In early studies, the frequency of pulmonary toxicity in amiodarone therapy was 2 to 17 percent.2 More recent studies have shown a lower incidence in patients receiving dosages of 300 mg per day or less. Neither amiodarone nor DEA is dialyzable. crcl <10 ml/minute: Administer every 8-24 hours. The rate of the maintenance infusion may be increased to achieve effective arrhythmia suppression. May follow with 0.125 to 0.25 mg IV q2-6h until 0.75 to 1.5 mg is given over 24hrs. Infusion: whenever possible administer through a central venous catheter. 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. Drugs for Conversion of Atrial Fibrillation | AAFP AF recurrence occurred in 24.5% of patients (n = 45). (If given IVPush-admin over at least 5 min).PSVT: (For patients not on digoxin): 0.25 to 0.5 mg IV. 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. 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). Sotalol hydrochloride is a racemic mixture of two isomers, both of which have similar Class III antiarrhythmic effects, while the l-isomer is responsible for virtually all of the beta-blocking activity. 2017;52:665672. Infuse 100 mL over 10 minutes. Add 3 mL of Cordarone I.V. Do Not Copy, Distribute or otherwise Disseminate without express permission. Interactions with warfarin and digoxin are the most clinically important. The Fab fragment-digoxin complex accumulates in the blood, from which it is excreted by the kidney. Routine screening for adult respiratory distress syndrome is of limited value, because pulmonary toxicity can develop rapidly with no antecedent abnormalities on chest radiographs or pulmonary function tests. HONcode standard for trust- worthy health, Skeletal Muscle Index And Ovarian Cancer Prognosis: A Meta-Analysis, 7 Natural Remedies for Rheumatoid Arthritis. Drugs for Conversion of Atrial Fibrillation | AAFP Half-life: 38-48 hrs. 10-15g of amiodarone is required to load a patient. 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. 3 mL (150 mg) 10 Single-dose vials per carton (NDC 60505-0722-0). Infuse 100 mL over 10 minutes. Cordarone I.V. Do Not Copy, Distribute or otherwise Disseminate without express permission. and transmitted securely. Factors that increase likelihood of digoxin toxicity: Hypokalemia, hypomagnesaemia, hypothyroidism, renal dysfunction, interacting drugs (eg quinidine, verapamil). The initial rate of infusion should be monitored closely and should not exceed that prescribed in DOSAGE AND ADMINISTRATION. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. On the other hand, it is possible that this is a very lightweight, elderly woman, and the physician is being extremely cautious on the loading or there are other comorbid conditions that could increase the risk of amiodarone toxicity. *Assuming a 720 mg/day infusion (0.5 mg/min). 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. Crcl 30-60 ml/min: Administer every 24 hours. 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). Reconstitution: Dissolve each vial with 4 ml sterile water (do not shake). Infusion: 1 to 3 weeks Initial Daily Dose of Oral Cordarone : 600-800 mg. The dosage of amiodarone should be kept at the lowest effective level. After absorption, the drug undergoes extensive enterohepatic circulation. The difficulty of using this drug safely and effectively itself poses a significant risk to patients. Bradycardia and heart block occur in 1 to 3 percent of patients receiving amiodarone.2 Amiodarone-induced proarrhythmia occurs at an annual rate of less than 1 percent.11 Although almost all patients treated with the drug have prolongation of the QT interval, polymorphic ventricular tachycardia (i.e., torsades de pointes) is rare. 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. Initial Daily Dose of Oral Cordarone : 600-800 mg. Amiodarone injection belongs to the group of medicines known as antiarrhythmics. Therefore, physicians must use the lowest possible dosage of amiodarone and, if possible, discontinue treatment if adverse effects occur. Amiodarone is generally considered a class III antiarrhythmic drug, but it possesses electrophysiologic characteristics of all four Vaughan Williams classes. (Enter numeric value only. Renal Dosing: CRCL <10 ml/minute: Decrease usual dose by 25% to 50% in severe renal impairment. PMC Safety outcomes include occurrence of bradycardia or hypotension while on amiodarone. Amiodarone is an iodine-containing compound with some structural similarity to thyroxine. Renal Dosing: CRCL 30-40 ml/minute: 100mg every 8 hours CRCL 15-30 ml/minute: 100mg every 12 hours CRCL <15 ml/minute: 100mg every 24 hours, Supplied: (Norpace): Capsule 100 mg, 150 mg (Norpace CR): Capsule (controlled release) 100 mg, 150 mg. A-fib/Flutter: Dosing (adults):: Usual initial dose: 500 mcg orally twice daily. Manifestations of life-threatening toxicity include severe ventricular arrhythmias such as ventricular tachycardia or ventricular fibrillation, or progressive bradyarrhythmias such as severe sinus bradycardia or second or third degree heart block not responsive to atropine. Number of vials needed =[(steady state serum digoxin level (ng/ml) x weight (kg)] / 100. Due to rapid distribution, serum concentrations decline to 10% of peak values within 30 to 45 minutes after the end of the infusion. 