The long half-life is thought to be a result of the drug's slow release from lipid-rich tissues.2. Discontinue this drug if the patient experiences signs or symptoms of clinical liver injury. Cordarone I.V. Despite such measures, bradycardia was progressive and terminal in 1 patient during the controlled trials. For control of postoperative hypertension, as many as one-third of patients may require higher doses (250-300 mcg/kg/minute) to control blood pressure; the safety of doses >300 mcg/kg/minute has not been studied. Therefore, for infusions longer than 1 hour, Cordarone I.V. endobj CRCL <20 ml/min: Contraindicated in this group, Supplied: 125 mcg, 250 mcg, 500 mcg capsule. The patient is now taking nothing by mouth (NPO), and the physician would like to Injection: 80 mg/ml (10 ml) (gluconate). Intravenous amiodarone therapy should not be used in patients with bradycardia or heart block who do not have a pacemaker. Because absorption and elimination are variable, maintenance-dose selection is difficult, and it is not unusual to require dosage decrease or discontinuation of treatment. Maintenance dose: Digoxin clearance= [CRCL + 40] x 1.44 (add 20 instead of 40 if pt has CHF). The recommended starting dose of Cordarone I.V. Cite this: Reza Taheri. If the starting dose is 500 mcg twice daily, then adjust to 250 mcg twice daily. A meta-analysis11 of double-blind trials found the frequency of adult respiratory distress syndrome to be 1 percent annually. HEPATOTOXICITY: Liver injury is common with this drug, but is usually mild and evidenced only by abnormal liver enzymes. In clinical trials, treatment-emergent, drug-related hypotension was reported as an adverse effect in 288 (16%) of 1836 patients treated with intravenous amiodarone. 5 0 obj dose. Bethesda, MD 20894, Web Policies The primary outcome was AF recurrence within 24 hours after IV amiodarone discontinuation. May follow with 0.125 to 0.25 mg IV q2-6h until 0.75 to 1.5 mg is given over 24hrs. Close monitoring is indicated during the loading phase and surrounding any dose adjustments. Because phlebitis may occur, the drug should be given through a central venous line when possible. % What should we do for this patient? 10-15g of amiodarone is required to load a patient. Amiodarone is used in the treatment of atrial fibrillation, although the FDA has not approved this indication. Inform patients administering this drug to do so consistently with regard to meals. On the other hand, it is possible that this is a very lightweight, elderly woman, and the physician is being extremely cautious on the loading or there are other comorbid conditions that could increase the risk of amiodarone toxicity. The recommended starting dose of Cordarone I.V. <> In addition to blocking sodium channels, amiodarone blocks myocardial potassium channels, which contributes to slowing of conduction and prolongation of refractoriness. WebIntravenous procainamide (Procainamide Hydrochloride Injection) is effective in cardioversion in up to 60 percent of patients in uncontrolled series. Crcl 30-60 ml/min: Administer every 24 hours. David McAuley, Pharm.D. Consider stopping amiodarone; causal relationship is uncertain. Intravenous Although the exact mechanism by which adenosine receptor activation relaxes vascular smooth muscle is not known, there is evidence to support both inhibition of the slow inward calcium current reducing calcium uptake, and activation of adenylate cyclase through A2 receptors in smooth muscle cells. The only information that I could find about PO to IV conversion involved patients who are stabilized on amiodarone PO for 4 months or longer. This adverse effect occurs at a rate of 0.6 percent annually.11, Patients with liver toxicity are rarely symptomatic. This site needs JavaScript to work properly. Avoid excessive heat. Bradycardia and heart block occur in 1 to 3 percent of patients receiving amiodarone.2 Amiodarone-induced proarrhythmia occurs at an annual rate of less than 1 percent.11 Although almost all patients treated with the drug have prolongation of the QT interval, polymorphic ventricular tachycardia (i.e., torsades de pointes) is rare. Not preferred drug for PSVT because it is not rapidly effective (may take up to 60 minutes). 