Amiodarone

Testa Rosa, RN · Aug 29, 2012

It's a powerful anti-arrithmic medication that I've just used-- IV push to convert a pt in sustained v-tach (and about to code) to a Sinus Tach--so right now I LOVE IT!

Stormy8 · Aug 29, 2012

Awesome!! When you administer it IVP...how fast can you push it? over 3 min? 150mg? People at work say you can when it's emergent but normally it's over 10 min.

resumecpr · Aug 29, 2012

Hi everyone!
I want to try and understand Amiodarone better. To my understanding this is a drug used to treat fast HR, ex a. Fib. My question is, before you administer, do you check the BP? Doesn't this drug drop the BP? PO? IV?
I appreciate your thoughts.
Thanks!

Any patient who requires amiodarone IV needs to be at the very least monitored on a telemetry unit. Where I work, these patients are in the ICU and have VS every hour and on continuous monitoring.

The half life is about 45 days and the side effects are numerous. Hypotension and bradycardia are two common side effects. It is contraindicated with patients on Diflucan as it can prolong the QT interval.

I have never pushed amiodarone unless the patient is in cardiac arrest, following the AHA ACLS guidelines. The dose is 300mg.

Usually after the patient stablizes (2-3 days depending on many many other things), the MD will change the Amio to PO. Usually between 200-400mg PO BID.

Hope this helps.

BrandonLPN, LPN · Aug 29, 2012

We give PO amiodarone on a long term basis in LTC. We don't check the pulse before administering it and there are no ordered parameters for holding it. Should we be checking the pulse before we give it?

*4!#6 · Aug 29, 2012

I've given this drug too and it freaks me out just because of how powerful it is and the number of side effects. I have always checked an apical pulse and a BP before giving it. I too am wondering if this is necessary, and any more information about the drug -- what types of arrythmias is it used for when given on a long term basis PO? Most common side effects?

bubblejet50 · Aug 29, 2012

We give PO amiodarone on a long term basis in LTC. We don't check the pulse before administering it and there are no ordered parameters for holding it. Should we be checking the pulse before we give it?

When I worked ltc we took pulse for amiodarone but most of us medication nurses were in school and didnt feel comfortable not taking the pulse so we put that extra parameter in. im not sure if it actually requires it because if they are in a fib it should (should being the key word) bring the hr down. Our don never watched our parameters to see what needed hr or bp so it fell on us...most new grad lpns in an rn program so we had the school mentality still.

Esme12, ASN, BSN, RN · Aug 29, 2012

All units/facilities have drug books/policies about how and where (what unit) a drug can be administered and by whom. Please check with your facilities policies and procedures and/or pharmacy before administering any drug. In general, Amiodarone is generally considered a class III antiarrhythmic drug.

Like class I drugs, amiodarone blocks sodium channels at rapid pacing frequencies, and like class II drugs, it exerts a noncompetitive antisympathetic action. One of its main effects, with prolonged administration, is to lengthen the cardiac action potential, a class III effect.

The negative chronotropic effect of amiodarone in nodal tissues is similar to the effect of class IV drugs. In addition to blocking sodium channels, amiodarone blocks myocardial potassium channels, which contributes to slowing of conduction and prolongation of refractoriness.

The antisympathetic action and the block of calcium and potassium channels are responsible for the negative dromotropic effects on the sinus node and for the slowing of conduction and prolongation of refractoriness in the atrioventricular (AV) node. Its vasodilator action can decrease cardiac workload and consequently myocardial oxygen consumption.

Amiodarone is metabolized by the liver and can cause pulmonary fibrosis. PLEASE USE LINK TO SEE ALL ABOUT AMIODARONE.

Amiodarone - Cordarone ® -* Intravenous (IV) Dilution

Recommended concentration: 1-6 mg/ml.

Central line is required for concentrations > 2 mg/ml.

Supplied: 3 ml amp (50 mg/ml.

Infusion: whenever possible administer through a central venous catheter. Also, an in-line filter should be used during administration. Cordarone I.V. concentrations greater than 3 mg/mL in D5W have been associated with a high incidence of peripheral vein phlebitis; however, concentrations of 2.5 mg/mL or less 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. Cordarone I.V. infusions exceeding 2 hours must be administered in glass or polyolefin bottles containing D5W.

Use of evacuated glass containers for admixing Cordarone I.V. is not recommended as incompatibility with a buffer in the container may cause precipitation.

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. Infuse 100 mL over 10 minutes.

Followed by slow: 360 mg over the NEXT 6 hours (1 mg/min). Add 18 mL of Cordarone I.V. (900 mg) to 500 mL D5W (conc = 1.8 mg/mL).

Maintenance infusion: 540 mg over the REMAINING 18 hours (0.5 mg/min).

After the first 24 hours, the maintenance infusion rate of 0.5 mg/min (720 mg/24 hours) should be continued utilizing a concentration of 1 to 6 mg/mL (Cordarone I.V. concentrations greater than 2 mg/mL should be administered via a central venous catheter).

