(loading dose only): 2 to 2.5 times the IV dose. Infusion: >3 weeks 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. Add 3 mL of Cordarone I.V. Monitoring: Obtain blood samples at least 4 hrs after IV dose and 6-8hrs after oral dose. 5 0 obj Reconstitution/preparation techniques: The manufacturer product information should be consulted. INFUSION Duration of Cordarone I.V. The maintenance infusion of up to 0.5 mg/min can be cautiously continued for 2 to 3 weeks regardless of the patient's age, renal function, or Left-ventricular function. Cite this: Reza Taheri. Organophosphate or carbamate poisoning: 2 mg IV, followed by 2 mg every 15 minutes until adequate response (initial doses of up to 6 mg may be used in life-threatening cases). Initial dose: 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: No adjustment recommended WebThis calculator is not appropriate for the following patient populations: Significant drug interactions (eg, amiodarone, quinidine, verapamil, or macrolide antibiotics) End-stage Intravenous amiodarone therapy should not be used in patients with bradycardia or heart block who do not have a pacemaker. Amiodarone Hydrochloride Injection, 50 mg/mL is supplied in: (150 mg) to 100 mL D5W. MeSH 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. Hypotension, bradycardia, atrioventricular block. Amiodarone injection belongs to the group of medicines known as antiarrhythmics. Thyroid toxicity is the most common complication that requires intervention. Infusion*: <1 week 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. 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. 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. The https:// ensures that you are connecting to the Unauthorized use of these marks is strictly prohibited. Accessibility ---------------------------------------Supplied: Injection, powder for reconstitution: Digibind: 38 mg. ========================= Dilution: Prescribed dose/ 50 ml NS. Followed by Slow: 360 mg over the NEXT 6 hours (1 mg/min). Renal Dosing: crcl 10-50 ml/minute: Administer every 6-12 hours. See labeling for oral amiodarone. 3.Drug in bag. Click the topic below to receive emails when new articles are available. INFUSION *Assuming a 720 mg/day infusion (0.5 mg/min). 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. This adverse effect occurs at a rate of 0.6 percent annually.11, Patients with liver toxicity are rarely symptomatic. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Renal Dosing: CRCL >60 ml/min: Administer 500 mcg twice daily. A patient started on oral (PO) amiodarone approximately 1 week ago (400 mg/day). HEPATOTOXICITY: Liver injury is common with this drug, but is usually mild and evidenced only by abnormal liver enzymes. Copyright 2021 GlobalRPH - Web Development by. 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. DIGIBIND binds molecules of digoxin, making them unavailable for binding at their site of action on cells in the body. Onset of action: 2-10 minutes. 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. (900 mg) to 500 ml D 5 W (conc = 1.8 mg/ml). CRCL <20 ml/min: Contraindicated in this group, Supplied: 125 mcg, 250 mcg, 500 mcg capsule. For control of postoperative hypertension, as many as one-third of patients may require higher doses (250-300 mcg/kg/minute) to control blood pressure; the safety of doses >300 mcg/kg/minute has not been studied. Commenting is limited to medical professionals. In some cases, hypotension may be refractory resulting in fatal outcome (see package insert for ADVERSE REACTIONS, Postmarketing Reports). Infuse 100 mL over 10 minutes. The patient is obviously at great risk during this time and may need prolonged hospitalization. CRCL 20-39 ml/min: Administer 125 mcg twice daily. All Rights Reserved. Hypotension should be treated initially by slowing the infusion; additional standard therapy may be needed, including the following: vasopressor drugs, positive inotropic agents, and volume expansion. Dose Adjustments. Use of evacuated glass containers for admixing Cordarone I.V. MULTAQ should be taken as one tablet with the morning meal and one tablet with the evening meal. The authors report no conflicts of interest. Advise patients to moderate alcohol consumption while taking this drug. Amiodarone is generally considered a class III antiarrhythmic drug, but it possesses electrophysiologic characteristics of all four Vaughan Williams classes. Cordarone I.V. Infusion*: <1 week Initial Daily Dose of Oral Cordarone : 800-1600 mg, Duration of Cordarone I.V. official website and that any information you provide is encrypted 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. If the starting dose was 250 mcg twice daily, then adjust to 125 mcg twice daily. Crcl 30-60 ml/min: Administer every 24 hours. This website also contains material copyrighted by 3rd parties. 