Amiodarone considerations for use american college of cardiology. Black box warning may cause potentially fatal toxicities, including pulmonary toxicity, hepatic injury, and worsened arrhythmia. In 1974 the drug was reintroduced to the market after its abilities to treat arrhythmias during emergency cardiac events and to. Amiodarone intravenous route description and brand names. After completion of a riskbenefit analysis, the qas authorises the administration of sodium chloride 0. Amiodarone is a class antiarrhythmic that prolongs the cardiac action potential and the. Index summary chart 2 iv medication drip chart amiodarone 2 atracurium 2, 5 cisatracurium 2, 5 dexmedetomidine 2 dobutamine 2, 6. Amiodarone infusion protocols university medical center. Amiodarone is an antiarrhythmic medication used to treat and prevent a number of types of irregular heartbeats.
Nexterone amiodarone hydrochloride injection label fda. Atrial fibrillation with a rapid ventricular rate often adds to the impaired haemodynamic status of patients with depressed left ventricular function. Amiodarone injection is used to correct lifethreatening heart rhythm problems called ventricular arrhythmias. The spreadsheet of these changes is for reference only, and the information located in the full protocol book is the official medical reference for ems providers. The dosage protocol used for vtvf therapy seems to be tolerable in patients with af and ahf. Intravenous amiodarone bolus immediately controls heart rate. Loading dose worksheet for intravenous amiodarone 1. Amiodarone hydrochloride injection is a sterile clear, paleyellow micellar solution visually free from particulates. Amiodarone cordarone, pacerone considerations for use usfda approved indications. One for the amiodarone and one for other medications the patient may need. Adult critical care intravenous infusions titration protocol. Titration protocol nursing staff to titrate drip to achieve goal ordered by provider in assigned time intervals. Amiodarone infusions must not be administered via the drug infusion port on a haemodialysis circuit. Camporesi, mdc amiodarone isanantiarrhythmic medication used totreat andprevent certaintypes of.
This medicine is used in patients who have already been treated with other medicines that did not work. Amiodarone hyaluronidase vitrase, amphadase, hydase, hylenex nitropaste 1 15 unitsml in 0. After the first 24 hours, continue the maintenance infusion rate of 0. Intravenous amiodarone is useful in the treatment of af with rapid ventricular response in patients with ahf while showing rhythm and rate control effects. After extravasation, the patient reported severe pain at the site. Cordarone amiodarone hcl is a member of a new class of antiarrhythmic drugs with predominantly class iii vaughan williams classification effects, available for oral administration as pink, scored tablets containing 200 mg of amiodarone hydrochloride. The majority of the time during 72 h after rosc was spent for ttm. This loading dose worksheet is intended to guide medical, nursing and pharmacy staff in the safe and appropriate prescription and administration of intravenous amiodarone loading doses in adults 2. Replacement therapy may not be necessary in such patients if. The aim of this study is to determine if there is a reduction in the incidence of postoperative af after implementing a protocol that uses amiodarone as a prophylactic agent during cardiac surgery. Amiodarone blocks sodium channels at rapid pacing frequencies and exerts a noncompetitive antisympathetic action. Amiodarone injection fda prescribing information, side. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment.
As a result, baseline testing and careful monitoring of patients taking amiodarone is essential. Nov 06, 2018 provides accurate and independent information on more than 24,000 prescription drugs, overthecounter medicines and natural products. Management of amiodarone extravasation with intradermal. It seems that most commonly patients are given a 300 mg bolus of amiodarone initially and then given a continuous drip. Amiodarone for atrial fibrillation following cardiac. In a recent metaanalysis, adult patients taking lower doses of amiodarone 152330 mg daily for at least 12 months were more. Atrial fibrillation management of acute atrial fibrillation. Click here to view a print quality pdf of this table. Where multiple infusions are required, administer with other compatible drugs, via a threeway tap. They are started at 1 mgmin for 6 hours, and then moved down to 0. Intravenously administered amiodarone causes heart block or bradycardia in 4. For further product information and current package insert, please visit.
