patient on IV Amidorone and PO Amiodorone at the same time?

[raindrop]

The patient was in Afib and the MD ordered a bolus of Ami followed by a continious drip. The patient was also started on PO amiodorone 400mg BID. The drip has been infusing for almost 24 hours and the patient had not yet converted. Patient had also received 3 doses of PO Amio in addition to the drip in the 24 hours. The resident for the evening was upset that the patient had received so much Amio over the course of 24 hours. He said PO should only be given if the drip is going to be turned off within 4-6 hours????

[MendedHeart]

No that is incorrect. PO Amio takes days to weeks to build up or load. Giving IV and PO together can be ok ...Google it and you will find studies.

[loveRNlove]

On our floor the doctors want us to hold off on PO amio if we have to start a drip. We will usually give them one dose of PO right before the last bag runs out then d/c the gtt.

[MendedHeart]

Yea, this is typically the case, but I think in some circumstances it is fine. What was the patients hr after being on the drip? Ive seen this done on a few occasions, and I hAve akso seen cardizem and amio at the same time.

[Anna Flaxis, BSN, RN]

Amiodarone has a potential for fatal toxicity and has no antidote. I'm guessing the resident's concern about the 24 hour cumulative total dose was related to this. If the patient was elderly, the risk is increased. Also, Amiodarone has a super long half life. One resource I have says 26-107 days, and another says 58 days. Probably where he got the 4-6 hours is that this is the peak plasma time for the PO dose.

[lifelonglearnern]

It is odd to me that the pt was receiving 400 mg po bid.... that's a touch much for a po dose, especially if gtt was going at full strength... usually I give 200 mg..... still, it is not uncommon for the patients I care for, in new onset afib or afib c rvr to receive the gtt and po amio simultaneously. :)

[misskarkey]

Typically on our floor, we infuse a bolus, run a drip at 1 mg/kg/hr (I believe it's mg's) for only 6 hrs, then drop the rate by half to 0.5 mg/kg/hr. We have 400 in 250 bags so our cc's are 34 cc x 6 hrs and then 17 cc. Our most common practice on our floor is to hold off on the oral amio until the drip is being dc'd (give oral and shut drip off maybe 2 hrs later). However, over my years of nursing, there are times where the cardiologist specifically ordered both iv and oral. I clarify to be sure, as like I said, it is not the norm. Also, someone above mentioned that 400mg was too much. In my experience, 200mg is the smallest dose we give. We usually start out with taper doses.

[MendedHeart]

Typically on our floor we infuse a bolus, run a drip at 1 mg/kg/hr (I believe it's mg's) for only 6 hrs, then drop the rate by half to 0.5 mg/kg/hr. We have 400 in 250 bags so our cc's are 34 cc x 6 hrs and then 17 cc. Our most common practice on our floor is to hold off on the oral amio until the drip is being dc'd (give oral and shut drip off maybe 2 hrs later). However, over my years of nursing, there are times where the cardiologist specifically ordered both iv and oral. I clarify to be sure, as like I said, it is not the norm. Also, someone above mentioned that 400mg was too much. In my experience, 200mg is the smallest dose we give. We usually start out with taper doses.[/quote']

Yes, are gtts are the same. Some of our pts start on 400mg PO TID

[RNGriffin]

The Resident should consult with the PCP. Normally you'll maintain the drip and titrate during the day( at least that's how our specialist prefer to cv our patients) in order to build up therapeutic range. The PO form is started early on in tx, usually within 24hrs, to prepare the patient for maintenance.

This is considered our obs period, we're watching for prodysrhythmias.

Most patients can tolerate 2000mg/day without complications. It really depends on what your loading dose was, and your current infusion rates, also when was the order given. If you are giving 800mg/day/Po and running 0.5mg/min presently, you would need to calculate to be certain the patient isn't receiving more than 2200mg/day and what his/her present rhythm is..this is where I watch the patient to determine the physicians order and patient's tolerance.

[JSBSN]

It's 1mg/min x 6 hrs followed by 0.5. Not mg/kg/min. Weight based is 0.8mcg/kg/min usually and thats typically a more aggressive dose.

[ICU56]

We do it all the time for post op CABG/Vavles who drop into afib.

The dosing for the bolus and maintenance drip is about 1050 mgs/24 hours, add in the 400 bid and its still under max dosing recommendations.

Though we commonly use 200 bid or 400 qd, we have used more depending on patient.

[mschelee, MSN, RN]

Our protocol calls for PO Amiodorone to start approximately three hours before the gtts is discontinued, this is due to the PO 3-9 hour peak time. The resident may have been concerned because amiodarone is hepatotoxic.