<> Obtain a baseline chest X-ray and pulmonary-function tests, including diffusion capacity, when treatment with this drug is initiated. Web[IV route] Dose: 150 mg IV x1 over 10min, then 1 mg/min IV x6h, then 0.5 mg/min IV x18h [PO route] Dose: 400 mg PO qd; Start: load 800-1600 mg PO qd x1-3wk until response, then If the potassium concentration exceeds 5 mEq/L in the setting of severe digitalis intoxication, therapy with DIGIBIND is indicated. Pharmacologic stress agent (Adenoscan): Continuous I.V. Amiodarone is generally considered a class III antiarrhythmic drug, but it possesses electrophysiologic characteristics of all four Vaughan Williams classes. The elimination half-life of amiodarone is highly variable and unusually long, averaging about 58 days. levothyroxine: Dosing, contraindications, side effects, and pill Data sources include IBM Watson Micromedex (updated 1 May 2023), Cerner Multum (updated 17 Apr 2023), ASHP (updated 10 Apr 2023) and others. Half life: 9 minutes. Supplied: 50 mg, 100 mg, 150 mg tablet. metoprolol, propranolol, atenolol, diltiazem, amiodarone, lidocaine, bisoprolol, verapamil, flecainide, Tenormin. One of its main effects, with prolonged administration, is to lengthen the cardiac action potential, a class III effect. WebAdd 3 mL of Cordarone I.V. 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. Pulmonary toxicity has been fatal about 10% of the time. <>stream 300mg extended release tablet (sulfate). INDICATIONS AND USAGE MULTAQ is indicated to reduce the risk of cardiovascular hospitalization in patients with paroxysmal or persistent atrial fibrillation (AF) or atrial flutter (AFL), with a recent episode of AF/AFL and associated cardiovascular risk factors (i.e., age >70, hypertension, diabetes, prior cerebrovascular accident, left atrial diameter 50 mm or left ventricular ejection fraction [LVEF] <40%), who are in sinus rhythm or who will be cardioverted. 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. All of these events should be manageable in the proper clinical setting in most cases. The discoloration resolves over several months after amiodarone is discontinued. MeSH The long half-life is thought to be a result of the drug's slow release from lipid-rich tissues.2. Note: Decrease dose in patients with CHF, elderly, hepatic disease. Initial Daily Dose of Oral Cordarone : 400 mg 3 mL (150 mg) 10 Single-dose vials per carton (NDC 60505-0722-0). Each milliliter of the Cordarone I.V. Amiodarone DOSE RECOMMENDATIONS -- FIRST 24 HOURS -- Loading infusions. Each vial contains 38 mg which will bind approximately 0.5 mg of digoxin. Supplied: 80 mg, 120 mg, 160 mg, 240 mg tablet ---------- Drug UPDATES: SOTYLIZE (sotalol hydrochloride) oral solution Initial U.S. Approval: 1992 [Drug information / PDF] Dosing: Click (+) next to Dosage and Administration section (drug info link). Anti-Arrhythmics - GlobalRPH Number of vials needed =[(steady state serum digoxin level (ng/ml) x weight (kg)] / 100. 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.) This drug should be used at the lowest effective dose in order to prevent the occurrence of side effects. In some cases, hypotension may be refractory resulting in fatal outcome (see package insert for ADVERSE REACTIONS, Postmarketing Reports). infusion: 140 mcg/kg/minute for 6 minutes using syringe or columetric infusion pump; total dose: 0.84 mg/kg. Add 3 ml of Cordarone I.V. 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. Maintenance dose: Digoxin clearance= [CRCL + 40] x 1.44 (add 20 instead of 40 if pt has CHF). CRCL 40-60 ml/min: Administer 250 mcg twice daily. Obtain baseline and periodic liver transaminases and discontinue or reduce dose if the increase exceeds three times normal, or doubles in a patient with an elevated baseline. 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. FOIA Thallium-201 is injected at midpoint (3 minutes) of infusion. Amiodarone is a potent antiarrhythmic agent that is used to treat ventricular arrhythmias and atrial fibrillation. Close monitoring is indicated during the loading phase and surrounding any dose adjustments. Mechanisms of Action In a placebo-controlled study in patients with severe heart failure requiring recent hospitalization or referral to a specialized heart failure clinic for worsening symptoms (the ANDROMEDA Study), patients given dronedarone had a greater than two-fold increase in mortality. Half-life: 38-48 hrs. DOSAGE AND ADMINISTRATION The only recommended dosage of MULTAQ is 400 mg twice daily in adults. Amiodarone exhibits complex disposition characteristics after