The dosage protocol used for vtvf therapy seems to be tolerable in patients with af and ahf. Atrial fibrillation with a rapid ventricular rate often adds to the impaired haemodynamic status of patients with depressed left ventricular function. This product is available in the following dosage forms. Although it is an old drug, much has been learned recently about this complex drug and its application in a variety of cardiac arrhythmias. Not compatible with normal saline see below for continuous infusion instructions.
Nov 06, 2018 provides accurate and independent information on more than 24,000 prescription drugs, overthecounter medicines and natural products. This medicine is available only with your doctors prescription. Management of amiodarone extravasation with intradermal. Gastrointestinal side effects of amiodarone include nausea, anorexia, and constipation. Considerations for use from the atrial fibrillation. Oct 01, 2017 on postoperative day 3, the patient again developed atrial fibrillation, and the amiodarone infusion 1. Ensure the words loading dose are included in the additional instructions indication section of the drug chart.
One for the amiodarone and one for other medications the patient may need. This medicine is used in patients who have already been treated with other medicines that did not work. Atrial fibrillation management of acute atrial fibrillation. When infusions exceed 2 hours, amiodarone can absorb into the plastic used for standard iv bags. Guidelines for the administration of iv amiodarone register. Dose range icu maximum dose titration increment titration interval goal to be selected by prescriber amiodarone pacerone antiarrhythmic. Rarely, acute liver disorders may occur that warrants withdrawal of treatment. Only use for adults with life threatening arrhythmias when other treatments ineffective or not tolerated. This products label may have been revised after this insert was used in production. Amiodarone blocks sodium channels at rapid pacing frequencies and exerts a noncompetitive antisympathetic action. The amiodarone drip was discontinued, and amiodarone 400 mg orally twice daily was started.
Potent antiarrhythmic agent and the first line antiarrhythmic agent given during cardiac arrest. The results of this study suggest that the implementation of a peripheral. Black box warning may cause potentially fatal toxicities, including pulmonary toxicity, hepatic injury, and worsened arrhythmia. Assure no other medication is injected or infusing with amiodarone assure you always have two lines. 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. The patient also received a 150mg bolus dose of amiodarone peripherally, approximately 10 hours after restarting the amiodarone. An additional finding was that the severity of phlebitis was reduced, as well. Follow up with an infusion of 1 mgmin iv x 6 hours, then 0. Guidelines for the administration of iv amiodarone clinical. A placebocontrolled study of iv amiodarone 300 mg over 2 hours. Feb, 2019 prophylactic amiodarone was defined as a continuous intravenous infusion of amiodarone 1 mgminute for 6 h, followed by 0. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. Amiodarone cordarone, pacerone considerations for use usfda approved indications. Repeated infusion is very irritant and continuous infusion should therefore be via a central line 8.
Guidelines for the administration of iv amiodarone clinical guideline register no. Amiodarone shared care guideline page 4 of 5 version. Titration protocol nursing staff to titrate drip to achieve goal ordered by provider in assigned time intervals. Although amiodarone is effective, it is not generally recommended for minor rhythm disturbances because of its toxicity. Although a starting dose adequate to suppress lifethreatening arrhythmias is needed, close monitoring with adjustment of dose is essential. Amiodarone hyaluronidase vitrase, amphadase, hydase, hylenex nitropaste 1 15 unitsml in 0. The north american society for pacing and electrophysiology naspe recommends amiodarone. The preguideline phlebitis rate was 85% and postguideline rate was 38%, representing a 47% change or improvement. Amiodarone injection is used to correct lifethreatening heart rhythm problems called ventricular arrhythmias. Amiodarone and its metabolite have been shown to cross the placenta. It is a difficult and challenging drug to use in clinical practice. Effect of prophylactic amiodarone infusion on the recurrence of ventricular arrhythmias in outofhospital cardiac arrest survivors. Because of the toxicity and serious sideeffects of amiodarone, use it cautiously and do not exceed the cumulative total of 2.
Amiodarone infusion protocols university medical center. Conversely, intravenous iv amiodarone begins to act within one hour, with rapid onset of action within minutes following an iv bolus. Amiodarone infusions must not be administered via the drug infusion port on a haemodialysis circuit. The patient must be monitored whilst on this infusion.
This includes ventricular tachycardia vt, ventricular fibrillation vf, and wide complex tachycardia, as well as atrial fibrillation and paroxysmal supraventricular tachycardia. Assess the iv site prior to infusion assess for pain, redness, and assure an adequate flush with 10 ml normal saline. Follow the above loading infusion with a continuous iv infusion amiodarone at a rate of 1 mgminute 33. Amiodarone is an antiarrhythmic medication used to treat and prevent a number of types of irregular heartbeats. Amiodarone can be used to treat tachyarrhythmias, including atrial fibrillation, ventricular tachycardia and patients at high risk of sudden cardiac death. This may involve withdrawing previously mixed and labelled solutions prepared from the referring hospital. Intravenously administered amiodarone causes heart block or bradycardia in 4. Dec 01, 2003 intravenously administered amiodarone causes heart block or bradycardia in 4. These results show the prophylactic use of intravenous amiodarone infusion for the first 48hr of the postoperative period is a safe and effective treatment to prevent postoperative af after. Amiodarone infusions must be administered by syringe pump or infusion pump. 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.
