Page 120 - 2023 SMOG Digital

AMIODARONE Lactation: Yes, Not Recommended
Class / Mechanism of Action
Antiarrhythmic Agent, Class III
Inhibits adrenergic stimulation (alpha and beta blocking), prolongs action potential and refractory period
(prolongs PR and QT intervals); decreases AV conduction and sinus node function (decreases sinus rate)
Indications
Labeled Indications: Management of life-threatening recurrent ventricular fibrillation (VF) or
hemodynamically unstable ventricular tachycardia (VT) refractory to other antiarrhythmic agents
Unlabeled:
• Recurrent, hemodynamically unstable VT. (after other drugs have failed)
• Ventricular tachyarrhythmias (ACLS/PALS 2015): VF/VT Cardiac arrest unresponsive to CPR, Shock,
and Vasopressor.
Contraindications
• Hypersensitivity to amiodarone, iodine, or any component of the formulation
• Severe sinus-node dysfunction
• 2 nd and 3 rd degree heart block (except in patients with a functioning artificial pacemaker)
• Bradycardia causing syncope (except in patients with a functioning artificial pacemaker)
• Cardiogenic shock
Adverse Reactions / Precautions
• Complex drug with multiple complex drug reactions! (Do not administer with procainamide)
• Hypotension
• Dizziness, fatigue, Headache, Poor coordination, Neuropathy
• Nausea, Vomiting
• Dysrhythmias, Asystole, AF, Bradycardia, AV block, Conduction abnormalities, SA node dysfunction
Dose and Administration: ADULT PEDIATRIC Always Reference BROSELOW Tape
Pulseless VT or VF (ACLS, 2015): Pulseless VT or VF (PALS, 2015):
IV/IO push IV/IO push
• 300mg rapid bolus; should be diluted in 30mL • 5mg/kg IV bolus during cardiac arrest, May
of NS, Plasmalyte, or D5W; if pulseless VT or repeat twice for refractory VF/pulseless VT.
VF continues after subsequent defibrillation • Max single dose: 300mg
attempt or recurs, administer supplemental
dose of 150mg. Tachycardia with Pulse and poor perfusion, or
symptomatic with adequate perfusion (PALS,
Recurrent, Hemodynamically unstable VT 2015):
(ACLS, 2015): IV/IO push
Initial Dose: • Loading dose: 5mg/kg over 20–60min (Fast
IV/IO slow push push or bolus can precipitate cardiac failure!)
• 150mg IV over 1 st 10 minutes (15mg per min) • Can repeat two times (max dose: 15mg/kg in
dilute in 100ml of NS, PlasmaLyte, or D5W 24hr)
(concentration 1.5mg/ml).
• May repeat 150mg q10min prn if VT recurs • Max single dose: 300mg
Maintenance Infusion following initial dosing:
• 360mg over 6 hours (1mg/min) dilute in
500ml of NS, PlasmaLyte, or D5W
(concentration 0.72mg/ml).

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