intravenous administration. Amiodarone Loading Dose Regimen Amiodarone is eliminated primarily by hepatic metabolism and biliary excretion and there is negligible excretion of amiodarone or DEA in urine. HEPATOTOXICITY: Liver injury is common with this drug, but is usually mild and evidenced only by abnormal liver enzymes. Druga PO to IV Considerations Comments Amiodarone (Cordarone) Use an IV dose thats 50% of the PO maintenance Hepatic impairment: Maximum daily dose: 1200 mg. Onset of the antiarrhythmic effect of intravenous amiodarone occurs in less than 30 minutes.15, In the Advanced Cardiac Life Support (ACLS) guidelines published in 2000, amiodarone and procainamide are recommended for the initial treatment of hemodynamically stable wide-complex tachycardia.16 However, these guidelines list amiodarone as being only possibly effective for the treatment of refractory pulseless ventricular tachycardia or ventricular fibrillation. Frendl G, Sodickson AC, Chung MK, et al. -----------------------------------Dosage Each vial of Digibind 38 mg or DigiFab 40 mg will bind ~0.5 mg of digoxin or digitoxin. of Oral Versus Intravenous Amiodarone in (If given IVPush-admin over at least 5 min).PSVT: (For patients not on digoxin): 0.25 to 0.5 mg IV. is about 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: First Rapid: 150 mg ---------------------------------------Supplied: Injection, powder for reconstitution: Digibind: 38 mg. ========================= Dilution: Prescribed dose/ 50 ml NS. Amiodarone Intravenous Neurologic toxicity associated with amiodarone therapy can include ataxia, paresthesias, and tremor. This site complies with the HONcode standard for trust- worthy health information: verify here. Approved for acute termination. 3 0 obj 4 0 obj An official website of the United States government. The authors report no conflicts of interest. This may be calculated if the amount ingested is known or the postdistribution serum drug level is known (round dose to the nearest whole vial). WebLidocaine is rarely indicated in cats, because clinically significant or life-threatening ventricular arrhythmias are rare in this species. INFUSION Duration of Cordarone I.V. 2.Weight of patient. Indications INDICATIONS All Rights Reserved. Copyright 2022 Wolters Kluwer Health, Inc. All rights reserved. No significant association was found between various overlap durations and AF recurrence (odds ratio (OR) 1.00, 95% CI 1.00-1.01, P = 0.9). The relationship between plasma amiodarone concentrations and effect, as well as the contribution of the metabolite DEA, is not well established.2 Routine monitoring of the amiodarone plasma level is not recommended.4 [Evidence level C, consensus/expert guidelines], Amiodarone is approved for use in the secondary prevention of life-threatening ventricular arrhythmias. If the starting dose is 500 mcg twice daily, then adjust to 250 mcg twice daily. +*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 Effective in @30% of patients. Inform patients administering this drug to do so consistently with regard to meals. Routine screening for adult respiratory distress syndrome is of limited value, because pulmonary toxicity can develop rapidly with no antecedent abnormalities on chest radiographs or pulmonary function tests. PO to IV Amiodarone Switch-Medscape-Apr22,2004. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. HOW SUPPLIED ---------------------- /QU+(R% $Kh=c6cL`bv!w? Supplied: 150 mg, 200 mg, 250 mg capsule. Duration of Cordarone I.V. dose. Assistant Professor of Pharmacy Practice /Assistant Professor of Medicine, Schools of Pharmacy & Medicine, Loma Linda University, Loma Linda, California; Co-Director, Lipid Clinic, VA Loma Linda Healthcare System, Loma Linda, California. <> If the starting dose was 125 mcg twice daily, then adjust to 125 mcg every day. The bioavailability of amiodarone is variable but generally poor, ranging from 22 to 95 percent.1 Absorption is enhanced when the drug is taken with food.2 Amiodarone is highly lipid soluble and is stored in high concentrations in fat and muscle, as well as in the liver, lungs, and skin. Webbetween PO and IV (64% vs. 68%, respectively; p=NS) 223 patients with symptomatic atrial fibrillation on digoxin PO amiodarone 600 mg in3 divided doses vs. IV amiodarone 5mg/kg Followed by Slow: 360 mg over the NEXT 6 hours (1 mg/min). Initial dose: 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: No adjustment recommended Long-Term Use Slow digoxin loading Slow oral digitalization, generally preferred for most patients, can be achieved by starting a maintenance dose of 0.125 to 0.25 mg daily. Any report from the patient of worsening dyspnea or cough should elicit a prompt assessment for pulmonary toxicity. David McAuley, Pharm.D. Last updated on Sep 13, 2022. Bradycardia and AV Block 10-15g of amiodarone is required to load a patient. Dosage for toxicity during chronic therapy : for adults, 6 vials (228mg) usually is adequate to reverse most cases of toxicity. Select one or more newsletters to continue. There is limited experience in patients receiving Cordarone I.V. 2014 AATS guidelines for prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. DOSE RECOMMENDATIONS -- FIRST 24 HOURS -- Loading infusions. 