Also, an in-line filter should be used during administration. <>
Supplied: 200 mg, 300 mg tab (sulfate). In some cases, hypotension may be refractory resulting in fatal outcome (see package insert for ADVERSE REACTIONS, Postmarketing Reports). Initial Daily Dose of Oral Cordarone : 800-1600 mg, Duration of Cordarone I.V. The drug prevents the recurrence of life-threatening ventricular arrhythmias and produces a modest reduction of sudden deaths in high-risk patients. The recommended starting dose of Cordarone I.V. Continued monitoring for doses 2-5: QTc interval must be determined 2-3 hours after each subsequent dose of dofetilide for in-hospital doses 2-5. Considerations for PO to IV Dose Conversions Close monitoring is indicated during the loading phase and surrounding any dose adjustments. endobj
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). Amiodarone is an iodine-containing compound with some structural similarity to thyroxine. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Approved for acute termination. Although the U.S. Food and Drug Administration (FDA) has labeled amiodarone only for the treatment of life-threatening ventricular arrhythmias, the drug also is used to treat atrial fibrillation. -----------------------------------Dosage Each vial of Digibind 38 mg or DigiFab 40 mg will bind ~0.5 mg of digoxin or digitoxin. Prevention of ventricular fibrillation: Initial bolus: 0.5 mg/kg; repeat every 5-10 minutes to a total dose of 2 mg/kg. Cordarone I.V. 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. HHS Vulnerability Disclosure, Help Anti-Arrhythmics - GlobalRPH A local search option of this data can be found here. PO to IV Amiodarone Switch-Medscape-Apr22,2004. WebIntravenous procainamide (Procainamide Hydrochloride Injection) is effective in cardioversion in up to 60 percent of patients in uncontrolled series. PULMONARY TOXICITY: This drug has several potentially fatal toxicities, the most important of which is pulmonary toxicity (hypersensitivity pneumonitis or interstitial/alveolar pneumonitis) that has resulted in clinically manifest disease at rates as high as 10% to 17% in some series of patients with ventricular arrhythmias given doses around 400 mg/day, and as abnormal diffusion capacity without symptoms in a much higher percentage of patients. Intravenous amiodarone is a class III antiarrhythmic agent which has been reported to be safe and most effective in various clinical settings, without an associated increase in mortality rate. Ingestion of more than 10 mg of digoxin in previously healthy adults or 4 mg of digoxin in previously healthy children, or ingestion causing steady-state serum concentrations greater than 10 ng/mL, often results in cardiac arrest. endobj
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IV to oral transition (infusion duration [assuming 0.5 mg/min infusion]: initial oral daily dose). <>stream
= Link to Medscape monograph about a drug. Available for Android and iOS devices. Dilution Amiodarone - GlobalRPH If the potassium concentration exceeds 5 mEq/L in the setting of severe digitalis intoxication, therapy with DIGIBIND is indicated. Cordarone I.V. (150 mg) to 100 mL D5W. Peak concentrations after 10-minute infusions of 150 mg intravenous amiodarone in patients with ventricular fibrillation (VF) or hemodynamically unstable ventricular tachycardia (VT) range between 7 and 26 mg/L. Druga PO to IV Considerations Comments Amiodarone (Cordarone) Use an IV dose thats 50% of the PO maintenance Pre- and post-treatment with amiodarone may promote successful and sustained cardioversion. Amiodarone is a potent antiarrhythmic agent that is used to treat ventricular arrhythmias and atrial fibrillation. Assistance in calculating accurate rates of medication administration. Oral Loading - Half-life elimination: 40-55 days (range: 26-107 days); 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. HOW SUPPLIED ---------------------- Grapefruit juice can inhibit amiodarone metabolism and lead to elevated drug levels,3 but the impact of this interaction on the long-term efficacy and toxicity of amiodarone is not known. This content is owned by the AAFP. The initial infusion rate should not exceed 30 mg/min. INFUSION One meta-analysis of 13 studies of patients with congestive heart failure or recent myocardial infarction showed a small reduction in total annual mortality, from 12.3 percent to 10.9 percent (absolute risk reduction [ARR], 2.4 percent; number needed to treat [NNT], 42).5 [Evidence level A, meta-analysis] The benefit of amiodarone therapy was more pronounced in the patients who had congestive heart failure, with treatment reducing the annual mortality rate from 24.3 percent to 19.9 percent (ARR, 4.4 percent; NNT, 23). J Thorac Cardiovasc Surg. Amiodarone injection is contraindicated in patients with known hypersensitivity to any of the components of amiodarone injection, including iodine, or in patients with cardiogenic shock, marked sinus bradycardia, and second- or third-degree AV block unless a functioning pacemaker is available. WebA = Airway - Assess for airway obstruction, assess for breathing, perform intubation B = Breathing - Ventilate with 100% oxygen, 10-24 breaths/minute C = Circulation - Assess for heart beat and pulses if absent, begin chest compressions, 100-120 compressions/minute Begin ADVANCED life support Obtain Electrocardiogram and Determine Arrest Rhythm Amiodarone: Guidelines for Use and Monitoring | AAFP WebThis calculator is not appropriate for the following patient populations: Significant drug interactions (eg, amiodarone, quinidine, verapamil, or macrolide antibiotics) End-stage WebUse oral administration wherever possible. Restated: Duration of IV infusion < 1 week: 800-1600mg/day po initially x 1-2 weeks or complete current week; 1-3 weeks: 600-800mg/day po initially - total therapy ~ 1 month counting IV infusion ; >3 weeks: 400mg po qd initially. Decrease dose by 30-50% in hepatic insufficiency. CONTRAINDICATIONS There are no known contraindications to the use of DIGIBIND. Renal Dosing Crcl <10 ml/minute: Administer 75% of normal dose. HEPATOTOXICITY: Liver injury is common with this drug, but is usually mild and evidenced only by abnormal liver enzymes. If intravenous amiodarone is administered during pregnancy, the patient should be apprised of the potential hazard to the fetus. 