Posology. Intravenously administered amiodarone causes heart block or bradycardia in 4.9 percent of patients and hypotension in 16 percent.2 If these conditions occur, infusion of the drug should be discontinued, or the rate of infusion should be reduced. If the measured QTc is >500 msec (550 msec in patients with ventricular conduction abnormalities) dofetilide should be stopped. % Storage requirements: The manufacturer product information should be consulted. > 3 weeks. Because phlebitis may occur, the drug should be given through a central venous line when possible. This website also contains material copyrighted by 3rd parties. Dosage for acute ingestion of unknown amount: 20 vials (760mg) of Digibind is adequate to treat most life-threatening ingestions. 2 Patients who received intravenous Advise patients that most manufacturers of corneal refractive laser surgery devices consider corneal refractive laser surgery contraindicated in patients taking this drug. The net effect is to shift the equilibrium away from binding of digoxin to its receptors in the body, thereby reversing its effects. All of these events should be manageable in the proper clinical setting in most cases. Infusion*: <1 week The only information that I could find about PO to IV conversion involved patients who are stabilized on amiodarone PO for 4 months or longer. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Initial Daily Dose of Oral Cordarone : 800-1600 mg, Duration of Cordarone I.V. Such patients should not be given dronedarone. In a retrospective survey of 192 patients with ventricular tachyarrhythmias, 84 required dose reduction and 18 required at least temporary discontinuation because of adverse effects, and several series have reported 15% to 20% overall frequencies of discontinuation due to adverse reactions. Attempts to substitute other antiarrhythmic agents when this drug must be stopped will be made difficult by the gradually, but unpredictably, changing body burden of this drug. Fab dose based on serum drug level postdistribution: Fab dose based on serum drug level postdistribution: Digoxin: No. Hypotension (refractory to dopamine/dobutamine): Initial (continuous infusion): 1 mcg/minute (range: 1-10 mcg/minute); titrate to desired effect; severe cardiac dysfunction may require doses >10 mcg/minute (up to 0.1 mcg/kg/minute). After the first 24 hours, the maintenance infusion rate of 0.5 mg/min (720 mg/24 hours) should be continued utilizing a concentration of 1 to 6 mg/mL (Cordarone I.V. Use Alaris LVP with Guardrails and select amIODAROne LOAD - = 60 kg in Critical Care Adult or Coronary Care Unit profile. Amiodarone 150 mg/3 ml Concentrate for Solution for Injection/Infusion Active Ingredient: amiodarone hydrochloride Company: Bowmed Ibisqus Limited See contact details About Medicine Prescription only medicine Healthcare Professionals (SmPC) Patient Leaflet (PIL) This information is for use by healthcare professionals Consider stopping amiodarone; causal relationship is uncertain. Administration of Cordarone in divided doses with meals is suggested for total daily doses of 1,000 mg or higher, or when gastrointestinal intolerance occurs.) Obtain first level within 24 hours of digitalization. Factors that increase likelihood of digoxin toxicity: Hypokalemia, hypomagnesaemia, hypothyroidism, renal dysfunction, interacting drugs (eg quinidine, verapamil). Amiodarone has a variable oral bioavailability. The initial infusion rate should not exceed 30 mg/min. Also, an in-line filter should be used during administration. Supplied: 150 mg, 200 mg, 250 mg capsule. Approved for acute termination. Cordarone IV may be used alone or with other How many mg/minute of amiodarone is infusing? concentrations greater than 2 mg/ml should be administered via a central venous catheter). Onset of the antiarrhythmic effect of intravenous amiodarone occurs in less than 30 minutes.15, In the Advanced Cardiac Life Support (ACLS) guidelines published in 2000, amiodarone and procainamide are recommended for the initial treatment of hemodynamically stable wide-complex tachycardia.16 However, these guidelines list amiodarone as being only possibly effective for the treatment of refractory pulseless ventricular tachycardia or ventricular fibrillation. Amiodarone: I.V. Unfortunately, there is substantial interpatient variability in response time to IV amiodarone, and the bioavailability of the oral form is also quite variable ranging from 30% to 70%. Adenosine is thought to exert its pharmacological effects through activation of purine receptors (cell-surface A1 and A2 adenosine receptors). WebAmiodarone IV-Oral conversion and loading Calculation (s) used Determine the appropriate oral loading regime based on the cumulative dose received via the IV route, as follows: - (Doses <0.5 mg