Conversely, intravenous iv amiodarone begins to act within one hour, with rapid onset of action within minutes following an iv bolus. Amiodarone requires a dedicated infusion line and must not be administered with other drugs. Pacerone, cordarone amiodarone dosing, indications. Amiodarone monitoring protocol amiodarone is for initiation by the consultant or specialist only. Because of the toxicity and serious sideeffects of amiodarone, use it cautiously and do not exceed the cumulative total of 2. If the patient is on oral amiodarone, the following cardiac arrest administration protocols continue to be authorised. Follow the directions on your prescription label carefully, and ask your doctor or pharmacist to explain any part you do not understand. Nursing tips for administering amiodarone from new to icu. This medicine is available only with your doctors prescription.
Also for the amiodarone protocol group, the rate of adverse. If administered peripherally the infusion must be diluted appropriately as it may. The action of prophylactic amiodarone might be influenced by lower body temperature, as amiodarone had a comparable antiarrhythmic effect to placebo in a hypothermic animal model. You may take amiodarone either with or without food, but be sure to take it the same way each time. This includes ventricular tachycardia vt, ventricular fibrillation vf, and wide complex tachycardia, as well as atrial fibrillation and paroxysmal supraventricular tachycardia. Considerations for use from the atrial fibrillation. Oct 26, 2018 cordarone iv amiodarone hydrochloride intravenous.
Amiodarone infusions must not be administered via the drug infusion port on a. Data sources include ibm watson micromedex updated 10 apr 2020, cerner multum updated 6 apr 2020. Discontinue drip if systolic bp is less than 90 or heart rate in less than 60 and notify physician. Amiodarone infusion in the treatment of acute atrial. Only use for adults with life threatening arrhythmias when other treatments ineffective or not tolerated.
The nursing staff was instructed to treat the patient for the amiodarone extravasation with traditional nonpharmacologic measures, including warm compresses and elevation of the extremity. In addition, it produces a negative chronotropic effect in nodal tissues. Amiodarone is effective for maintaining sinus rhythm but has greater toxicities than other antiarrhythmics used for atrial fibrillation. Follow up with an infusion of 1 mgmin iv x 6 hours, then 0. Amiodarone protocol provides costeffective reduction in. There is no precise protocol for switching from iv to oral treatment but the. If lidocaine lignocaine has been administered to a patient with conscious vt that progresses into cardiac arrest, the following administration protocols continue to be authorised. The amiodarone drip was discontinued, and amiodarone 400 mg orally twice daily was started.
Information in this booklet should be used as a guide only. The drug prevents the recurrence of lifethreatening ventricular arrhythmias and. Amiodarone is a class iii antiarrhythmic agent and is used for the treatment of various types of tachyarrhythmias. This product is available in the following dosage forms. Standard dilutions amount of drug infusion volume infusion rate. Amiodarone infusions must be administered by syringe pump or infusion pump. Amiodarone may be administered via a peripheral cannula or central line. Recommendations for conversion to intravenous amiodarone after oral administration. Amiodarone for atrial fibrillation following cardiac surgery.
Digoxin second line rate control agent, primarily because it tends to exert its rate controlling effect at rest, less so with exercise. Guidelines for the administration of iv amiodarone clinical. Onset of the antiarrhythmic effect of intravenous amiodarone occurs in less than 30 minutes. Amiodarone must always be administered via a dedicated lumen and never piggybacked with other drugs or fluids. This is only a rough method of calculation, and clinicians should exercise their judgement in. It can be given by mouth, intravenously, or intraosseously. Amiodarone supplants lidocaine in acls and cpr protocols anna mizzi, mda, thanh tranb, devanand mangar, mdb, enrico m. Heart rate control and heart rhythm control for atrial fibrillation black box warning may cause potentially fatal toxicities, including pulmonary toxicity, hepatic injury, and worsened arrhythmia. Amiodarone injection belongs to the group of medicines known as antiarrhythmics. This products label may have been revised after this insert was used in production. Amiodarone in pediatric patients macdonald dick ii, m. Data sources include ibm watson micromedex updated 10 apr 2020, cerner multum updated 6 apr 2020, wolters kluwer updated. Most useful in combination with a betablocker or a calcium channel blocker, especially for patients with systolic heart failure, or in cases where low blood pressure is a.
Oct 01, 2017 the amiodarone drip was discontinued, and amiodarone 400 mg orally twice daily was started. Rhythm and rate control effects of intravenous amiodarone. Intravenous amiodarone protocol scan to pharmacy and place in orders section of chart a physicians order is required for implementation of the protocol. Also for the amiodarone protocol group, the rate of adverse events was included based as the or from logistic regression. The patient must be monitored whilst on this infusion. Intravenous amiodarone bolus immediately controls heart.
