Amiodarone is a class III antiarrhythmic agent and is used for the treatment of various types of tachyarrhythmias. Because of the toxicity and serious side-effects of amiodarone, use it cautiously and do not exceed the cumulative total of 2.2 grams in 24 hours.
Indications for ACLS
Within ACLS, amiodarone is used for its antiarrhythmic properties and is effective for the treatment of supraventricular arrhythmias and ventricular arrhythmias.
The mechanism of action for amiodarone’s antiarrhythmic properties remains unclear, but it continues to be the primary antiarrhythmic medication for the treatment of ventricular fibrillation and ventricular tachycardia within the cardiac arrest algorithm.
For cardiac arrest, amiodarone is used after the third shock for ventricular fibrillation and ventricular tachycardia that is unresponsive to shock delivery, CPR, and vasopressors. For tachycardia with a pulse, amiodarone may be considered, and expert consultation should be obtained prior to its use.
Do not use amiodarone for individuals with polymorphic VT associated with a prolonged QT interval because this may worsen the patient’s condition.
Amiodarone is only used after defibrillation (or cardioversion) and epinephrine (first line medication) fail 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 that are not life-threatening, consider expert consultation 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
To prepare Amiodarone for an IV infusion, mix with D5W and give through an in-line filter. Alternatively, it is NOT necessary to dilute amiodarone for IV push administration and a filter is not necessary.
When infusions exceed 2 hours, amiodarone can absorb into the plastic used for standard IV bags. This will change the medication concentration. Therefore, when an infusion exceeds 2 hours use a glass or polyolefin bottle for the administration container.
Zeinab Said says
If patient received first dose Epinephrine for PEA and next cycle showed VF do we have to wait 3 shock to give amiodaron or can be given after the first shock ?
The amiodarone would be given after the 3rd shock.
Hi. May I know what is the normal cumulative dose of amiodarone? At what cumulative dose, it is considered to cause amiodarone pulmonary toxicity
The maximum cumulative dose in a 24 hour period is 2.2 g
Is it necessary to dilute amiodarone before injection?
And how much time dose it necessary to push 300mg amiodarone?10 min??
During cardiac arrest amiodarone can be given in 10 mL of the diluent that is used to dilute it or undiluted if it is in the solution form from the vial.
During cardiac arrest amiodarone is pushed the same way that Epinephrine is pushed (rapidly) and always followed by 20 mL of normal saline.
Kelly Gee says
If ROSC is achieved and patient returns back to VFib arrest. Do we restart the amiodarone algorithm? Meaning do we give another initial dose of 300mg IVP.
There is no clarity in the American Heart Association ACLS guidelines regarding this question. The maximum dose for a 24 hour period is 2.2 g of amiodarone and that would need to be maintained.
The most likely option here would be for the physician running the code and the team to determine the best option. My guess would be they would probably start off where they had left during the initial code. A second option would be to start at the beginning using 300 mg, but I think this is unlikely.
If a patient achieved ROSC after giving amiodarone 300mg bolus during vfib arrest and are now in a sinus rhythm, are there any situations where you would give a 150mg bolus x10 mins once ROSC is achieved and before starting the maintenance 1mg/min infusion?
There would not be any situation where you would give the bolus unless the person was to go back into cardiac arrest. And as a matter of fact, he would not need to give the post arrest infusion unless there are continued arrhythmias during the post arrest phase.