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.) Not preferred drug for PSVT because it is not rapidly effective (may take up to 60 minutes). There has been limited experience in patients receiving intravenous amiodarone for longer than 3 weeks. 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. Peak serum concentrations after single 5 mg/kg 15-minute intravenous infusions in healthy subjects range between 5 and 41 mg/L. endobj A much less common presentation is adult respiratory distress syndrome. > 3 weeks. The dosage of amiodarone should be kept at the lowest effective level. Corneal microdeposits are visible on slit-lamp examination in nearly all patients treated with amiodarone.19 These deposits seldom affect vision and rarely necessitate discontinuation of the drug. Because absorption and elimination are variable, maintenance-dose selection is difficult, and it is not unusual to require dosage decrease or discontinuation of treatment. IV to oral transition (infusion duration [assuming 0.5 mg/min infusion]: initial oral daily dose). 1 0 obj Renal Dosing: CRCL <10 ml/minute: Decrease usual dose by 25% to 50% in severe renal impairment. and transmitted securely. A filter is not required for IV direct administration. crcl <10 ml/minute: Administer every 8-24 hours. National Institutes of Health, U.S. National Library of Medicine, DailyMed Database. A-fib: 10 to 15 mcg/kg IBW given as above. Copyright 1993-2021 The CYP3A4 isoenzyme is present in both the liver and intestines. 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. Because phlebitis may occur, the drug should be given through a central venous line when possible. 2 0 obj Questions. Unable to load your collection due to an error, Unable to load your delegates due to an error. (Doses <0.5 mg have been associated with paradoxical bradycardia.). A steady state will be achieved after five cycles of the drug half-life (T1/2), which is approximately 7 to 10 days in the average subject. Amiodarone exhibits complex disposition characteristics after intravenous administration. Studies on the use of amiodarone for the primary prevention of sudden death in high-risk patients have had mixed results. CONTRAINDICATIONS There are no known contraindications to the use of DIGIBIND. Conversion from oral to IV: Decrease IV dose by 20 to 25%. Close monitoring is indicated during the loading phase and surrounding any dose adjustments. WebThere were no significant differences in amiodarone dosing, electrolyte abnormalities, volume status or concomitant cardiac medications at the time of IV to PO transition. 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. If side effects become excessive, the dose should be reduced. The beta-blocking effect of sotalol is non-cardioselective, half maximal at an oral dose of about 80 mg/day and maximal at doses between 320 and 640 mg/day. Safety outcomes include occurrence of bradycardia or hypotension while on amiodarone. endstream Cardiac Arrest: First dose: Give 300 mg (6 mL) IV direct UNDILUTED. Greenberg JW, Lancaster TS, Schuessler RB, et al. Cordarone IV is a prescription medicine used to treat the symptoms of irregular heart rhythm (Ventricular Arrhythmias). 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). Please review the latest applicable package insert for additional information and possible updates. The recommended starting dose of Cordarone I.V. Pharmacokinetics and Metabolism concentrations greater than 2 mg/mL should be administered via a central venous catheter). Copyright 2003 by the American Academy of Family Physicians. Crcl <40 ml/min: Use is contraindicated. Amiodarone hydrochloride should only be used when facilities exist for cardiac monitoring, defibrillation, and cardiac pacing. Cordarone I.V is not intended for maint therapy. 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. Discontinue this drug if the patient experiences signs or symptoms of clinical liver injury. 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 <>stream Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. The affinity of DIGIBIND for digitoxin is about 108 to 109 M-1. WebAdd 3 mL of Cordarone I.V. Amiodarone is an iodine-containing compound with some structural similarity to thyroxine. Like class I drugs, amiodarone blocks sodium channels at rapid pacing frequencies, and like class II drugs, it exerts a noncompetitive antisympathetic action. One of its main effects, with prolonged administration, is to lengthen the cardiac action potential, a class III effect. 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. 