Amiodarone was first made in 1961 and came into medical use in 62 for chest pain believed to be related to the heart. It was pulled from the market in 67 due to its side effects. In 74 it was found to be useful for the management of arrhythmias and was reintroduced. Amiodarone is also known in the ICU & ED environment as Amio. Some common names for Amio is Cordarone and Pacerone. I like to call it the 'Big A'
Amiodarone is a complex drug and known as a Type III antiarrhythmic with effects on sodium, potassium, and calcium channels as well as a-and B- adrenergic blocking properties. Patients must be hospitalized while the loading doses of amiodarone are administered.
Amiodarone should be prescribed only by clinicians who are experienced in the treatment of life-threatening arrhythmias, and are thoroughly familiar with amiodarone's risks and benefits, and have access to laboratory facilities capable of adequately monitoring the effectiveness and side effects of amiodarone treatment.
Amiodarone lowers the defibrillation threshold making defibrillation more effective at lower energy settings.
Indications:
VF/ pVT unresponsive to CPR, Defib, and at least one dose of Epinephrine
Recurrent hemodynamically unstable VT
May be used for the treatment of some Atrial and Ventricular arrhythmias, but with the support of expert consultation.
Mechanism of Action: Class III Antiarrhythmic, but possesses electrophysiologic properties of all 4 classes. Effects sodium, potassium & calcium channels. Exerts noncompetitive Alpha & Beta-Adrenergic inhibition.
Route: IV/IO
Dosage for Adult Cardiac Arrest: First Dose 300mg IV push followed by a D5W flush and Second Dose 150mg IV push. The first dose is usually given after the patient has received at least three shocks and 1 dose of Epinephrine 1mg. In Cardiac arrest, the patient can only receive 2 doses.
The pattern followed by clinicians in VF/pVT arrest is usually High-Quality CPR, Defibrillate 1, Defibrillate 2, Epinephrine, Defibrillate 3, Amiodarone, Defibrillate 4, Epinephrine, Defibrillate 5, Amiodarone, Defibrillate 6, Epinephrine. I always remember that after the equal number of shocks, 2,4,6, etc. the patient will receive an Epi and after an uneven number of shocks 3 & 5 the patient will receive Amiodarone….all assuming that the rhythm did not change from VF/pVT to something else in-between. If this pattern is followed your patient will receive one dose of Epinephrine every 4 minutes and one dose of Amiodarone every 4 minutes. The usual dose interval for both medications is every 3-5 minutes as per AHA guidelines.
It should be noted that the Amiodarone doses could be replaced with Lidocaine as an alternative. We will discuss Lidocaine in a future video in the Emergency Medication Series. Most clinicians these days will use the Big 'A'
Adult Life-Threatening Arrhythmias:
Rapid infusion: 150 mg IV over first 10 minutes (15mg/min). May repeat rapid infusion (150 mg IV) every 10 minutes as needed
Slow infusion: 360 mg IV over 6 hours (1 mg/min)
Maintenance infusion: 540mg IV over 18 hours (0.5mg/min)
Maximum cumulative dose: 2.2 g IV over 24 hours.
Pediatric Dosages:
For Refractory VF or Pulseless VT we can give 5 mg/kg IV/IO bolus. We can repeat the 5 mg/kg IV/IO bolus up to total dose of 15 mg/kg. Keep in mind that we can not exceed the 2.2 g in adolescents in 24 hours.
Maximum single dose: 300 mg
For Poor Perfusing Supraventricular and Ventricular Arrhythmias, the Loading dose: 5 mg/kg IV/IO over 20-60 minutes
The maximum single dose is 300 mg
Maxi cumulative dose: 2.2g IV over 24 hours. May be administered as follows
Precautions:
Rapid infusion may lead to hypotension
With prolonged usage, cumulative doses above 2.2 g over 24 hours was shown to cause significant hypotension in clinical trials
We should not administer with other drugs that prolong QT interval for example, procainamide
Amiodarone has a very long Terminal elimination and half-life lasts up to 40 days.
Disclaimer: This video is for educational purposes only and is not intended as medical advice. While we strive for 100% accuracy, errors may occur, and medications or protocols may change over time.
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