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. INDICATIONS AND USAGE: SOTYLIZE is an antiarrhythmic indicated for: The treatment of life-threatening ventricular arrhythmias. The site is secure. All of these events should be manageable in the proper clinical setting in most cases. Cite this: Reza Taheri. The .gov means its official. This site needs JavaScript to work properly. The affinity of DIGIBIND for digitoxin is about 108 to 109 M-1. Long-Term Use -----------------------------------INDICATIONS AND USAGE DIGIBIND, Digoxin Immune Fab (Ovine), is indicated for treatment of potentially life-threatening digoxin intoxication.3 Although designed specifically to treat life-threatening digoxin overdose, it has also been used successfully to treat life-threatening digitoxin overdose.3 Since human experience is limited and the consequences of repeated exposures are unknown, DIGIBIND is not indicated for milder cases of digitalis toxicity. The dosage in cats is 0.10.4 mg/kg, IV bolus over ~1 min, then increase to a total dose of 0.251 mg/kg, IV slowly, if no response. The bioavailability of amiodarone is variable but generally poor, ranging from 22 to 95 percent.1 Absorption is enhanced when the drug is taken with food.2 Amiodarone is highly lipid soluble and is stored in high concentrations in fat and muscle, as well as in the liver, lungs, and skin. In clinical trials, after 48 hours of continued infusions (125, 500, or 1000 mg/day) plus supplemental (150 mg) infusions (for recurrent arrhythmias), amiodarone mean serum concentrations between 0.7 to 1.4 mg/L were observed (n=260). Lidocaine (xylocaine ) Ventricular arrhythmia: 1-1.5 mg/kg IV bolus over 2-3 minutes; may repeat doses of 0.5-0.75 mg/kg in 5-10 minutes up to a total of 3 mg/kg; 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. Prevention of ventricular fibrillation: Initial bolus: 0.5 mg/kg; repeat every 5-10 minutes to a total dose of 2 mg/kg. Supplied: 225 mg, 325 mg, 425 mg extended release cap. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Conversion from oral to IV: Decrease IV dose by 20 to 25%. 2 0 obj IV to oral transition (infusion duration HtT0}WvlF v@$)IV>/_rif9s3' DOSE RECOMMENDATIONS -- FIRST 24 HOURS -- Loading infusions. 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. Initiate antithyroid drug therapy; consider stopping amiodarone. 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. Monitoring: Pacerone, Cordarone, Nexterone, Cordarone IV. The most serious potential adverse effect of amiodarone therapy is pulmonary toxicity, which may result from direct drug-induced phospholipidosis or immune-mediated hypersensitivity.19 The most common clinical presentation is subacute cough and progressive dyspnea, with associated patchy interstitial infiltrates on chest radiographs and reduced diffusing capacity on pulmonary function tests. Hypotension Hypotension 2010;55:13701376. (900 mg) to 500 mL D5W (conc = 1.8 mg/mL). Advise patients to avoid consumption of grapefruit juice during treatment with this drug. 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. Because of the complexity and widespread use of this agent, other treatment decisions often are affected. INFUSION Duration of Cordarone I.V. INDICATIONS AND USAGE MULTAQ is indicated to reduce the risk of cardiovascular hospitalization in patients with paroxysmal or persistent atrial fibrillation (AF) or atrial flutter (AFL), with a recent episode of AF/AFL and associated cardiovascular risk factors (i.e., age >70, hypertension, diabetes, prior cerebrovascular accident, left atrial diameter 50 mm or left ventricular ejection fraction [LVEF] <40%), who are in sinus rhythm or who will be cardioverted. A meta-analysis11 of double-blind trials found the frequency of adult respiratory distress syndrome to be 1 percent annually. If the starting dose is 500 mcg twice daily, then adjust to 250 mcg twice daily. 