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. Copyright 2021 GlobalRPH - Web Development by, RECOMMENDATIONS FOR ORAL DOSAGE AFTER I.V. If the QTc >15% of baseline, or if the QTc is >500 msec (550 msec in patients with ventricular conduction abnormalities), dofetilide should be adjusted. Frendl G, Sodickson AC, Chung MK, et al. Accessibility Please enter a Recipient Address and/or check the Send me a copy checkbox. government site. How many mL is 300 mg of amiodarone? Crcl 10-30 ml/min: Administer every 36-48 hours. The CYP3A4 isoenzyme is present in both the liver and intestines. Copyright 1993-2021 Renal impairment does not influence the pharmacokinetics of amiodarone. Postoperative atrial fibrillation following cardiac surgery: a persistent complication. 300mg extended release tablet (sulfate). Clipboard, Search History, and several other advanced features are temporarily unavailable. Decrease dose by 30-50% in hepatic insufficiency. Amiodarone does not need to be protected from light during administration. Abstract The use of amiodarone for postoperative atrial fibrillation (AF) is widespread; however, there is a paucity of data on the optimal duration of overlap when transitioning from intravenous (IV) to oral amiodarone. 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). 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. Conversion from oral to IV: Decrease IV dose by 20 to 25%. Infuse 100 mL over 10 minutes. Amiodarone crosses the placenta and reaches measurable levels in breast milk. Stop amiodarone; initiate corticosteroid therapy. Intravenous to Oral Transition of Amiodarone (IOTA): Effect of Congestive heart failure can mimic amiodarone pneumonitis and, thus, must be ruled out early in the evaluation. The major metabolite of amiodarone is desethylamiodarone (DEA), which is known to have antiarrhythmic properties. concentrations should not exceed 2 mg/mL unless a central venous catheter is used. Consensus follow-up recommendations from the NASPE are summarized in Table 4.4 A form to guide patient monitoring is provided in Figure 1. Add 3 ml of Cordarone I.V. Oral: 0.4 mg, may repeat every 4 to 6 hours. endobj If severe, stop amiodarone or insert pacemaker. Treatments of amiodaroneinduced hyperthyroidism include the withdrawal of amiodarone (if this can be done safely), the addition of antithyroid medications or prednisone, and surgical thyroidectomy.20, Liver toxicity, manifested by elevation of liver transaminase levels, is common in patients who are receiving long-term amiodarone therapy. Initiate antithyroid drug therapy; consider stopping amiodarone. RECOMMENDATIONS FOR ORAL DOSAGE AFTER I.V. Cardiac Arrest: First dose: Give 300 mg (6 mL) IV direct UNDILUTED. Amiodarone: Dosage, Mechanism/Onset of Action, Half-Life Neurologic toxicity associated with amiodarone therapy can include ataxia, paresthesias, and tremor. Fab dose based on serum drug level postdistribution: Fab dose based on serum drug level postdistribution: Digoxin: No. Unfortunately, there is substantial interpatient variability in response time to IV amiodarone, and the bioavailability of the oral form is also quite variable ranging from 30% to 70%. WebAmiodarone shows beta blocker-like and calcium channel blocker-like actions on the SA and AV nodes, increases the refractory period via sodium- and potassium-channel effects, and slows intra-cardiac conduction of the cardiac action potential, via sodium-channel effects. Amiodarone injection belongs to the group of medicines known as antiarrhythmics. WebIV Drip Rate Calculator. MULTAQ should be taken as one tablet with the morning meal and one tablet with the evening meal. INFUSION, Recommendations for conversion to intravenous amiodarone after oral administration, HONcode standard for