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. If the QTc >15% of baseline, or if the QTc is >500 msec (550 msec in patients with ventricular conduction abnormalities), dofetilide should be adjusted. Cordarone IV may be used alone or with other If liver enzyme levels are three times higher than normal, amiodarone should be discontinued unless a patient is at high risk for recurrence of life-threatening arrhythmia.2. concentrations should not exceed 2 mg/mL unless a central venous catheter is used. The rate of the maintenance infusion may be increased to achieve effective arrhythmia suppression. 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: Ocular: Ophthalmic examination, including fundoscopy and slit-lamp examination, Respiratory: History, physical exam, chest X-ray, and pulmonary function tests, including diffusion capacity. 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. Bookshelf Do Not Copy, Distribute or otherwise Disseminate without express permission. Initial Daily Dose of Oral Cordarone : 600-800 mg. Peak levels after 150 mg of supplemental infusions in patients with VT/VF range between 7 and 26 mg/L. In a meta-analysis of 18 RCTs, amiodarone was similar to other antiarrhythmic drugs in its ability to convert patients to normal sinus rhythm (72.1 percent for amiodarone compared with 71.9 percent for other antiarrhythmic drugs).18 [Evidence level A, meta-analysis] The meta-analysis did not address the effect of antiarrhythmic drugs on mortality and other clinical outcomes. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Initial Daily Dose of Oral Cordarone : 800-1600 mg, Duration of Cordarone I.V. Increased incidence of myopathy when simvastatin dosage is higher than 20 mg per day, Increased sildenafil plasma concentration, Increased cyclosporine plasma concentration, Additive effects: possible elevated plasma concentrations of quinidine, disopyramide (Norpace), flecainide (Tambocor), propafenone (Rythmol), and dofetilide (Tikosyn), Additive QT effect: possible increased risk of proarrhythmia, Increased plasma concentration of hepatically metabolized drugs: possible increased risk of proarrhythmia, Complete history and physical examination, with special attention to congestive heart failure, arrhythmia symptoms, and concomitant medications, Thyroid studies and liver transaminase levels, Digoxin level, prothrombin time, and INR, when appropriate, Ophthalmologic examination (if preexisting visual impairment), Close surveillance of heart rate, especially during first week of treatment, History and physical examination directed at detecting anticipated adverse effects, Close monitoring of prothrombin time and INR (at least once a week during first six weeks of treatment). (loading dose only): 2 to 2.5 times the IV dose. Eur J Cardiothorac Surg. = Link to Medscape monograph about a drug. After absorption, the drug undergoes extensive enterohepatic circulation. A reduction of the resting heart rate due to the beta-blocking effect of sotalol is observed at daily doses >/=90 mg/m2 in children. WebThere were no significant differences in amiodarone dosing, electrolyte abnormalities, volume status or concomitant cardiac medications at the time of IV to PO transition. Total volume: 106 mL. Oral Loading - Half-life elimination: 40-55 days (range: 26-107 days); 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.) If severe, stop amiodarone or insert pacemaker. If the starting dose was 250 mcg twice daily, then adjust to 125 mcg twice daily. Supplied: 250 mg, 500 mg capsule. Infusion: 1 to 3 weeks Initial Daily Dose of Oral Cordarone : 600-800 mg. This drug should be used at the lowest effective dose in order to prevent the occurrence of side effects. IV: In patients with extended and recurrent sun exposure, bluish skin discoloration may develop in exposed areas. Monitor apical pulse daily.. Onset/peak: IV: 5-30min/ 1-4hrs Oral: 1-2hrs/ 2-8 hrs. Infusion rate: 318 mL/hr. The net effect is to shift the equilibrium away from binding of digoxin to its receptors in the body, thereby reversing its effects. