Oral Loading - Half-life elimination: 40-55 days (range: 26-107 days); 3 0 obj Copyright 2022 Wolters Kluwer Health, Inc. All rights reserved. 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: CORDARONE I.V. DOSE RECOMMENDATIONS FIRST 24 HOURS Loading infusions First Rapid: 150 mg over the FIRST 10 minutes (15 mg/min). 1.Desired Dose. A loading regimen (i.e., use of a relatively high dosage at the beginning of therapy) can shorten the delay. Reconstitution/preparation techniques: The manufacturer product information should be consulted. Various practice guidelines recommend amiodarone as a second-line drug in the long-term treatment of atrial fibrillation in patients with structural heart disease and in highly symptomatic patients without heart disease.10 Several smaller studies have shown that amiodarone is similar to quinidine and sotalol in the treatment of atrial fibrillation in these patients.11,12 In one randomized controlled trial (RCT),12 sinus rhythm was maintained successfully for 16 months in 65 percent of patients treated with amiodarone, compared with 37 percent of patients treated with sotalol or propafenone (ARR, 28 percent; NNT, 3.6). If cardiac arrest is imminent, may give as a bolus. Initiate this drug in a clinical setting where continuous ECGs and cardiac resuscitation are available. contains polysorbate 80, which is known to leach di-(2-ethylhexyl)phthalate (DEHP) from polyvinylchloride (PVC) (see DOSAGE AND ADMINISTRATION). IV to oral transition (infusion duration 2014;148:e15393. endobj Amiodarone does not need to be protected from light during administration. If severe, stop amiodarone or insert pacemaker. Medically reviewed by Drugs.com. Commenting is limited to medical professionals. concentrations should not exceed 2 mg/mL unless a central venous catheter is used. Renal Dosing: crcl 10-50 ml/minute: Administer every 6-12 hours. INFUSION Duration of Cordarone I.V. crcl <10 ml/minute: Administer every 8-24 hours. Cordarone IV is a prescription medicine used to treat the symptoms of irregular heart rhythm (Ventricular Arrhythmias). In clinical trials, treatment-emergent, drug-related hypotension was reported as an adverse effect in 288 (16%) of 1836 patients treated with intravenous amiodarone. government site. This adverse effect occurs at a rate of 0.6 percent annually.11, Patients with liver toxicity are rarely symptomatic. Any report from the patient of worsening dyspnea or cough should elicit a prompt assessment for pulmonary toxicity. Pharmacokinetics Reconstitution: Dissolve each vial with 4 ml sterile water (do not shake). Hepatic impairment: Reduce dose by 50%. Patients taking amiodarone should not eat grapefruit or drink grapefruit juice because it can inhibit the conversion of amiodarone to an active metabolite. Refractory ventricular fibrillation: Repeat 1.5 mg/kg bolus may be given 3-5 minutes after initial dose. Loading Dose (Daily): (Ventricular Arrhythmias) 800 to 1,600 mg x 1-3 weeks, then 600 to 800 mg x ~1 month, then start maintenance of 400mg/day. The patient is now taking nothing by mouth (NPO), and the physician would like to switch to intravenous (IV) amiodarone. Renal Dosing: CRCL <10 ml/minute: Decrease usual dose by 25% to 50% in severe renal impairment. Typical amiodarone dosages in the ACLS setting are provided in Table 1.2,10 In patients who require long-term treatment, intravenous dosing should be switched to oral dosing. 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 *Assuming a 720 mg/day infusion (0.5 mg/min). A-fib: 10 to 15 mcg/kg IBW given as above. Stopping the infusion and restarting at a slower rate may help if infusion-related reactions occur. Peripheral neuropathy has been reported to occur at a rate of 0.3 percent annually.11. concentrations greater than 2 mg/mL should be administered via a central venous catheter). Although the U.S. Food and Drug Administration (FDA) has labeled amiodarone only for the treatment of life-threatening ventricular arrhythmias, the drug also is used to treat atrial fibrillation. The primary treatment for pulmonary toxicity is withdrawal of amiodarone and provision of supportive care and, in some cases, corticosteroids. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Cordarone I.V is not intended for maint therapy. <> Hypotension is the most common adverse effect seen with intravenous amiodarone. The affinity of DIGIBIND for digitoxin is about 108 to 109 M-1. Consider stopping amiodarone; causal relationship is uncertain. Patients treated with amiodarone should be followed regularly to assess ongoing need for amiodarone, efficacy of the drug, appropriateness of dosage, adverse effects, and potential drug interactions. If intravenous amiodarone is administered during pregnancy, the patient should be apprised of the potential hazard to the fetus. Copyright 2021 GlobalRPH - Web Development by, RECOMMENDATIONS FOR ORAL DOSAGE AFTER I.V. 