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). The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Dosing (adults): Arrhythmias: Oral: Initial: 200 mg every 8 hours with food (may load with 400 mg if necessary); adjust dose every 2-3 days; usual dose: 200-300 mg every 8 hours; maximum: 1.2 g/day (some patients respond to every 12-hour dosing). In clinical trials, treatment-emergent, drug-related hypotension was reported as an adverse effect in 288 (16%) of 1836 patients treated with intravenous amiodarone. Use Alaris LVP with Guardrails and select amIODAROne LOAD - = 60 kg in Critical Care Adult or Coronary Care Unit profile. contains polysorbate 80, which is known to leach di-(2-ethylhexyl)phthalate (DEHP) from polyvinylchloride (PVC) (see DOSAGE AND ADMINISTRATION). May repeat x 1 in 10 minutes if needed. Neurologic toxicity associated with amiodarone therapy can include ataxia, paresthesias, and tremor. Amiodarone injection is used to treat life-threatening heart rhythm problems called ventricular arrhythmias. 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. Please see our, 2010synthroid-levoxyl-levothyroxine-342732. The initial rate of infusion should be monitored closely and should not exceed that prescribed in DOSAGE AND ADMINISTRATION. To comment please, Comments on Medscape are moderated and should be professional in tone and on topic. 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. The rate of the maintenance infusion may be increased to achieve effective arrhythmia suppression. Heart Views. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. You will receive email when new content is published. The drug's high iodine content likely is a factor in its effects on the thyroid gland. <> +*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 The major metabolite of amiodarone is desethylamiodarone (DEA), which is known to have antiarrhythmic properties. infusions exceeding 2 hours must be administered in glass or polyolefin bottles containing D5W. WebLowest effective dose, ideally 200 mg or less orally once per day or in divided doses. From in vitro studies, the protein binding of amiodarone is >96%. DOSE RECOMMENDATIONS -- FIRST 24 HOURS -- Loading infusions. (150 mg) to 100 ml D 5 W. Infuse 100 ml over 10 minutes. Adverse reactions: Severe hypotension; bradycardia; ventricular standstill in digitalized patients; asystole; respiratory failure. <> 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. WebConventional IV preparation contains polysorbate 80 and benzyl alcohol Newer IV formulation (Nexterone) does not contain polysorbate 80 or benzyl alcohol Conversion to oral Amiodarone: I.V. Because of the complexity and widespread use of this agent, other treatment decisions often are affected. Dosing (adults): Ventricular arrhythmias: Oral: 1200-1800 mg/day in 3 divided doses, up to 2400 mg/day. 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. 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. Total volume: 106 mL. Advise patients to avoid consumption of grapefruit juice during treatment with this drug. Supplied: 150 mg, 200 mg, 250 mg capsule. Administration advice: The manufacturer product information should be consulted. Bronchospasm: 0.1-0.5 mg IM, SQ (1:1000): every 10-15 minutes to 4 hours. The time at which a previously controlled life-threatening arrhythmia will recur after discontinuation or dose adjustment is unpredictable, ranging from weeks to months. -----------------------------------Dosage Each vial of Digibind 38 mg or DigiFab 40 mg will bind ~0.5 mg of digoxin or digitoxin. Hypotension In children, a Class III electrophysiological effect can be seen at daily doses of 210 mg/m2 body surface area (BSA). concentrations greater than 2 mg/ml should be administered via a central venous catheter). CONTRAINDICATIONS Intravenous amiodarone has interesting and complex pharmacokinetics. Dosing (adults): IVPB: 0 to 1 mg/50 ml D5W or NS over 10 minutes. %PDF-1.7 Hepatic impairment: Reduce dose by 50%. 2 Patients who received intravenous Digoxin is considered to be a 3rd line drug in stable patients who fail to respond to adenosine/verapamil/esmolol. 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. Administer thyroid hormone supplementation. Supplied: Adenocard: 3 mg/ml (2 ml, 4 ml) Adenoscan: 3 mg/ml (20 ml, 30 ml). Initial Daily Dose of Oral Cordarone 1 week 800-1600 mg 1-3 weeks 600-800 mg >3 weeks* 400 mg # Assuming a 720 mg/day infusion (0.5 mg/min). * Cordarone I.V. is not intended for maintenance treatment. HOW SUPPLIED Cordarone I.V. (amiodarone HCl) is available in packages of 10 ampuls (2 cartons each containing 5 ampuls), 3 mL each, as follows: High-resolution computed tomographic scanning can be helpful in making a diagnosis. Federal government websites often end in .gov or .mil. INDICATIONS AND USAGE: SOTYLIZE is an antiarrhythmic indicated for: The treatment of life-threatening ventricular arrhythmias. If intravenous amiodarone is administered during pregnancy, the patient should be apprised of the potential hazard to the fetus. 