Amiodarone (IV — ICU/Peri-Arrest)

Source quote (eMC §4.2): 'The standard recommended dose is 5mg/kg bodyweight given by intravenous infusion over a period of 20 minutes to 2 hours.' Amiodarone should only be used where facilities exist for cardiac monitoring, defibrillation and cardiac pacing, and only in a special care unit under continuous ECG and blood pressure monitoring. MAINTENANCE INFUSION: 10-20 mg per kg bodyweight in physiological glucose solution every 24 hours (on average 600 to 800 mg per 24 hours, up to a maximum of 1200 mg per 24 hours) for a few days. EXTREME CLINICAL EMERGENCY (slow injection): at the discretion of the clinician, 150-300 mg (or 2.5-5 mg/kg) in 10-20 ml 5% glucose over a minimum of 3 minutes; this should not be repeated for at least 15 minutes, and patients treated this way must be closely monitored, e.g. in an intensive care unit. CARDIOPULMONARY RESUSCITATION: the recommended dose for ventricular fibrillation / pulseless ventricular tachycardia resistant to defibrillation is 300 mg (or 5 mg/kg bodyweight) diluted in 20 ml 5% dextrose and rapidly injected; an additional 150 mg (or 2.5 mg/kg bodyweight) IV dose may be considered if ventricular fibrillation persists. For prolonged, refractory ventricular fibrillation after adrenaline and defibrillation: 300 mg as bolus injection, repeated if necessary with a 150 mg bolus injection. Amiodarone can cause severe irritation of the vein — adequate rinsing after bolus injection must be ensured, and peripheral administration should be followed by 200 ml of infusion fluid. DILUTION LIMITS: do not use concentrations below 300 mg per 500 ml; to prevent phlebitis do not use concentrations exceeding 3 mg/ml; do not add other medicinal products to the infusion fluid and do not give other substances in the same syringe. A central line is recommended whenever repeated or continuous infusions are intended. CHANGEOVER TO ORAL: as soon as an adequate response has been obtained (if possible commence oral maintenance on the first day of the infusion), oral therapy should be initiated concomitantly at the usual loading dose (200 mg three times a day), then phased out gradually. STATINS: in patients taking amiodarone with simvastatin, the simvastatin dose should not exceed 20 mg/day. ELDERLY: use the minimum effective dose; the elderly may be more susceptible to bradycardia and conduction defects if too high a dose is employed; pay particular attention to thyroid function monitoring. PAEDIATRIC: safety and efficacy in children have not been established, and because of the benzyl alcohol content intravenous amiodarone is CONTRAINDICATED in neonates, infants and children up to 3 years old — verify any paediatric use against a children's formulary.