trust- worthy health, Skeletal Muscle Index And Ovarian Cancer Prognosis: A Meta-Analysis, 7 Natural Remedies for Rheumatoid Arthritis. HHS Vulnerability Disclosure, Help These intracellular metabolites of adenosine are not vasoactive. CRCL 20-39 ml/min: Administer 125 mcg twice daily. Peak concentrations after 10-minute infusions of 150 mg intravenous amiodarone in patients with ventricular fibrillation (VF) or hemodynamically unstable ventricular tachycardia (VT) range between 7 and 26 mg/L. 4i$h>B/>tJ1g'nS-84]h9L\\: Assuming that the plan was not to load the patient, you could simply convert to an equivalent IV dose. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. A much less common presentation is adult respiratory distress syndrome. Monitoring: Pacerone, Cordarone, Nexterone, Cordarone IV. It is used in patients who have already been treated with other medicines that did not work well. WebA client is receiving an IV solution of sodium chloride 0.9% (Normal Saline) 250 ml with amiodarone (Cordarone) 1 gram at 17 ml/hour. Administration advice: The manufacturer product information should be consulted. Adverse reactions: dose related hypotension; ventricular arrhythmias; heart failure. Intraoperative tachycardia and/or hypertension (immediate control): Initial bolus: 80 mg IV (~1 mg/kg) over 30 seconds, followed by a 150 mcg/kg/minute infusion, if necessary. How many mg/minute of amiodarone is infusing? Supplied: 0.02 mg/ml (10 ml); 0.2 mg/ml (1:5000) (1 ml, 5 ml). Factors that increase likelihood of digoxin toxicity: Hypokalemia, hypomagnesaemia, hypothyroidism, renal dysfunction, interacting drugs (eg quinidine, verapamil). 2011;92:11441152. Digoxin levels predictably double after coadministration with amiodarone.22 This increase occurs because of the inhibition of digoxin secretion from renal tubules and the inhibition of the P-glycoprotein membrane transporter system.23 The digoxin dosage should be reduced by 50 percent when amiodarone is started, and plasma digoxin levels should be monitored closely. Predicted Css= (Dose) (0.65 to 0.8)/ Digoxin clearance. US BOXED WARNINGS (TABLET): These effects may also be seen with IV administration. Please review the latest applicable package insert for additional information and possible updates. Pharmacologic stress agent (Adenoscan): Continuous I.V. Digitalis-induced progressive elevation of the serum potassium concentration also suggests imminent cardiac arrest. All Rights Reserved. Click the topic below to receive emails when new articles are available. In addition, no significant association was found between duration of overlap and rates of bradycardia (OR 1.00, 95% confidence interval (CI) 0.99-1.00, P = 0.08) or hypotension (OR 1.00, 95% CI 0.99-1.00, P = 0.21), which occurred in 35.9% and 47.3% of patients, respectively. Half life: 9 minutes. INFUSION Initial Daily Dose of Oral Cordarone 1 week 800-1600 mg 1-3 weeks 600-800 mg >3 weeks* 400 mg # Assuming a 720 mg/day infusion (0.5 mg/min). * Cordarone I.V. is not intended for maintenance treatment. HOW SUPPLIED Cordarone I.V. (amiodarone HCl) is available in packages of 10 ampuls (2 cartons each containing 5 ampuls), 3 mL each, as follows: (150 mg) to 100 mL D5W (concentration = 1.5 mg/mL). The initial infusion rate should not exceed 30 mg/min. The initial rate of infusion should be monitored closely and should not exceed that prescribed in DOSAGE AND ADMINISTRATION. Patients with the indicated arrhythmias must be hospitalized while the loading dose is given, and a response generally requires at least one week, usually two or more. The rate of the maintenance infusion may be increased to achieve effective arrhythmia suppression. 