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Federal government websites often end in .gov or .mil. Hepatic impairment: Reduce dose by 50%. 6 0 obj government site. This article reviews the pharmacology, indications, adverse effects, and drug interactions of amiodarone, and outlines a strategy for surveillance of patients who are taking this drug. Storage requirements: The manufacturer product information should be consulted. Reconstitution/preparation techniques: The manufacturer product information should be consulted. El-Chami MF, Kilgo P, Thourani V, et al. Various practice guidelines recommend amiodarone as a second-line drug in the long-term treatment of atrial fibrillation in patients with structural heart disease and in highly symptomatic patients without heart disease.10 Several smaller studies have shown that amiodarone is similar to quinidine and sotalol in the treatment of atrial fibrillation in these patients.11,12 In one randomized controlled trial (RCT),12 sinus rhythm was maintained successfully for 16 months in 65 percent of patients treated with amiodarone, compared with 37 percent of patients treated with sotalol or propafenone (ARR, 28 percent; NNT, 3.6). (Enter numeric value only. Recommendations for conversion to intravenous amiodarone after oral administration: During long-term amiodarone therapy (ie, 4 months), the mean plasma-elimination half-life of the active metabolite of amiodarone is 61 days. (Doses <0.5 mg have been associated with paradoxical bradycardia.). Although the frequency of such proarrhythmic events does not appear greater with this drug than with many other agents used in this population, the effects are prolonged when they occur. by 25% full replacement dose qwk if hyperactivity risk; give PO form on empty stomach, 30-60min before morning meal; IM/IV dose is 50-75% of PO dose [>12 yo, growth/puberty complete] You will receive email when new content is published. The primary treatment for pulmonary toxicity is withdrawal of amiodarone and provision of supportive care and, in some cases, corticosteroids. If you log out, you will be required to enter your username and password the next time you visit. Normal subjects over 65 years of age show lower clearances (about 100 mL/hr/kg) than younger subjects (about 150 mL/hr/kg) and an increase in t1/2 from about 20 to 47 days. Cordarone I.V is not intended for maint therapy. Crcl 30-60 ml/min: Administer every 24 hours. J Am Coll Cardiol. The initial infusion rate should not exceed 30 mg/min. The https:// ensures that you are connecting to the Considerations for PO to IV Dose Conversions Adenosine is thought to exert its pharmacological effects through activation of purine receptors (cell-surface A1 and A2 adenosine receptors). The systemic availability of oral amiodarone in healthy subjects ranges between 33% and 65%. WebConventional IV preparation contains polysorbate 80 and benzyl alcohol Newer IV formulation (Nexterone) does not contain polysorbate 80 or benzyl alcohol Conversion to oral The dosage of amiodarone should be kept at the lowest effective level. endobj Because absorption and elimination are variable, maintenance-dose selection is difficult, and it is not unusual to require dosage decrease or discontinuation of treatment. In clinical studies of 2 to 7 days, clearance of amiodarone after intravenous administration in patients with VT and VF ranged between 220 and 440 mL/h/kg. David McAuley, Pharm.D. <> Decrease dose by 30-50% in hepatic insufficiency. All Rights Reserved. The North American Society for Pacing and Electrophysiology (NASPE) recommends amiodarone as the antiarrhythmic agent of choice in patients who have survived sustained ventricular tachyarrhythmias, particularly those with left ventricular dysfunction.4. This retrospective, observational, single-center study included cardiothoracic surgery patients who were initiated on IV amiodarone for supraventricular arrhythmia and subsequently transitioned to oral amiodarone. Hypotension, bradycardia, atrioventricular block. Thyroid toxicity is the most common complication that requires intervention. Our study suggests following conversion to normal sinus rhythm; cardiothoracic surgery patients can effectively and safely be transitioned from IV to oral amiodarone without the need for specific overlap duration or transition strategy. It is used in patients who have already been treated with other medicines that did not work well. Discontinue this drug if the patient experiences signs or symptoms of clinical liver injury. % Intraoperative tachycardia and/or hypertension (immediate control): Initial bolus: 80 mg IV (~1 mg/kg) over 30 seconds, followed by a 150 mcg/kg/minute infusion, if necessary. Monitor BUN and serum creatinine q2days (qd if unstable). Amiodarone administered orally or intravenously - the 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. 