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 for Conversion of Atrial Fibrillation | AAFP In contrast, a recent study comparing the use of amiodarone and lidocaine in patients with shock-resistant, out-of-hospital ventricular fibrillation showed that amiodarone therapy substantially improves survival and hospital admission rates.17 [Evidence level A, RCT]. The net effect is to shift the equilibrium away from binding of digoxin to its receptors in the body, thereby reversing its effects. May be further diluted with normal saline. 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. Amiodarone Federal government websites often end in .gov or .mil. These symptoms often are dosage related and usually improve when the dosage is reduced. CRCL 40-60 ml/min: Administer 250 mcg twice daily. Medically reviewed by Drugs.com. Postoperative atrial fibrillation following cardiac surgery: a persistent complication. A much less common presentation is adult respiratory distress syndrome. WebThere were no significant differences in amiodarone dosing, electrolyte abnormalities, volume status or concomitant cardiac medications at the time of IV to PO transition. Amiodarone is more effective than sotalol or propafenone in preventing recurrent atrial fibrillation in patients for whom a rhythm-control strategy is chosen. concentrations should not exceed 2 mg/mL unless a central venous catheter is used. In early studies, the frequency of pulmonary toxicity in amiodarone therapy was 2 to 17 percent.2 More recent studies have shown a lower incidence in patients receiving dosages of 300 mg per day or less. Therefore, all patients should be cautioned to use sunblock and, whenever possible, to cover exposed skin when they are outdoors. A steady state will be achieved after five cycles of the drug half-life (T1/2), which is approximately 7 to 10 days in the average subject. 1 0 obj
Amiodarone (Cordarone) is a complex antiarrhythmic agent with multiple electrophysiologic effects, unusual pharmacokinetics, and numerous potentially harmful drug interactions and adverse effects. Thyroid abnormalities have been described in up to 10 percent of patients receiving long-term amiodarone therapy.2 Hyperthyroidism may result from an excess of iodine or acute thyroiditis.20 Hypothyroidism is two to four times more common than hyperthyroidism.2, In hypothyroid patients with a strong clinical indication for amiodarone, the drug may be continued with appropriate thyroid hormone supplementation. lxEG@Ff j|h^^xklM&A{r:hY3ES$O~"s\B@CK*c#wOgrPhRML,rAWy\ijC
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stNbS7Y< of vials = digitoxin (ng/mL) x body weight (kg) divided by 1000. See labeling for oral amiodarone. Obtain a baseline chest X-ray and pulmonary-function tests, including diffusion capacity, when treatment with this drug is initiated. Ann Thorac Surg. Crcl 30-60 ml/min: Administer every 24 hours. Duration of Cordarone I.V. -----------------------------------INDICATIONS AND USAGE DIGIBIND, Digoxin Immune Fab (Ovine), is indicated for treatment of potentially life-threatening digoxin intoxication.3 Although designed specifically to treat life-threatening digoxin overdose, it has also been used successfully to treat life-threatening digitoxin overdose.3 Since human experience is limited and the consequences of repeated exposures are unknown, DIGIBIND is not indicated for milder cases of digitalis toxicity. >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. endobj
Crcl <40 ml/min: Use is contraindicated. Infuse 100 mL over 10 minutes. This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. All Rights Reserved. Patients treated with amiodarone should be followed regularly to assess ongoing need for amiodarone, efficacy of the drug, appropriateness of dosage, adverse effects, and potential drug interactions. WebWhen appropriate, monitor and adjust IV dose as necessary. infusion over >/= 30 minutes is preferred. Duration of Cordarone I.V. If you log out, you will be required to enter your username and password the next time you visit. Amiodarone: I.V. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. You must declare any conflicts of interest related to your comments and responses. %