2 Patients who received intravenous Estimation of the dose is based on the body burden of digitalis. Because of the complexity and widespread use of this agent, other treatment decisions often are affected. Renal Dosing: CRCL >60 ml/min: Administer 500 mcg twice daily. The dosage of amiodarone should be kept at the lowest effective level. The drug prevents the recurrence of life-threatening ventricular arrhythmias and produces a modest reduction of sudden deaths in high-risk patients. A patient started on oral (PO) amiodarone approximately 1 week ago (400 mg/day). Liver enzyme levels three times higher than normal. WebAdd 3 mL of Cordarone I.V. In a retrospective survey of 192 patients with ventricular tachyarrhythmias, 84 required dose reduction and 18 required at least temporary discontinuation because of adverse effects, and several series have reported 15% to 20% overall frequencies of discontinuation due to adverse reactions. Maintenance infusion: 540 mg over the REMAINING 18 hours (0.5 mg/min). Amiodarone dosing in adults by indication - UpToDate This drug should be used at the lowest effective dose in order to prevent the occurrence of side effects. Recommendations for conversion to intravenous amiodarone after oral administration: During long-term amiodarone therapy (ie, 4 months), the mean plasma-elimination half-life of the active metabolite of amiodarone is 61 days. Duration of Cordarone I.V. INFUSION Duration of Cordarone I.V. Pacerone, Cordarone (amiodarone) dosing, indications, interactions The difficulty of using this drug safely and effectively itself poses a significant risk to patients. Supplied: Adenocard: 3 mg/ml (2 ml, 4 ml) Adenoscan: 3 mg/ml (20 ml, 30 ml). Long-Term Use Advise patients to moderate alcohol consumption while taking this drug. (900 mg) to 500 mL D5W (conc = 1.8 mg/mL). Neither amiodarone nor DEA is dialyzable. Dosing (adults): Arrhythmias: Oral: Initial: 200 mg every 8 hours with food (may load with 400 mg if necessary); adjust dose every 2-3 days; usual dose: 200-300 mg every 8 hours; maximum: 1.2 g/day (some patients respond to every 12-hour dosing). Steady-state amiodarone concentrations of 1 to 2.5 mg/L have been associated with antiarrhythmic effects and acceptable toxicity following chronic oral amiodarone therapy. All Rights Reserved. 2017;52:665672. Refractory ventricular fibrillation: Repeat 1.5 mg/kg bolus may be given 3-5 minutes after initial dose. Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). In patients with extended and recurrent sun exposure, bluish skin discoloration may develop in exposed areas. 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. 3 0 obj The use of amiodarone for postoperative atrial fibrillation (AF) is widespread; however, there is a paucity of data on the optimal duration of overlap when transitioning When the maintenance dose is given IV, the onset and peak will occur earlier, however the duration of action is the same. WebConventional IV preparation contains polysorbate 80 and benzyl alcohol Newer IV formulation (Nexterone) does not contain polysorbate 80 or benzyl alcohol Conversion to oral Amiodarone is an iodine-containing compound with some structural similarity to thyroxine. An official website of the United States government. INDICATIONS AND USAGE: SOTYLIZE is an antiarrhythmic indicated for: The treatment of life-threatening ventricular arrhythmias. Cordarone IV Number of vials needed =[(steady state serum digoxin level (ng/ml) x weight (kg)] / 100. DEA serum concentrations above 0.05 mg/L are not usually seen until after several days of continuous infusion but with prolonged therapy reach approximately the same concentration as amiodarone. CRCL 40-60 ml/min: Administer 250 mcg twice daily. Like class I drugs, amiodarone blocks sodium channels at rapid pacing frequencies, and like class II drugs, it exerts a noncompetitive antisympathetic action. Note: Decrease dose in patients with CHF, elderly, hepatic disease. Corneal microdeposits are visible on slit-lamp examination in nearly all patients treated with amiodarone.19 These deposits seldom affect vision and rarely necessitate discontinuation of the drug. