How do you prepare an amiodarone intravenous infusion drip?

Amiodarone Intravenous Infusion Preparation and Administration

Prepare amiodarone by administering an initial loading dose of 150 mg diluted in 100 mL D5W infused over 10 minutes, followed by a maintenance infusion of 1 mg/min for 6 hours (360 mg), then 0.5 mg/min for the remaining 18 hours (540 mg), with a maximum total dose of 2.2 g over 24 hours. 1, 2, 3

Standard Preparation Protocol

Loading Dose

• Mix 150 mg amiodarone in 100 mL of D5W 2, 3
• Infuse over 10 minutes using a volumetric infusion pump (never use drop counter sets, as they can underdose by up to 30%) 3
• For cardiac arrest with VF/pulseless VT unresponsive to defibrillation, use 300 mg IV/IO bolus, with a second 150 mg bolus if rhythm persists 2

Maintenance Infusion Preparation

• First 6 hours: 1 mg/min (total 360 mg over 6 hours) 1, 2, 3
• Next 18 hours: 0.5 mg/min (total 540 mg over 18 hours) 1, 2, 3
• Prepare concentrations of 1-6 mg/mL depending on access 3

Critical Administration Requirements

Vascular Access and Concentration Rules

• For concentrations >2 mg/mL, a central venous catheter is mandatory 2, 3
• For infusions >1 hour, do not exceed 2 mg/mL concentration unless using a central line to prevent severe peripheral vein phlebitis 2, 3
• Concentrations >3 mg/mL are associated with high incidence of peripheral vein phlebitis 3

Equipment and Container Requirements

• Use only glass or polyolefin bottles containing D5W for infusions exceeding 2 hours 3
• Do not use evacuated glass containers for admixing, as buffer incompatibility may cause precipitation 3
• Use an in-line filter during administration 3
• Must use a volumetric infusion pump (drop counters cause 30% underdosing) 3
• Administer through a dedicated central venous catheter whenever possible 3

Supplemental Dosing for Breakthrough Arrhythmias

• For breakthrough VF or hemodynamically unstable VT: administer 150 mg supplemental bolus mixed in 100 mL D5W over 10 minutes 3
• Maximum of 6-8 supplemental boluses in any 24-hour period 1
• Do not exceed initial infusion rate of 30 mg/min 3
• Total daily dose should not exceed 2.2 g over 24 hours (mean daily doses >2100 mg associated with increased hypotension risk) 2, 3

Monitoring Requirements During Infusion

Immediate Monitoring

• Continuous cardiac monitoring for hypotension (occurs in 16% of IV patients), bradycardia (4.9%), AV block, and QT prolongation 2, 4
• Blood pressure monitoring every 5-10 minutes during loading dose 4
• Watch for phlebitis at infusion site if using peripheral access 2

High-Risk Populations Requiring Extra Caution

• Patients with severe left ventricular dysfunction: significant hypotension risk during loading phase 5
• Hepatic dysfunction: use with extreme caution, as higher concentrations and faster rates than recommended have caused hepatocellular necrosis and acute renal failure leading to death 3

Absolute Contraindications

Do not administer amiodarone without a functioning pacemaker in patients with: 2

• Second- or third-degree AV block
• Sick sinus syndrome
• Severe sinus node dysfunction

Critical Drug Incompatibilities

Use separate IV lines for these medications (amiodarone forms precipitates with): 3

• The FDA label specifies multiple Y-site incompatibilities requiring dedicated IV access 3

Dose adjustments required for: 4

• Digoxin: reduce dose by 50% (levels will double) 4
• Warfarin: reduce dose by 33-50%, monitor INR at least weekly (interaction peaks at 7 weeks) 4
• Avoid concomitant QT-prolonging drugs without expert consultation 4

Duration of Therapy

• Maintenance infusion of 0.5 mg/min can continue for 2-3 weeks regardless of age, renal function, or left ventricular function 3
• Limited experience beyond 3 weeks of continuous IV therapy 3
• When transitioning to oral: use 400-600 mg daily in divided doses for 2-4 weeks, then 100-200 mg daily maintenance 4