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%. If the QTc >15% of baseline, or if the QTc is >500 msec (550 msec in patients with ventricular conduction abnormalities), dofetilide should be adjusted. El-Chami MF, Kilgo P, Thourani V, et al. Add 3 mL of Cordarone I.V. Hepatic impairment: Maximum daily dose: 1200 mg. Factors that increase likelihood of digoxin toxicity: Hypokalemia, hypomagnesaemia, hypothyroidism, renal dysfunction, interacting drugs (eg quinidine, verapamil). PMC Adenosine is thought to exert its pharmacological effects through activation of purine receptors (cell-surface A1 and A2 adenosine receptors). In some cases, hypotension may be refractory resulting in fatal outcome (see package insert for ADVERSE REACTIONS, Postmarketing Reports). How many mg/minute of amiodarone is infusing? This dose can be used in patients in acute distress or when a serum concentration is not available. Replacement therapy may not be necessary in such patients if oral therapy is discontinued for a period <2 weeks, since any changes in serum amiodarone concentrations during this period may not be clinically significant. Pharmacologic stress agent (Adenoscan): Continuous I.V. Crcl <10 ml/min: Individualize dose. In patients receiving oral amiodarone therapy, there may be a delay of two weeks or more before antiarrhythmic effects are noted. 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). Thallium-201 is injected at midpoint (3 minutes) of infusion. 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. Therefore, physicians must use the lowest possible dosage of amiodarone and, if possible, discontinue treatment if adverse effects occur. Our study suggests following conversion to normal sinus rhythm; cardiothoracic surgery patients can effectively and safely be transitioned from IV to oral amiodarone without the need for specific overlap duration or transition strategy. From in vitro studies, the protein binding of amiodarone is >96%. Congestive heart failure can mimic amiodarone pneumonitis and, thus, must be ruled out early in the evaluation. (150 mg) to 100 mL D5W (concentration = 1.5 mg/mL). 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. [Loading: 10 to 15 mcg/kg IBW in divided doses (q4-8h) over 12-24hrs.] Peak concentrations after 10-minute infusions of 150 mg intravenous amiodarone in patients with ventricular fibrillation (VF) or hemodynamically unstable ventricular tachycardia (VT) range between 7 and 26 mg/L. Infusion*: <1 week CRCL 40-60 ml/min: Administer 250 mcg twice daily. See table. of vials = level (ng/mL) x body weight (kg) divided by 100, Digitoxin: No. One of its main effects, with prolonged administration, is to lengthen the cardiac action potential, a class III effect. (Enter numeric value only. Due to rapid distribution, serum concentrations decline to 10% of peak values within 30 to 45 minutes after the end of the infusion. Mechanism of Action Adenosine is a potent vasodilator in most vascular beds, except in renal afferent arterioles and hepatic veins where it produces vasoconstriction. Amiodarone crosses the placenta and reaches measurable levels in breast milk. Its vasodilatory action can decrease cardiac workload and consequently myocardial oxygen consumption. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. After absorption, the drug undergoes extensive enterohepatic circulation. Neither amiodarone nor DEA is dialyzable. Amiodarone is an iodinated benzofuran derivative that was synthesized and tested as an antianginal agent in the 1960s but was later discovered to have antiarrhythmic Adenosine may also lessen vascular tone by modulating sympathetic neurotransmission. Many factors (ie, age, weight, sex, other comorbid conditions, indication for amiodarone use [atrial vs ventricular arrhythmias as well as treatment vs prophylaxis for an arrhythmia], and history of prior antiarrhythmic use) need to be considered to weigh risk vs benefit of amiodarone use as well as a decision to load or not to load. Slow digoxin loading Slow oral digitalization, generally preferred for most patients, can be achieved by starting a maintenance dose of 0.125 to 0.25 mg daily. Repeat history, physical exam, and chest X-ray every 3 to 6 months. Half life: 9 minutes. Adverse reactions: sinus bradyarrhythmias; AV block; N/V/D; yellow vision and hallucinations; supra and ventricular arrhythmias. DEA serum concentrations above 0.05 mg/L are not usually seen until after several days of continuous infusion but with prolonged therapy reach approximately the same concentration as amiodarone. If you log out, you will be required to enter your username and password the next time you visit. 