for prolonged infusions. 1, 3 If only peripheral access is available and the infusion duration exceeds 1 hour, the 2 mg/mL concentration limit becomes mandatory. 1
An in-line filter should be used during administration to prevent particulate matter from entering the circulation. 4
Standard Dosing Context
The 350 mg dose over 6 hours represents part of the standard maintenance protocol. The complete American Heart Association regimen consists of: 1, 3
- Loading dose: 150 mg IV over 10 minutes (diluted in 100 mL D5W)
- First maintenance: 1 mg/min for 6 hours (360 mg total)
- Second maintenance: 0.5 mg/min for remaining 18 hours (540 mg total)
Your 350 mg dose closely approximates the first 6-hour maintenance phase (360 mg at 1 mg/min = 60 mg/hour × 6 hours). 1
Monitoring During Infusion
Continuous ECG monitoring is mandatory throughout the entire infusion period. 1, 4 Specifically monitor for:
- Heart rate changes (reduce infusion rate if heart rate decreases by 10 beats/minute) 4, 3
- Hypotension (occurs in 16% of IV amiodarone patients and persists throughout maintenance infusion, not just during loading) 5
- Bradycardia (occurs in 4.9% of patients) 4
- AV conduction abnormalities and heart block 1, 4
- QT interval prolongation 1
Common Pitfall to Avoid
Do not use normal saline or lactated Ringer's solution for dilution. Amiodarone is only compatible with D5W for intravenous administration. 2 Using other diluents can cause precipitation and loss of drug efficacy.
Do not exceed 2 mg/mL concentration without central venous access, as this significantly increases the risk of severe phlebitis and tissue damage at peripheral sites. 1