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: - Disclaimer. endobj 2011;92:11441152. IV: ER Tab: 500 mg, 750 mg, 1000 mg. Injection: 100 mg/ml (10 ml); 500 mg/ml (2 ml). See table. DOSE RECOMMENDATIONS -- FIRST 24 HOURS -- Loading infusions. (150 mg) to 100 mL D5W (concentration = 1.5 mg/mL). Avoid excessive heat. Copyright 2022 Wolters Kluwer Health, Inc. All rights reserved. Repeat history, physical exam, and chest X-ray every 3 to 6 months. A patient started on oral (PO) amiodarone approximately 1 week ago (400 mg/day). In the event of breakthrough episodes of VF or hemodynamically unstable VT, Give 150-mg/100 ml D5W over 10 minutes to minimize potential for hypotension. Select one or more newsletters to continue. Use carton to protect contents from light until used. Its vasodilatory action can decrease cardiac workload and consequently myocardial oxygen consumption. How many mg/minute of amiodarone is infusing? If patient is < 60kg give 0.01 mg/kg over 10 minutes. The initial infusion rate should not exceed 30 mg/min. 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. When switching from another antiarrhythmic, initiate a 200 mg dose 6-12 hours after stopping former agents, 3-6 hours after stopping procainamide. In light of these variabilities, it is very difficult to come up with an exact equivalent dose, but generally most practitioners cut the dose by approximately 50% when converting from PO to IV. Peak serum concentrations after 15-minute infusions in healthy volunteers range from 5 to 41 mg/L. Prevention of ventricular fibrillation: Initial bolus: 0.5 mg/kg; repeat every 5-10 minutes to a total dose of 2 mg/kg. These symptoms often are dosage related and usually improve when the dosage is reduced. Adenosine is thought to exert its pharmacological effects through activation of purine receptors (cell-surface A1 and A2 adenosine receptors). Restated: Duration of IV infusion < 1 week: 800-1600mg/day po initially x 1-2 weeks or complete current week; 1-3 weeks: 600-800mg/day po initially - total therapy ~ 1 month counting IV infusion ; >3 weeks: 400mg po qd initially. US BOXED WARNINGS (TABLET): These effects may also be seen with IV administration. 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. 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. Neonatal Hypo- or Hyperthyroidism 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. Amiodarone crosses the placenta and reaches measurable levels in breast milk. 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. This site needs JavaScript to work properly. 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 DOSAGE AND ADMINISTRATION The only recommended dosage of MULTAQ is 400 mg twice daily in adults. Each milliliter of the Cordarone I.V. A local search option of this data can be found here. Amiodarone reduces warfarin clearance and can lead to sudden and pronounced increases in the prothrombin time and International Normalized Ratio.21 The peak effects of interaction occur approximately seven weeks after initiation of therapy. HHS Vulnerability Disclosure, Help A similar problem exists when this drug is not effective; it still poses the risk of an interaction with whatever subsequent treatment is tried. Dosage modification: c interval should be measured 2-3 hours after the initial dose. 300mg extended release tablet (sulfate). The net effect is to shift the equilibrium away from binding of digoxin to its receptors in the body, thereby reversing its effects. Do Not Copy, Distribute or otherwise Disseminate without express permission. Patients taking amiodarone should not eat grapefruit or drink grapefruit juice because it can inhibit the conversion of amiodarone to an active metabolite. 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. These conditions often are dosage related and improve when the dosage is reduced. Add 3 ml of Cordarone I.V. 8600 Rockville Pike If the starting dose is 500 mcg twice daily, then adjust to 250 mcg twice daily. This site complies with the HONcode standard for trust- worthy health information: verify here. 2010;11:5763. If side effects become excessive, the dose should be reduced. Eur J Cardiothorac Surg. 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. Thallium-201 is injected at midpoint (3 minutes) of infusion. Such patients should not be given dronedarone. Pulmonary toxicity has been fatal about 10% of the time.