2 Patients who received intravenous Amiodarone injection belongs to the group of medicines known as antiarrhythmics. IV compatibility: The manufacturer product information should be consulted. Bethesda, MD 20894, Web Policies Obtain baseline and periodic liver transaminases and discontinue or reduce dose if the increase exceeds three times normal, or doubles in a patient with an elevated baseline. 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. In addition to blocking sodium channels, amiodarone blocks myocardial potassium channels, which contributes to slowing of conduction and prolongation of refractoriness. CONTRAINDICATIONS MeSH +*59mQau]pR+T7{vN2{pU[9jY0HR{Ui&IljC,7mh-`}pJ1l!:s(tG$IS|-L[UFrYfFqj9'FPaP9*?&L,?uH`Xp2YdCq1X,Q>Rxw:se2Uk;XuHepn dGB$rRE*17wAp_gCw88lg# wBEaz-EBpzxjcTE)a- WIT In children, a Class III electrophysiological effect can be seen at daily doses of 210 mg/m2 body surface area (BSA). Not preferred drug for PSVT because it is not rapidly effective (may take up to 60 minutes). 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. The major metabolite of amiodarone is desethylamiodarone (DEA), which is known to have antiarrhythmic properties. Although no dosage adjustment for patients with renal, hepatic, or cardiac abnormalities has been defined during chronic treatment with oral amiodarone, close clinical monitoring is prudent for elderly patients and those with severe left ventricular dysfunction. The recommended starting dose of Cordarone I.V. based on a 1:2.5 conversion from IV to PO: = Link to online calculator. A naive look at this scenario gives the impression that the patient has not been started on an oral loading dose of amiodarone. Supplied: 250 mg, 500 mg capsule. 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.) If patient is < 60kg give 0.01 mg/kg over 10 minutes. Assuming that the plan was not to load the patient, you could simply convert to an equivalent IV dose. J Am Coll Cardiol. concentrations greater than 3 mg/mL in D5W have been associated with a high incidence of peripheral vein phlebitis; however, concentrations of 2.5 mg/mL or less appear to be less irritating. 1 0 obj If you believe a loading dose is appropriate, then start him/her on IV loading while NPO. Initial Daily Dose of Oral Cordarone : 600-800 mg. WebA = Airway - Assess for airway obstruction, assess for breathing, perform intubation B = Breathing - Ventilate with 100% oxygen, 10-24 breaths/minute C = Circulation - Assess for heart beat and pulses if absent, begin chest compressions, 100-120 compressions/minute Begin ADVANCED life support Obtain Electrocardiogram and Determine Arrest Rhythm official website and that any information you provide is encrypted This article reviews the pharmacology, indications, adverse effects, and drug interactions of amiodarone, and outlines a strategy for surveillance of patients who are taking this drug. WebIntravenous procainamide (Procainamide Hydrochloride Injection) is effective in cardioversion in up to 60 percent of patients in uncontrolled series. Intravenous amiodarone therapy should not be used in patients with bradycardia or heart block who do not have a pacemaker. This site needs JavaScript to work properly. Thyroid function test should be performed where appropriate prior to therapy in all patients. Infusion rate: 318 mL/hr. 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. All Rights Reserved. Add 18 mL of Cordarone I.V. Do Not Copy, Distribute or otherwise Disseminate without express permission. endobj 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. Obtain a baseline chest X-ray and pulmonary-function tests, including diffusion capacity, when treatment with this drug is initiated. In patients with extended and recurrent sun exposure, bluish skin discoloration may develop in exposed areas. Cordarone I.V. Drug-related bradycardia occurred in 90 (4.9%) of 1836 patients in clinical trials while they were receiving intravenous amiodarone for life-threatening VT/VF; it was not dose-related. > 3 weeks. [900 mg / 500 ml ] [See comments] A patient started on oral (PO) amiodarone approximately 1 week ago (400 mg/day). The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Intraoperative tachycardia and/or hypertension (immediate control): Initial bolus: 80 mg IV (~1 mg/kg) over 30 seconds, followed by a 150 mcg/kg/minute infusion, if necessary. A similar problem exists when this drug is not effective; it still poses the risk of an interaction with whatever subsequent treatment is tried.
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