have been associated with paradoxical bradycardia.). Assuming that the plan was not to load the patient, you could simply convert to an equivalent IV dose. Thyroid abnormalities have been described in up to 10 percent of patients receiving long-term amiodarone therapy.2 Hyperthyroidism may result from an excess of iodine or acute thyroiditis.20 Hypothyroidism is two to four times more common than hyperthyroidism.2, In hypothyroid patients with a strong clinical indication for amiodarone, the drug may be continued with appropriate thyroid hormone supplementation. Bradycardia: 0.5 mg I.V every 5 minutes, not to exceed a total of 3 mg or 0.04 mg/kg; may give intratracheal in 1 mg/10 ml dilution only, intratracheal dose should be 2-2.5 times the I.V. Laboratory studies to assess liver and thyroid function should be performed at least every six months. May be administered once a day; twice a day dosing is recommended for total daily doses of 1000 mg or more or in patients who experience gastrointestinal tolerance. The antisympathetic action and the block of calcium and potassium channels are responsible for the negative dromotropic effects on the sinus node and for the slowing of conduction and prolongation of refractoriness in the atrioventricular (AV) node. A-fib: 10 to 15 mcg/kg IBW given as above. Data sources include IBM Watson Micromedex (updated 1 May 2023), Cerner Multum (updated 17 Apr 2023), ASHP (updated 10 Apr 2023) and others. The .gov means its official. There has been limited experience in patients receiving intravenous amiodarone for longer than 3 weeks. Cardiac Arrest: First dose: Give 300 mg (6 mL) IV direct UNDILUTED. WebDose: individualize dose PO qd; Start: 2-3 mcg/kg/dose PO qd, then adjust dose q2wk; Info: adjust dose based on TFTs; start 25% full replacement dose, then incr. Before Like class I drugs, amiodarone blocks sodium channels at rapid pacing frequencies, and like class II drugs, it exerts a noncompetitive antisympathetic action. HHS Vulnerability Disclosure, Help Half-life: 38-48 hrs. Instruct patients to avoid sun exposure and use sun-barrier creams or protective clothing. The difficulty of using this drug safely and effectively itself poses a significant risk to patients. The intracellular uptake of adenosine is mediated by a specific transmembrane nucleoside transport system. Amiodarone is used in the treatment of atrial fibrillation, although the FDA has not approved this indication. Pre- and post-treatment with amiodarone may promote successful and sustained cardioversion. Add 3 mL of Cordarone I.V. 2014;148:e15393. PMC The elimination half-life of amiodarone is highly variable and unusually long, averaging about 58 days. A meta-analysis11 of double-blind trials found the frequency of adult respiratory distress syndrome to be 1 percent annually. (150 mg) to 100 mL D5W (concentration = 1.5 mg/mL). Careers. Hypotension necessitating alterations in intravenous amiodarone therapy was reported in 3% of patients, with permanent discontinuation required in less than 2% of patients. This retrospective, observational, single-center study included cardiothoracic surgery patients who were initiated on IV amiodarone for supraventricular arrhythmia and subsequently transitioned to oral amiodarone. The rate of the maintenance infusion may be increased to achieve effective arrhythmia suppression. 5 0 obj Digoxin levels predictably double after coadministration with amiodarone.22 This increase occurs because of the inhibition of digoxin secretion from renal tubules and the inhibition of the P-glycoprotein membrane transporter system.23 The digoxin dosage should be reduced by 50 percent when amiodarone is started, and plasma digoxin levels should be monitored closely. Predicted Css= (Dose) (0.65 to 0.8)/ Digoxin clearance. ---------------------------------------Supplied: Injection, powder for reconstitution: Digibind: 38 mg. ========================= Dilution: Prescribed dose/ 50 ml NS. CRCL 40-60 ml/min: Administer 250 mcg twice daily. Dosage modification: c interval should be measured 2-3 hours after the initial dose. INFUSION endobj Copyright 2003 by the American Academy of Family Physicians. Congestive heart failure can mimic amiodarone pneumonitis and, thus, must be ruled out early in the evaluation. Ann Thorac Surg. No significant association was found between various overlap durations and AF recurrence (odds ratio (OR) 1.00, 95% CI 1.00-1.01, P = 0.9). Peak levels after 150 mg of supplemental infusions in patients with VT/VF range between 7 and 26 mg/L. Use of evacuated glass containers for admixing Cordarone I.V. Initiate this drug in a clinical setting where continuous ECGs and cardiac resuscitation are available. If liver enzyme levels are three times higher than normal, amiodarone should be discontinued unless a