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. The rate of the maintenance infusion may be increased to achieve effective arrhythmia suppression.

The initial infusion rate should not exceed 30 mg/min. The maintenance infusion of up to 0.5mg/min can be cautiously continued for 2 to 3 weeks regardless of the patient's age, renal function, or Left-ventricular function.

Hypotension

Hypotension is the most common adverse effect seen with intravenous amiodarone. In clinical trials, treatment-emergent, drug-related hypotension was reported as an adverse effect with intravenous amiodarone. Clinically significant hypotension during infusions was seen most often in the first several hours of treatment and was not dose related, but appeared to be related to the rate of infusion.

Hypotension should be treated initially by slowing the infusion; additional standard therapy may be needed, including the following: vasopressor drugs, positive inotropic agents, and volume expansion. The initial rate of infusion should be monitored closely and should not exceed that prescribed in DOSAGE AND ADMINISTRATION.

In some cases, hypotension may be refractory resulting in fatal outcome (see package insert for ADVERSE REACTIONS, Postmarketing Reports).

Bradycardia and AV Block

Drug-related bradycardia occurred while patients were receiving intravenous amiodarone for life-threatening VT/VF; it was not dose-related. Bradycardia should be treated by slowing the infusion rate or discontinuing amiodarone. In some patients, inserting a pacemaker is required. Patients with a known predisposition to bradycardia or AV block should be treated with intravenous amiodarone in a setting where a temporary pacemaker is available.

http://www.globalrph.com/antiarrhythmics.htm

Always consult you facilities policy and procedures before administering any medication.

http://www.globalrph.com/antiarrhythmics.htm

I hope this helps.

volunteerpioneer · Aug 30, 2012

I work in a CT ICU and when a pt converts into A-fib, usually 2nd or 3rd post op day, it's almost standard that the doc's write an order for a bolus of 150mg/min over 30 min followed by 1mg/min drip. I've seen a couple patients convert back to NSR right after the bolus and it's really cool :)

Stormy8 · Aug 31, 2012

Great info! Thanks everyone!

Stormy8 · Sep 3, 2012

With IV amiodarone, you want to watch the BP but what about PO?

Esme12, ASN, BSN, RN · Sep 3, 2012

google is your friend......Important safety information:

Amiodarone may cause dizziness. These effects may be worse if you take it with alcohol or certain medicines. Use Amiodarone with caution. Do not drive or perform other possibly unsafe tasks until you know how you react to it.
Do not stop taking Amiodarone without checking with your doctor.
Severe and sometimes fatal lung or breathing problems have been reported with Amiodarone. Contact your doctor right away if you develop shortness of breath, chest pain, wheezing, fever, or cough, or if you begin coughing up blood.
Amiodarone may cause vision problems that may lead to permanent blindness. Contact your doctor right away if you experience vision changes (eg, seeing halos, blurred vision, loss of vision).
Long-term exposure to Amiodarone may cause blue-gray discoloration of the skin, particularly of the face and hands. This effect is not harmful and usually reverses, sometimes incompletely, after the medicine is stopped. Avoiding prolonged exposure to the sun may help to prevent this effect.
Limit alcoholic beverages while taking Amiodarone.
It may take several days to weeks for Amiodarone to work. A response may not be seen for up to 3 weeks after the medicine is started.
Amiodarone stays in your body for weeks or months even after you stop taking it. Use caution during treatment with Amiodarone and for several months after you stop taking it if you are taking any medicines that may interact with it.
Amiodarone may cause skin reactions similar to serious sunburn or sensitivity to sunlight. Avoid the sun, sunlamp, or booths while taking Amiodarone. Use a sunscreen or wear protective clothing if you must be outside for more than a short time.
Tell your doctor or dentist that you take Amiodarone before you receive any medical or dental care, emergency care, or surgery, including laser surgery on the eye.
Tell your doctor if you have severe or persistent diarrhea while you are taking Amiodarone. You will need to take care not to become dehydrated.
Your doctor may want you to check your pulse rate every day while you take Amiodarone. Learn how to monitor your pulse.
Carry an ID card at all times that says you take Amiodarone.
Lab tests, including electrocardiograms (ECGs), chest x-rays, lung function tests, liver function tests, thyroid function tests, and eye exams, may be performed while you use Amiodarone. These tests may be used to monitor your condition or check for side effects. Be sure to keep all doctor and lab appointments.
Use Amiodarone with caution in the ELDERLY; they may be more sensitive to its effects.
Amiodarone should be used with extreme caution in CHILDREN; safety and effectiveness in children have not been confirmed.
PREGNANCY and BREAST-FEEDING: Amiodarone has been shown to cause harm to the fetus. If you think you may be pregnant, contact your doctor. You will need to discuss the benefits and risks of using Amiodarone while you are pregnant. Amiodarone is found in breast milk. Do not breast-feed while taking Amiodarone.

Read more at Amiodarone Tablets Facts and Comparisons at Drugs.com