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. WebConventional IV preparation contains polysorbate 80 and benzyl alcohol Newer IV formulation (Nexterone) does not contain polysorbate 80 or benzyl alcohol Conversion to oral % In patients with extended and recurrent sun exposure, bluish skin discoloration may develop in exposed areas. Copyright 2023 American Academy of Family Physicians. Amiodarone: I.V. WebIV Drip Rate Calculator. Bookshelf Initial dose: 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: No adjustment recommended Maintenance infusion: 540 mg over the REMAINING 18 hours (0.5 mg/min). (150 mg) to 100 mL D5W (concentration = 1.5 mg/mL). This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. The relative efficacy of amiodarone and ICDs in preventing sudden death in patients without coronary disease is under investigation. Because absorption and elimination are variable, maintenance-dose selection is difficult, and it is not unusual to require dosage decrease or discontinuation of treatment. Monitoring: Obtain blood samples at least 4 hrs after IV dose and 6-8hrs after oral dose. Amiodarone Intravenous Patients taking amiodarone should not eat grapefruit or drink grapefruit juice because it can inhibit the conversion of amiodarone to an active metabolite. Amiodarone: Guidelines for Use and Monitoring | AAFP Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. <> Onset of action: 2-10 minutes. Intravenous Questions. Normal subjects over 65 years of age show lower clearances (about 100 mL/hr/kg) than younger subjects (about 150 mL/hr/kg) and an increase in t1/2 from about 20 to 47 days. In most instances, the toxicity is reversible. 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. This content is owned by the AAFP. Stopping the infusion and restarting at a slower rate may help if infusion-related reactions occur. Disclosure: Reza Taheri, PharmD, has no significant financial interests or relationships to disclose. Prevention of ventricular arrhythmias in patients with ICDs to decrease risk of shocks. 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 Ocular: Ophthalmic examination, including fundoscopy and slit-lamp examination, Respiratory: History, physical exam, chest X-ray, and pulmonary function tests, including diffusion capacity. Mechanisms of Action Photosensitivity is common in patients receiving amiodarone therapy. CRCL 40-60 ml/min: Administer 250 mcg twice daily. 2014 AATS guidelines for prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. Intravenously administered amiodarone is effective for the emergency treatment of ventricular tachyarrhythmias. If severe, stop amiodarone or insert pacemaker. However, the drug has many other effects: it slows heart rate and atrioventricular nodal conduction (via calcium channel and beta-receptor blockade), prolongs refractoriness (via potassium and sodium channel blockade), and slows intracardiac conduction (via sodium channel blockade). Advise patients to moderate alcohol consumption while taking this drug. Federal government websites often end in .gov or .mil. Copyright 1993-2021 > 3 weeks. If the potassium concentration exceeds 5 mEq/L in the setting of severe digitalis intoxication, therapy with DIGIBIND is indicated. This may be calculated if the amount ingested is known or the postdistribution serum drug level is known (round dose to the nearest whole vial). Initial Daily Dose of Oral Cordarone : 800-1600 mg, Duration of Cordarone I.V. Applies to the following strengths: 50 mg/mL; 200 mg; 300 mg; 100 mg; 400 mg; 150 mg/150 mL-D0.5%; 900 mg/500 mL-D5%; 450 mg/250 mL-D5%; 150 mg/100 mL-D5%; 360 mg/200 mL-D5%. Malignant Arrhythmia and Cardiac Arrest in the Operating Room. ATRIUM CE Final Gale Watson Supplied: 250 mg, 500 mg capsule. In patients who also are taking digoxin and warfarin, physicians must pay close attention to digoxin levels and prothrombin time, keeping in mind that the effects of interaction with amiodarone do not peak until seven weeks after the initiation of concomitant therapy. Cordarone I.V is not intended for maint therapy. Amiodarone is eliminated primarily by hepatic metabolism and biliary excretion and there is negligible excretion of amiodarone or DEA in urine. 5 0 obj If rounding is required, round to the nearest tenth.) Half life: 9 minutes. WebThis calculator is not appropriate for the following patient populations: Significant drug interactions (eg, amiodarone, quinidine, verapamil, or macrolide antibiotics) End-stage A-fib: 10 to 15 mcg/kg IBW given as above. /QU+(R% $Kh=c6cL`bv!w? Assistance in calculating accurate rates of medication administration. Neurologic toxicity associated with amiodarone therapy can include ataxia, paresthesias, and tremor. Renal Dosing Crcl <10 ml/minute: Administer 75% of normal dose. Consider stopping amiodarone; causal relationship is uncertain. This website also contains material copyrighted by 3rd parties. From in vitro studies, the protein binding of amiodarone is >96%. In most of the cases, the method of administration is via peripheral infusion. ). Emergency Last updated on Sep 13, 2022. Infusion*: <1 week Duration of Cordarone I.V. Frendl G, Sodickson AC, Chung MK, et al. E.T. In addition to blocking sodium channels, amiodarone blocks myocardial potassium channels, which contributes to slowing of conduction and prolongation of refractoriness. 