patient is at high risk for recurrence of life-threatening arrhythmia.2. Although amiodarone use during pregnancy is uncommon, there have been a small number of published reports of congenital goiter/hypothyroidism and hyperthyroidism associated with its oral administration. The systemic availability of oral amiodarone in healthy subjects ranges between 33% and 65%. Add 18 ml of Cordarone I.V. <>stream Loading infusions: 150 mg over the first 10 minutes (15 mg/min), followed by 360 mg over the next 6 hours (1 mg/min), Maintenance infusion: 540 mg over the remaining 18 hours (0.5 mg/min), Supplemental infusions: 150 mg over 10 minutes (15 mg/min) for breakthrough episodes of ventricular fibrillation (VF) or hemodynamically unstable ventricular tachycardia (VT). If the starting dose is 500 mcg twice daily, then adjust to 250 mcg twice daily. Amiodarone : I.V. DOSE RECOMMENDATIONS -- FIRST 24 HOURS -- Loading infusions. The recommended starting dose of Cordarone I.V. is about 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: First Rapid: 150 mg over the FIRST - 10 minutes (15 mg/min). Add 3 mL of Cordarone I.V. (150 mg) to 100 mL D5W. HOW SUPPLIED ---------------------- Treatment with Class I or III antiarrhythmics (e.g., amiodarone, flecainide, propafenone, quinidine, disopyramide, dofetilide, sotalol) or drugs that are strong inhibitors of CYP3A (e.g., ketoconazole) must be stopped before starting MULTAQ, HOW SUPPLIED MULTAQ 400-mg tablets are provided as white film-coated tablets for oral administration, oblong-shaped, engraved with a double wave marking on one side and "4142" code on the other side in:Bottles of 60 tablets, NDC 0024-4142-60 Bottles of 180 tablets, NDC 0024-4142-18 Bottles of 500 tablets NDC 0024-4142-50 Box of 10 blisters (10 tablets per blister) NDC 0024-4142-10. The site is secure. dose. The maintenance of normal sinus rhythm in patients with highly symptomatic atrial fibrillation/flutter (AFIB/AFL)HOW SUPPLIED: 5 mg/mL oral solution, Renal Dosing: Crcl <30 ml/min: Administer 50% of normal dose or 600 mg once daily. Neonatal Hypo- or Hyperthyroidism is about 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: First Rapid: 150 mg over the FIRST - 10 minutes (15 mg/min). Clinically significant hypotension during infusions was seen most often in the first several hours of treatment and was not dose related, but appeared to be related to the rate of infusion. WebIV Drip Rate Calculator. Crcl <10 ml/min: Individualize dose. In a placebo-controlled study in patients with severe heart failure requiring recent hospitalization or referral to a specialized heart failure clinic for worsening symptoms (the ANDROMEDA Study), patients given dronedarone had a greater than two-fold increase in mortality. In addition, no significant association was found between duration of overlap and rates of bradycardia (OR 1.00, 95% confidence interval (CI) 0.99-1.00, P = 0.08) or hypotension (OR 1.00, 95% CI 0.99-1.00, P = 0.21), which occurred in 35.9% and 47.3% of patients, respectively. The CYP3A4 isoenzyme is present in both the liver and intestines. Drip preparation: Add 2.5 grams/ 250 ml D5W or NS [Drip rate (ml/hr)= wt(kg) x mcg/min x 0.006 ]. HEPATOTOXICITY: Liver injury is common with this drug, but is usually mild and evidenced only by abnormal liver enzymes. Peak serum concentrations after single 5 mg/kg 15-minute intravenous infusions in healthy subjects range between 5 and 41 mg/L. IV: F~GMlILIvau88}]nv9W_%o"v2=Wo- hh J Am Coll Cardiol. Each milliliter of the Cordarone I.V. Maintenance dose should be determined according to antiarrhythmic effect as assessed by patient tolerance as well as symptoms, Holter recordings, and/or programmed electrical stimulation; some patients may require up to 600 mg/day while some can be controlled on lower doses. Injection: 80 mg/ml (10 ml) (gluconate). The long half-life is thought to be a result of the drug's slow release from lipid-rich tissues.2. Patients' on the "floors" may receive once daily IV maintenance doses, however, IV loading regimens (multiple doses) are restricted to pts on a monitor- ICU's. Mechanism of Action: Sotalol has both beta-adrenoreceptor blocking (Vaughan Williams Class II) and cardiac action potential duration prolongation (Vaughan Williams Class III) antiarrhythmic properties. CLINICAL PHARMACOLOGY After intravenous injection of Digoxin Immune Fab (Ovine) in the baboon, digoxin-specific Fab fragments are excreted in the urine with a biological half-life of about 9 to 13 hours.1 In humans with normal renal function, the half-life appears to be 15 to 20 hours.2 Experimental studies in animals indicate that these antibody fragments have a large volume of distribution in the extracellular space, unlike whole antibody which distributes in a space only about twice the plasma volume.1 Ordinarily, following administration of DIGIBIND, improvement in signs and symptoms of digitalis intoxication begins within one-half hour or less.2,3,4,5. Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). DOSE RECOMMENDATIONS -- FIRST 24 HOURS -- Loading infusions. A causal relationship is not well established. Amiodarone injection is contraindicated in patients with known hypersensitivity to any of the components of amiodarone injection, including iodine, or in patients with cardiogenic shock, marked sinus bradycardia, and second- or third-degree AV block unless a functioning pacemaker is available. Onset of action: 2-10 minutes. WebAdd 3 mL of Cordarone I.V. The affinity of DIGIBIND for digitoxin is about 108 to 109 M-1. Therefore, for infusions longer than 1 hour, Cordarone I.V. The recommended starting dose of Cordarone I.V. <> Maintenance infusion: 540 mg over the REMAINING 18 hours (0.5 mg/min). of vials = level (ng/mL) x body weight (kg) divided by 100, Digitoxin: No. You've successfully added to your alerts. Please review the latest applicable package insert for additional information and possible updates. A reduction of the resting heart rate due to the beta-blocking effect of sotalol is observed at daily doses >/=90 mg/m2 in children. Oral: 0.4 mg, may repeat every 4 to 6 hours. WebConventional IV preparation contains polysorbate 80 and benzyl alcohol Newer IV formulation (Nexterone) does not contain polysorbate 80 or benzyl alcohol Conversion to oral After a single dose of intravenous amiodarone in cirrhotic patients, significantly lower Cmax and average concentration values are seen for DEA, but mean amiodarone levels are unchanged. Despite such measures, bradycardia was progressive and terminal in 1 patient during the controlled trials. Estimation of the dose is based on the body burden of digitalis. After the first 24 hours, the maintenance infusion rate of 0.5 mg/min (720 mg/24 hours) should be continued utilizing a concentration of 1 to 6 mg/ml (Cordarone I.V. 3 0 obj Initial dose: 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: No adjustment recommended <> Recommendations for conversion to intravenous amiodarone after oral administration: During long-term amiodarone therapy (ie, 4 months), the mean plasma-elimination half-life of the active metabolite of amiodarone is 61 days. Long-Term Use INFUSION, Recommendations for conversion to intravenous amiodarone after oral administration, HONcode standard for trust- worthy health, Skeletal Muscle Index And Ovarian Cancer Prognosis: A Meta-Analysis, 7 Natural Remedies for Rheumatoid Arthritis. The patient is now taking nothing by mouth (NPO), and the physician would like to switch to intravenous (IV) amiodarone. In patients with severe left ventricular dysfunction, the pharmacokinetics of amiodarone are not significantly altered but the terminal disposition t1/2 of DEA is prolonged. Digitalis-induced progressive elevation of the serum potassium concentration also suggests imminent cardiac arrest. There is limited experience in patients receiving Cordarone I.V. WebAmiodarone is used to manage virtually all forms of supraventricular and ventricular tachycardia and has therefore become one of the most frequently used antiarrhythmic drugs in clinical practice. If you believe a loading dose is appropriate, then start him/her on IV loading while NPO. The authors report no conflicts of interest. Supplied: 200 mg, 300 mg tab (sulfate). Liver enzyme levels three times higher than normal. Stopping the infusion and restarting at a slower rate may help if infusion-related reactions occur. The rate of the maintenance infusion may be increased to achieve effective arrhythmia suppression. So I would first investigate the appropriateness of amiodarone use and its dose, and if indeed no loading approach is appropriate, I would just convert the patient to an equipotent IV dose while he/she is NPO. 324 mg extended release tab (gluconate). If cardiac arrest is imminent, may give as a bolus. Advise patients to moderate alcohol consumption while taking this drug. 3.Drug in bag. Patients with the indicated arrhythmias must be hospitalized while the loading dose is given, and a response generally requires at least one week, usually two or more. We comply with the HONcode standard for trustworthy health information. The patient is obviously at great risk during this time and may need prolonged hospitalization. The highly variable systemic availability of oral amiodarone may be attributed potentially to large interindividual variability in CYP3A4 activity. Renal Dosing: CRCL <10 ml/minute: Decrease usual dose by 25% to 50% in severe renal impairment. <>stream One of its main effects, with prolonged administration, is to lengthen the cardiac action potential, a class III effect. Amiodarone is