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Amiodarone and ACLS


Amiodarone and ACLS

Amiodarone is considered a class III antiarrhythmic agent and is used for various types tachyarrhythmias. Because of its associated toxicity and serious side-effects it should be used cautiously and care should be taken to ensure that cumulative doses are not exceeded.

Indications for ACLS

Amiodarone is an antiarrhythmic that is used to treat both supraventricular arrhythmias and ventricular arrhythmias.

The mechanism of action of amiodarone remains unknown, but within the framework of ACLS, amiodarone is used primarily to treat ventricular fibrillation and ventricular tachycardia that occurs during cardiac arrest and is unresponsive to shock delivery, CPR, and vasopressors.

Amiodarone should not be used in individuals with polymorphic VT as it associated with a prolonged QT interval which is made worse with antiarrhythmic drugs.

Amiodarone should only be used after defibrillation/cardioversion and first line drugs such as epinephrine and vasopressin have failed to convert VT/VF.


Amiodarone can be administered by intravenous or intraosseous route.


The maximum cumulative dose in a 24 hour period should not exceed 2.2 grams.

Within the VT/VF pulseless arrest algorithm, the dosing is as follows:
300mg IV/IO push → (if no conversion) 150 mg IV/IO push → (after conversion) Infusion #1 360 mg IV over 6 hours (1mg/min) → Infusion #2 540 mg IV over 18 hours (0.5mg/min)

For tachyarrhythmias other than life threatening, expert consultation should be considered before use.

For Tachycardia other than pulseless VT/VF, Amiodarone dosing is as follows: (see above note)
150 mg over 10 minutes → repeat as needed if VT recurs → maintenance infusion of 1mg/min for 6 hours

Amiodarone should only be diluted with D5W and given with an in-line filter.

Infusions exceeding 2 hours must be administered in glass or polyolefin bottles containing D5W.

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  115 Responses to “Amiodarone and ACLS”

  1. I remember after successfull conversion of VF a lidocaine bolus was given along with a maintence infusion of 2 – 4 mg/min. After successfull conversion of VF – to ROSC (say sinus) today in ACLS there is no bolus of amnioderone???

  2. I am taking the acls protest and it says after one dose of epi and two shocks five amiodarone 300. Am I wrong in thinking it was after the third shock?? They only gave epi once.

    • Epinephrine is given after the second shock. Any subsequent doses of epinephrine are given every 3 to 5 minutes. Epinephrine is basically on it’s own timetable after the initial dose.
      The first dose of Amiodarone is always given after the third shock. Any subsequent dose of amiodarone is given after the first dose has had adequate time to circulate. This usually occurs any time after the fourth shock, but always during CPR.

      Kind regards,

  3. Post arrest with ROSC within several minutes, should the initial bolus dosing of amiodarone be given IVP or should it be hung as a piggyback over 10 minutes?

    • This would be used only if arrhythmias persisted in the post arrest period. You do not use it as prophylactically.
      The initial bolus dosing should be given as follows:
      (after conversion) Infusion #1 360 mg IV over 6 hours (1mg/min) → Infusion #2 540 mg IV over 18 hours (0.5mg/min)

      Kind regards,

  4. My question is if you bulus with lidocaine can you use amiodarone for a maintenance drip or do you just stay with lidocaine or vise versa?

    • If the antiarrhythmic you use is effective for treatment then it would be appropriate to use this in the post arrest phase if there is any re-occurrence of the arrhythmia. Stick with what has worked. If the first does not work, try an alternative.

      Kind regards,

  5. After giving epinephrine, then going through a 2 minute cycle of compressions during cardic arrest, can you then give amiodarone. I know you are supposed to wait 3-5 min in between epinephrine doses, but can you slip in an amiodarone after only 2 minutes after giving epi?

    • Epinephrine is given after the 2nd shock during CPR. The first dose of amiodarone is given after the 3rd shock during CPR. This would be approximately 2 minutes.

      Kind regards,

  6. Why doe we need an in line filter with AMIODORONE

  7. Quick question:

    DO we push AMIODARIONE undiluted iv and flush with Saline or D5W?

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