Amiodarone requires a dedicated infusion line and must not be administered with other drugs amiodarone does not contain any preservative and should be prepared immediately prior to use and used within 12 hours use of an inline 0. Nov 01, 2018 amiodarone hydrochloride is a white to slightly yellow crystalline powder, and is very slightly soluble in water. In adult patients, amiodarone can be given for vtvf cardiac arrest via intravenous ivintraosseous io infusion as a 300 mg rapid bolus. Dec 01, 2003 amiodarone is a potent antiarrhythmic agent that is used to treat ventricular arrhythmias and atrial fibrillation. Amiodarone is absorbed onto pvc solutions for continuous infusion that will exceed 2 hours must be prepared in glass bottles, rigid pvc or nonpvc burettes. Amiodarone supplants lidocaine in acls and cpr protocols.
Cordarone amiodarone hydrochloride dose, indications. Mar 09, 2017 make sure to administer amioidarone according to your providers prescription. Estimates of the elimination halflife of amiodarone vary, depending on how the halflife has been measured and the route of amiodarone administration. Guidelines for the administration of iv amiodarone register. Thereby, prophylactic amiodarone was mostly infused to hypothermic patients.
It works directly on the heart tissue and will slow the nerve impulses in the heart. Amiodarone classification antidysrhythmic trade names cordarone desired effects amiodarone is a class iii antidysrhythmic agent used to treat supraventricular and ventricular dysrhythmias mechanism of action acts directly on the myocardium to delay repolarization and increase the duration of the action potential. After 6 hours, reduce the infusion to the maintenance infusion rate of 0. Description cordarone amiodarone hcl is a member of a new class of antiarrhythmic drugs with predominantly class iii vaughan williams classification effects, available for oral administration as pink, scored tablets containing 200 mg of amiodarone hydrochloride. Amiodarone may be a reasonable firstline agent in patients with concomitant heart failure or substantial left ventricular hypertrophy if rhythm control is preferred over rate control.
Some major protocol additions, deletions, and changes have been made this year. The long halflife of oral amiodarone 25 to 100 days and the potential severity and irreversible nature of some the adverse effects make early recognition of any potential adverse effects important. There is no precise protocol for switching from iv to oral treatment but the following method for calculating the oral dose required may be used. Assure no other medication is injected or infusing with amiodarone assure you always have two lines.
It was first created in 1962 to treat heart related chest pain, and later removed from the market due to side effects in 1967. Dose range icu maximum dose titration increment titration interval goal to be selected by prescriber amiodarone pacerone antiarrhythmic. Amiodarone is approved for use in the secondary prevention of lifethreatening ventricular arrhythmias. Amiodarone is an effective antiarrhythmic class 3 drug commonly used in acls and pals. Assess the iv site prior to infusion assess for pain, redness, and assure an adequate flush with 10 ml normal saline. The optimal dose for changing from intravenous to oral administration of amiodarone will depend on the dose of nexterone already. Make sure to administer amioidarone according to your providers prescription. The prescriber is responsible for the verification of indications and dosages listed in the manufacturers package insert for the individual drugs, from which most information for this dosing guide is obtained. The north american society for pacing and electrophysiology naspe recommends amiodarone. Effect of prophylactic amiodarone infusion on the recurrence. Guidelines for the administration of iv amiodarone clinical guideline register no. One of its main effects, with prolonged administration, is to lengthen the cardiac action potential.
S, mott childrens hospital, and the department of pediatrics, university of michigan medical school, ann arbor, michigan dick m, ii, and scqtt wa. Guidelines for the administration of iv amiodarone. Information for the user amiodarone 100 mg tablets amiodarone 200 mg tablets amiodarone hydrochloride read all of this leaflet carefully before you start taking this medicine because it contains important information for you. Feb, 2019 the majority of the time during 72 h after rosc was spent for ttm. Intravenous amiodarone is a recognised treatment alternative for the conversion of atrial fibrillation to sinus rhythm. However, optimal drug dosage and duration remains elusive. Contact physician after infusion time of 72 hours for order to continue. Qt interval from excess amiodarone administration, magnesium sulphate administration is to be considered. Only use for adults with lifethreatening arrhythmias.
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