considered to be a class III drug (Vaughan Williams classification), which indicates that it prolongs the QT interval. Frendl G, Sodickson AC, Chung MK, et al. Amiodarone hydrochloride should only be used when facilities exist for cardiac monitoring, defibrillation, and cardiac pacing. When switching from another antiarrhythmic, initiate a 200 mg dose 6-12 hours after stopping former agents, 3-6 hours after stopping procainamide. PO to IV Amiodarone Switch-Medscape-Apr22,2004. Inform patients administering this drug to do so consistently with regard to meals. Stop amiodarone; initiate corticosteroid therapy. [720 mg / 500 ml ] [See comments] If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential harm to the fetus. May consider giving 10 vials, observing the patient's response, and following with an additional 10 vials. RECOMMENDATIONS FOR ORAL DOSAGE AFTER I.V. by 25% full replacement dose qwk if hyperactivity risk; give PO form on empty stomach, 30-60min before morning meal; IM/IV dose is 50-75% of PO dose [>12 yo, growth/puberty complete] When the maintenance dose is given IV, the onset and peak will occur earlier, however the duration of action is the same. IV compatibility: The manufacturer product information should be consulted. Initial Daily Dose of Oral Cordarone : 400 mg infusion: 140 mcg/kg/minute for 6 minutes using syringe or columetric infusion pump; total dose: 0.84 mg/kg. See table. Amiodarone: I.V. A filter is not required for IV direct administration. *Assuming a 720 mg/day infusion (0.5 mg/min). Clipboard, Search History, and several other advanced features are temporarily unavailable. Half life: 9 minutes. WebIntravenous procainamide (Procainamide Hydrochloride Injection) is effective in cardioversion in up to 60 percent of patients in uncontrolled series. Supplied: Adenocard: 3 mg/ml (2 ml, 4 ml) Adenoscan: 3 mg/ml (20 ml, 30 ml). This has occurred in 2% to 5% of patients in various series, and significant heart block or sinus bradycardia has been seen in 2% to 5%. Copyright 2021 GlobalRPH - Web Development by. Increased incidence of myopathy when simvastatin dosage is higher than 20 mg per day, Increased sildenafil plasma concentration, Increased cyclosporine plasma concentration, Additive effects: possible elevated plasma concentrations of quinidine, disopyramide (Norpace), flecainide (Tambocor), propafenone (Rythmol), and dofetilide (Tikosyn), Additive QT effect: possible increased risk of proarrhythmia, Increased plasma concentration of hepatically metabolized drugs: possible increased risk of proarrhythmia, Complete history and physical examination, with special attention to congestive heart failure, arrhythmia symptoms, and concomitant medications, Thyroid studies and liver transaminase levels, Digoxin level, prothrombin time, and INR, when appropriate, Ophthalmologic examination (if preexisting visual impairment), Close surveillance of heart rate, especially during first week of treatment, History and physical examination directed at detecting anticipated adverse effects, Close monitoring of prothrombin time and INR (at least once a week during first six weeks of treatment). Amiodarone is a potent inhibitor of the hepatic and renal metabolism of several drugs (Table 3).4,2125 Amiodarone inhibits metabolism through several cytochrome P450 pathways, including CYP 2C9 (which metabolizes warfarin [Coumadin]), CYP 2D6 (which metabolizes several beta blockers and narcotics), and CYP 3A4 (which metabolizes cyclosporine [Sandimmune] and calcium channel blockers). Recommendations for conversion to intravenous amiodarone after oral administration: During long-term amiodarone therapy (ie, 4 months), the mean plasma-elimination half-life of the active metabolite of amiodarone is 61 days. 800 to 1,600 mg per day in divided doses until a total of 10 g has been given; then 200 to 400 mg per day. Patients with a known predisposition to bradycardia or AV block should be treated with intravenous amiodarone in a setting where a temporary pacemaker is available. Amiodarone injection belongs to the group of medicines known as antiarrhythmics. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Reconstitution: Dissolve each vial with 4 ml sterile water (do not shake). Duration of Cordarone I.V. Amiodarone is a potent antiarrhythmic agent that is used to treat ventricular arrhythmias and atrial fibrillation. Peripheral neuropathy has been reported to occur at a rate of 0.3 percent annually.11. 6 0 obj WebCriteria required for IV antibiotics prior to PO conversion: Tmax < 100.4F in the previous 24 hours WBC is normalizing Absence of neutropenia (defined as ANC < 500/mm3) Meets no exclusion criteria Exclusion Criteria Patient is NPO, meaning at least one of the following: Active NPO order in the chart All medications by the non-oral route
