ACLS/BLS Tips: Amiodarone
Quick Info
Indications:
VF/pVT unresponsive to shock delivery, CPR, and vasopressor (without a pulse)
Recurrent, hemodynamically unstable VT (with a pulse)
With expert consultation, may be used for some atrial and ventricular arrhythmias
Dose:
VF/pVT unresponsive to shock delivery, CPR, and vasopressor (without a pulse)
First Dose: 300 mg IV/IO push
Second Dose (if needed): 150 mg IV/IO push
Recurrent, hemodynamically unstable VT (with a pulse)
Rapid Infusion: 150 mg IV over 10 min (15 mg/min) - may repeat (150 mg) every 10 min as needed
Slow Infusion: 360 mg IV over 6 hrs (1mg/min)
Maintenance Infusion: 540 mg IV over 18 hours (0.5mg/min)
Max Daily Dose: 2.2 g IV over 24 hrs
Caution:
Rapid infusion or multiple dosing may cause hypotension
Do not administer with other drugs that prolong QT interval (e.g., procainamide)
Multiple complex drug interactions
Terminal elimination is very long (half life lasts up to 40 days)
Overview
Amiodarone is a class III antiarrhythmic medication used to treat and prevent a number of types of cardiac dysrhythmias. These dysrhythmias include ventricular tachycardia (VT), ventricular fibrillation (VF), and wide complex tachycardia, atrial fibrillation, and paroxysmal supraventricular tachycardia (American Society of Health-System Pharmacists, 2024). Despite Amiodarone being labelled as a class III antiarrhythmic (potassium blocking), it also works on the sodium and calcium channels, as well as posessinging alpha- and beta-adrenergic blocking properties. This helps prevent conduction of unwanted electrical activity by decreasing excitability of cardiac cells. Severe side effects can be related to amiodarone toxicity, such as interstitial pneumonitis, pulmonary fibrosis, hepatotoxicity, heart arrhythmias, optic neuropathies, hypo- or hyper-thyroidism, and death.
ACLS Tips
Amiodarone is a common drug thats given within any ACLS course, so it’s important to know when and how to give it.
Sometimes learners mix up the the dosing and administration of amiodarone between the the two primary indications:
In Cardiac Arrest with VF/pVT its a 300 mg IV/IO push dose
In Adult Tachycardia with a Pulse for recurrent VT its a 150mg IV infusion over 10 min, not a push dose!
In the Adult Tachycardia with a Pulse algorithm, patients who are hemodynamically unstable should not initially receive amiodarone, but be cardioverted first.
References:
American Society of Health-System Pharmacists. (2024). Amiodarone hydrochloride monograph for professionals. Drugs.com. https://www.drugs.com/monograph/amiodarone-hydrochloride.html
Heart & Stroke Foundation of Canada. (2020). Advanced Cardiac Life Support. Canada.