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). Atrial Fibrillation (AF) & Flutter complicating critical illness FDA-approved for acute termination of A-flutter/A-fib (may be alternative to cardioversion): 1mg IV over 10min. Amiodarone may subsequently be continued until the patient has recovered from their critical illness (e.g., for 1-2 weeks). A causal relationship is not well established. 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. Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). 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. [720 mg / 500 ml ] [See comments] These intracellular metabolites of adenosine are not vasoactive. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential harm to the fetus. If side effects become excessive, the dose should be reduced. 10-15g of amiodarone is required to load a patient. Studies on the use of amiodarone for the primary prevention of sudden death in high-risk patients have had mixed results. The dosage in cats is 0.10.4 mg/kg, IV bolus over ~1 min, then increase to a total dose of 0.251 mg/kg, IV slowly, if no response. Amiodarone administered orally or intravenously - the The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. The drug's high iodine content likely is a factor in its effects on the thyroid gland. There is limited experience in patients receiving Cordarone I.V. This site complies with the HONcode standard for trust- worthy health information: verify here. Any report from the patient of worsening dyspnea or cough should elicit a prompt assessment for pulmonary toxicity. In patients with severe left ventricular dysfunction, the pharmacokinetics of amiodarone are not significantly altered but the terminal disposition t1/2 of DEA is prolonged. Treatment with Class I or III antiarrhythmics (e.g., amiodarone, flecainide, propafenone, quinidine, disopyramide, dofetilide, sotalol) or drugs that are strong inhibitors of CYP3A (e.g., ketoconazole) must be stopped before starting MULTAQ, HOW SUPPLIED MULTAQ 400-mg tablets are provided as white film-coated tablets for oral administration, oblong-shaped, engraved with a double wave marking on one side and "4142" code on the other side in:Bottles of 60 tablets, NDC 0024-4142-60 Bottles of 180 tablets, NDC 0024-4142-18 Bottles of 500 tablets NDC 0024-4142-50 Box of 10 blisters (10 tablets per blister) NDC 0024-4142-10. Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. You've successfully added to your alerts. 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: CORDARONE I.V. DOSE RECOMMENDATIONS FIRST 24 HOURS Loading infusions First Rapid: 150 mg over the FIRST 10 minutes (15 mg/min). Gastrointestinal side effects of amiodarone include nausea, anorexia, and constipation. Intravenous [Loading: 10 to 15 mcg/kg IBW in divided doses (q4-8h) over 12-24hrs.] (150 mg) to 100 mL D5W (concentration = 1.5 mg/mL). Repeat history, physical exam, and chest X-ray every 3 to 6 months. National Library of Medicine Because implantable cardioverter-defibrillators (ICDs) are more effective than amiodarone in reducing mortality in high-risk patients with previous myocardial infarction, primary treatment should be an ICD.69 [Reference6 Evidence level A, meta-analysis] In these patients, amiodarone may be used as an adjunct to reduce the frequency of ICD shocks or to control atrial fibrillation in selected highly symptomatic patients. Initial dose: 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: No adjustment recommended Unable to load your collection due to an error, Unable to load your delegates due to an error. Amiodarone has been associated with toxicity involving the lungs, thyroid gland, liver, eyes, skin, and nerves (Table 2).2,5,11,19 The frequency of most adverse effects is related to the total amiodarone exposure (i.e., dosage and duration of treatment). However, recent studies have shown that aggressive attempts to maintain sinus rhythm using amiodarone or other drugs do not improve outcomes in relatively asymptomatic patients.13,14 Therefore, long-term amiodarone therapy, with its potential for toxicity, does not appear to be justified in patients who are taking anticoagulant drugs if rate-control strategies can provide satisfactory symptomatic improvement. Estimation of the dose is based on the body burden of digitalis. For control of postoperative hypertension, as many as one-third of patients may require higher doses (250-300 mcg/kg/minute) to control blood pressure; the safety of doses >300 mcg/kg/minute has not been studied. 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. This drug should be used at the lowest effective dose in order to prevent the occurrence of side effects. Stopping the infusion and restarting at a slower rate may help if infusion-related reactions occur. Copyright 2021 GlobalRPH - Web Development by. Amiodarone is an iodinated benzofuran derivative that was synthesized and tested as an antianginal agent in the 1960s but was later discovered to have antiarrhythmic What should we do for this patient? 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 Supplied: 225 mg, 325 mg, 425 mg extended release cap. ATRIUM CE Final Gale Watson Interactions with warfarin and digoxin are the most clinically important. Despite such measures, bradycardia was progressive and terminal in 1 patient during the controlled trials. 4.Volume of fluid in bag. Restated: Duration of IV infusion < 1 week: 800-1600mg/day po initially x 1-2 weeks or complete current week; 1-3 weeks: 600-800mg/day po initially - total therapy ~ 1 month counting IV infusion ; >3 weeks: 400mg po qd initially. May repeat x 1. Please confirm that you would like to log out of Medscape. This website also contains material copyrighted by 3rd parties. INFUSION, Recommendations for conversion to intravenous amiodarone after oral administration, HONcode standard for trust- worthy health, Skeletal Muscle Index And Ovarian Cancer Prognosis: A Meta-Analysis, 7 Natural Remedies for Rheumatoid Arthritis. Malignant Arrhythmia and Cardiac Arrest in the Operating Room. [Oral bioavailability (tablets): 70 to 80%]. Intravenous to Oral Transition of Amiodarone (IOTA): Effect