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. of vials = digitoxin (ng/mL) x body weight (kg) divided by 1000. Contraindicated in: sinus bradycardia; > 1st degree heart block; overt cardiac failure. The affinity of DIGIBIND for digoxin is in the range of 109 to 1011 M-1, which is greater than the affinity of digoxin for (sodium, potassium) ATPase, the presumed receptor for its toxic effects. 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). CLINICAL PHARMACOLOGY After intravenous injection of Digoxin Immune Fab (Ovine) in the baboon, digoxin-specific Fab fragments are excreted in the urine with a biological half-life of about 9 to 13 hours.1 In humans with normal renal function, the half-life appears to be 15 to 20 hours.2 Experimental studies in animals indicate that these antibody fragments have a large volume of distribution in the extracellular space, unlike whole antibody which distributes in a space only about twice the plasma volume.1 Ordinarily, following administration of DIGIBIND, improvement in signs and symptoms of digitalis intoxication begins within one-half hour or less.2,3,4,5. 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. The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. Monitoring: Pacerone, Cordarone, Nexterone, Cordarone IV. Safety outcomes include occurrence of bradycardia or hypotension while on amiodarone. INFUSION Not preferred drug for PSVT because it is not rapidly effective (may take up to 60 minutes). >50 kg: 150 mg every 6 hours or 300 mg every 12 hours (controlled release); if no response, may increase to 200 mg every 6 hours; maximum dose required for patients with severe refractory ventricular tachycardia is 400 mg every 6 hours. WebAmiodarone shows beta blocker-like and calcium channel blocker-like actions on the SA and AV nodes, increases the refractory period via sodium- and potassium-channel effects, and slows intra-cardiac conduction of the cardiac action potential, via sodium-channel effects. 2011;92:11441152. Postoperative atrial fibrillation following cardiac surgery: a persistent complication. The drug prevents the recurrence of life-threatening ventricular arrhythmias and produces a modest reduction of sudden deaths in high-risk patients. Typical amiodarone dosages in the ACLS setting are provided in Table 1.2,10 In patients who require long-term treatment, intravenous dosing should be switched to oral dosing. sharing sensitive information, make sure youre on a federal 8600 Rockville Pike 4.Volume of fluid in bag. Please see our, 2010synthroid-levoxyl-levothyroxine-342732. Monitoring: Obtain blood samples at least 4 hrs after IV dose and 6-8hrs after oral dose. IV to oral transition (infusion duration Adenosine may also lessen vascular tone by modulating sympathetic neurotransmission. Pharmacokinetics Advise patients that most manufacturers of corneal refractive laser surgery devices consider corneal refractive laser surgery contraindicated in patients taking this drug. May give by bolus injection if cardiac arrest is imminent. CONTRAINDICATIONS There are no known contraindications to the use of DIGIBIND. A local search option of this data can be found here. Interactions with warfarin and digoxin are the most clinically important. Amiodarone has a variable oral bioavailability. If the measured QTc is >500 msec (550 msec in patients with ventricular conduction abnormalities) dofetilide should be stopped. Predicted Css= (Dose) (0.65 to 0.8)/ Digoxin clearance. 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. 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. Factors that increase likelihood of digoxin toxicity: Hypokalemia, hypomagnesaemia, hypothyroidism, renal dysfunction, interacting drugs (eg quinidine, verapamil). Cordarone I.V is not intended for maint therapy. Amiodarone ER Tab: 500 mg, 750 mg, 1000 mg. Injection: 100 mg/ml (10 ml); 500 mg/ml (2 ml). 150 mg, 225 mg, 300 mg tablet. Administration advice: The manufacturer product information should be consulted. Overt liver disease can occur, however, and has been fatal in a few cases.
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