150-mg IV bolus over 10 minutes (if necessary, bolus may be repeated in 10 to 30 minutes); then 1 mg per minute for 6 hours; then 0.5 mg per minute for 18 hours; then reduce IV dosage or convert to oral dosing when possible. Followed by Slow: 360 mg over the NEXT 6 hours (1 mg/min). Use carton to protect contents from light until used. 4 0 obj Supplied: 150 mg, 200 mg, 250 mg capsule. The only information that I could find about PO to IV conversion involved patients who are stabilized on amiodarone PO for 4 months or longer. IV to oral transition (infusion duration [assuming 0.5 mg/min infusion]: initial oral daily dose). Amiodarone: Clinical uses - UpToDate Consensus follow-up recommendations from the NASPE are summarized in Table 4.4 A form to guide patient monitoring is provided in Figure 1. endobj If intravenous amiodarone is administered during pregnancy, the patient should be apprised of the potential hazard to the fetus. Please review the latest applicable package insert for additional information and possible updates. government site. +*59mQau]pR+T7{vN2{pU[9jY0HR{Ui&IljC,7mh-`}pJ1l!:s(tG$IS|-L[UFrYfFqj9'FPaP9*?&L,?uH`Xp2YdCq1X,Q>Rxw:se2Uk;XuHepn dGB$rRE*17wAp_gCw88lg# wBEaz-EBpzxjcTE)a- WIT National Library of Medicine The negative chronotropic effect of amiodarone in nodal tissues is similar to the effect of class IV drugs. Grapefruit juice can inhibit amiodarone metabolism and lead to elevated drug levels,3 but the impact of this interaction on the long-term efficacy and toxicity of amiodarone is not known. May be further diluted with normal saline. Hypersensitivity reaction: 0.2-0.5 mg IM, SQ every 20 minutes to 4 hours (maximum single dose: 1 mg). Crcl 40-60 ml/min: Administer every 24 hours. The patient is now taking nothing by mouth (NPO), and the physician would like to switch to intravenous (IV) amiodarone. If you log out, you will be required to enter your username and password the next time you visit. WebAmiodarone 300 mg (6 mL from TWO ampoules) added to 100 mL glucose 5%, administer by IV infusion over 20 minutes. 300mg extended release tablet (sulfate). To comment please, Comments on Medscape are moderated and should be professional in tone and on topic. Atrial Fibrillation (AF) & Flutter complicating critical illness 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. Ann Thorac Surg. HlTn6}W#\)XM6E/-le1C?b9vC_ E5W7+x^}dh Note: Decrease dose in patients with CHF, elderly, hepatic disease. 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. Oral: 250-500 mg/dose every 3-6 hours or 500 mg to 1 g every 6 hours extended release; usual dose: 50 mg/kg/24 hours; maximum: 4 g/24 hours. Renal Dosing: crcl 10-50 ml/minute: Administer every 6-12 hours. 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.) You will receive email when new content is published. In children, a Class III electrophysiological effect can be seen at daily doses of 210 mg/m2 body surface area (BSA). May give by bolus injection if cardiac arrest is imminent. Supplied: 80 mg, 120 mg, 160 mg, 240 mg tablet ---------- Drug UPDATES: SOTYLIZE (sotalol hydrochloride) oral solution Initial U.S. Approval: 1992 [Drug information / PDF] Dosing: Click (+) next to Dosage and Administration section (drug info link). CRCL 20-39 ml/min: Administer 125 mcg twice daily. Medscape Pharmacists. Because a typical oral amiodarone loading dose for ventricular arrhythmia starts with 800-1600 mg/day and for atrial fibrillation starts with 600-800 mg/day, I would assume that for one reason or another a decision was made not to load this patient. The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. The use of amiodarone for postoperative atrial fibrillation (AF) is widespread; however, there is a paucity of data on the optimal duration of overlap when transitioning from intravenous (IV) to oral amiodarone. Laboratory studies to assess liver and thyroid function should be performed at least every six months. 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. Intravenous to Oral Transition of Amiodarone (IOTA): Effect CRCL <20 ml/min: Contraindicated in this group, Supplied: 125 mcg, 250 mcg, 500 mcg capsule.
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