Administration of IV Amiodarone

• Amiodarone shows considerable interindividual variation in response.
• Thus, although a starting dose adequate to suppress life-threatening arrhythmias is needed, close monitoring with adjustment of dose as needed is essential.
• 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

Other available guides

  

OR

 Usually 300mg in 100mls Glucose 5% over 20 minutes to 2 hours, 

followed by 

continuous infusion of 900mg in 500mls Glucose 5% over 24 hours

 If the arrhythmia remains uncontrolled the infusion may be repeated in doses up to 1200mg (approximately 15mg/kg bodyweight) 

over 24 hours and the rate then adjusted on the basis of clinical response 

Injection

• In extreme clinical emergency Amiodarone Hydrochloride 150 mg/3 mL may, at the discretion of the clinician, be given as a slow injection of 150 - 300mg in 10 - 20mL 5% glucose over a minimum of 3 minutes. 
• This should not be repeated for at least 15 minutes. 
• Patients treated in this way must be closely monitored, e.g. in an intensive care
  unit.

Considerations

• Must be diluted in glucose 5% (do NOT dilute in sodium chloride). Also use D5% as IV flush
• whenever possible administer through a central venous catheter.
• an in-line filter should be used during administration
• Concentrations > 3 mg/mL in D5W have been associated with a high incidence of peripheral vein phlebitis
• Concentrations < 2.5 mg/mL appear to be less irritating.
• Therefore, for infusions longer than 1 hour, Cordarone I.V. concentrations should not exceed > 2 mg/mL unless a central venous catheter is used.
• infusions exceeding 2 hours must be administered in glass or polyolefin bottles containing D5W 

References

1. http://www.drugs.com/dosage/cordarone-injection.html
2. http://www.globalrph.com/amiodarone_dilution.htm
3. Loading Dose Worksheet – Amiodarone IV in Adults. Royal Cornwall Hospitals NHS Trust
4. Amiodarone Hydrochloride 150 mg/3 mL. BNM Group
5. Guidelines for the Administration of IV Amiodarone. Mid Essex