Pacerone, cordarone amiodarone dosing, indications. Amiodarone 150 mg infusion over the first 10 minutes. Amiodarone is approved for use in the secondary prevention of lifethreatening ventricular arrhythmias. One of its main effects, with prolonged administration, is to lengthen the cardiac action potential. Adult critical care intravenous infusions titration protocol. After extravasation, the patient reported severe pain at the site. Only use for adults with lifethreatening arrhythmias. Amiodarone has severe interactions with at least 30 different drugs. Onset of the antiarrhythmic effect of intravenous amiodarone occurs in less than 30 minutes.
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. Oct 26, 2018 cordarone iv amiodarone hydrochloride intravenous. Amiodarone king edward memorial hospital for women. Amiodarone injection belongs to the group of medicines known as antiarrhythmics.
Should the rsq clinical coordinator request an amiodarone infusion be commenced. Pdf effects of the prophylactic use of amiodarone infusion. Amiodarone intravenous route description and brand names. Amiodarone is a class antiarrhythmic that prolongs the cardiac action potential and the. Loading dose worksheet for intravenous amiodarone 1.
Do not start, stop, or change the dosage of any medicine before checking with your doctor, health care provider or pharmacist first. The recommended starting dose of amiodarone is about mg over the first 24 hours of therapy, delivered by the following infusion. Amiodarone is a class iii antiarrhythmic agent and is used for the treatment of various types of tachyarrhythmias. Dosing table on the drug amiodarone, including recommended dosage and major side effects.
Effect of prophylactic amiodarone infusion on the recurrence. For further product information and current package insert, please visit. There is no precise protocol for switching from iv to oral treatment but the. Based on the experience from clinical studies of intravenous amiodarone, a maintenance infusion of up to 0. Baxter healthcare corporation nexterone amiodarone. Continue amiodarone infusions already commenced at hospital, using the same concentration and administration rate already established. The digital clinical practice manual is expressly intended for use by qas paramedics when. Nexterone amiodarone hydrochloride injection, solution baxter healthcare corporation. If your doctor has directed you to use this medication, your doctor or pharmacist may already be aware of any possible drug interactions and may be monitoring you for them. A multidisciplinary team developed and implemented amiodarone peripheral infusion guidelines. Total dosage given via a peripheral catheter, duration of infusion, and number of catheters were significantly associated with phlebitis. Dilute 50mg 1ml of amiodarone 150mg3ml to a final volume. Amiodarone drug monitoring guideline this scp has been written to enable the safe and appropriate continuation of care for patients initiated on amiodarone in hospital. If lidocaine lignocaine has been administered to a patient with conscious vt that progresses into cardiac arrest, the following.
Intravenous amiodarone is useful in the treatment of af with rapid ventricular response in patients with ahf while showing rhythm and rate control effects. In addition, it produces a negative chronotropic effect in nodal tissues. Intravenous amiodarone bolus immediately controls heart. Intravenous amiodarone is a recognised treatment alternative for the conversion of atrial fibrillation to sinus rhythm. Alternatively, it is not necessary to dilute amiodarone for iv push administration and a filter is not necessary. Leeds teaching hospitals guidelines on the use of amiodarone for treatment of arrhythmias in children and neonates. To prepare amiodarone for an iv infusion, mix with d5w and give through an inline filter. Leeds teaching hospitals guidelines on the use of amiodarone. Amiodarone injection fda prescribing information, side. Peripheral line administration of intravenous amiodarone is associated with a. 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 first 24hour dose may be individualized for each patient.
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. Nov 01, 2018 amiodarone shows considerable interindividual variation in response. Digoxin second line rate control agent, primarily because it tends to exert its rate controlling effect at rest, less so with exercise. 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. Amiodaroneinduced phlebitis occurred in 40% of this sample at higher drug dosages. Intravenous amiodarone bolus immediately controls heart rate. In a total of 1836 patients in controlled and uncontrolled clinical trials, 14% of patients received cordarone i. Rhythm and rate control effects of intravenous amiodarone. If administered peripherally the infusion must be diluted appropriately as it may. Guidelines for the administration of iv amiodarone. Amiodarone infusion in the treatment of acute atrial.
Side effects of cordarone iv amiodarone intravenous. Data sources include ibm watson micromedex updated 10 apr 2020, cerner multum updated 6 apr 2020. Set the pump to infusion at 600 mlhour for ten minutes to deliver the 150 mg dose. Pediatric advanced life support dosing is 5 mgkg maximum 300 mg per dose rapid bolus ivio for cardiac arrest. Clinical trials apart from studies in patients with vt or vf, described below, there are two other studies of amiodarone showing an antiarrhythmic effect before significant levels of dea could have accumulated. Upon return of spontaneous circulation, follow with an infusion of 1 mgminute for 6 hours, then 0. Has been clinically demonstrated to improve the rate of rosc and hospital admission in adults with refractory ventricular fibrillation and pulseless ventricular tachycardia. March 2015 liver function tests every 6 months initial elevation of serum transaminases can occur and these may resolve spontaneously, or with reduction of dosage. Intravenous amiodarone was approved in 1995 for the treatment of malignant and resistant ventricular arrhythmia. It works directly on the heart tissue and will slow the nerve impulses in the heart. Estimates of the elimination halflife of amiodarone vary, depending on how the halflife has been measured and the route of amiodarone administration. Iv line following amiodarone administration in cardiac arrest. Click here to view a print quality pdf of this table. Intravenous amiodarone protocol scan to pharmacy and place in orders section of chart a physicians order is required for implementation of the protocol.
1372 279 1420 564 125 34 879 2 615 797 1373 775 1396 1090 1083 104 1081 800 787 717 755 1066 278 1137 760 1442 787 1426 48 747 481 1281