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. However, the drug has many other effects: it slows heart rate and atrioventricular nodal conduction (via calcium channel and beta-receptor blockade), prolongs refractoriness (via potassium and sodium channel blockade), and slows intracardiac conduction (via sodium channel blockade). Infusion rate: 318 mL/hr. DOSAGE AND ADMINISTRATION The only recommended dosage of MULTAQ is 400 mg twice daily in adults. Crcl <40 ml/min: Use is contraindicated. infusion: 140 mcg/kg/minute for 6 minutes using syringe or columetric infusion pump; total dose: 0.84 mg/kg. Once inside the cell, adenosine is rapidly phosphorylated by adenosine kinase to adenosine monophosphate, or deaminated by adenosine deaminase to inosine. Amiodarone Hydrochloride 50 mg/ml Concentrate Loading infusions: 150 mg over the first 10 minutes (15 mg/min), followed by 360 mg over the next 6 hours (1 mg/min), Maintenance infusion: 540 mg over the remaining 18 hours (0.5 mg/min), Supplemental infusions: 150 mg over 10 minutes (15 mg/min) for breakthrough episodes of ventricular fibrillation (VF) or hemodynamically unstable ventricular tachycardia (VT). Dosage for acute ingestion of unknown amount: 20 vials (760mg) of Digibind is adequate to treat most life-threatening ingestions. Atrial Fibrillation (AF) & Flutter complicating critical illness Patients treated with amiodarone should be followed regularly to assess ongoing need for amiodarone, efficacy of the drug, appropriateness of dosage, adverse effects, and potential drug interactions. Intravenous Amiodarone FDA-approved for acute termination of A-flutter/A-fib (may be alternative to cardioversion): 1mg IV over 10min. May give by bolus injection if cardiac arrest is imminent. This has occurred in 2% to 5% of patients in various series, and significant heart block or sinus bradycardia has been seen in 2% to 5%. Lidocaine (xylocaine ) Ventricular arrhythmia: 1-1.5 mg/kg IV bolus over 2-3 minutes; may repeat doses of 0.5-0.75 mg/kg in 5-10 minutes up to a total of 3 mg/kg; If the starting dose was 125 mcg twice daily, then adjust to 125 mcg every day. Federal government websites often end in .gov or .mil. See table. No significant association was found between various overlap durations and AF recurrence (odds ratio (OR) 1.00, 95% CI 1.00-1.01, P = 0.9). WebA = Airway - Assess for airway obstruction, assess for breathing, perform intubation B = Breathing - Ventilate with 100% oxygen, 10-24 breaths/minute C = Circulation - Assess for heart beat and pulses if absent, begin chest compressions, 100-120 compressions/minute Begin ADVANCED life support Obtain Electrocardiogram and Determine Arrest Rhythm One meta-analysis of 13 studies of patients with congestive heart failure or recent myocardial infarction showed a small reduction in total annual mortality, from 12.3 percent to 10.9 percent (absolute risk reduction [ARR], 2.4 percent; number needed to treat [NNT], 42).5 [Evidence level A, meta-analysis] The benefit of amiodarone therapy was more pronounced in the patients who had congestive heart failure, with treatment reducing the annual mortality rate from 24.3 percent to 19.9 percent (ARR, 4.4 percent; NNT, 23). Due to rapid distribution, serum concentrations decline to 10% of peak values within 30 to 45 minutes after the end of the infusion. Because a typical oral amiodarone loading dose for ventricular arrhythmia starts with 800-1600 mg/day and for atrial fibrillation starts with 600-800 mg/day, I would assume that for one reason or another a decision was made not to load this patient. In patients who also are taking digoxin and warfarin, physicians must pay close attention to digoxin levels and prothrombin time, keeping in mind that the effects of interaction with amiodarone do not peak until seven weeks after the initiation of concomitant therapy. concentrations greater than 2 mg/ml should be administered via a central venous catheter). You've successfully added to your alerts. Maintenance infusion: 540 mg over the REMAINING 18 hours (0.5 mg/min). Would you like email updates of new search results? Commenting is limited to medical professionals. Renal Dosing: CRCL <10 ml/minute: Decrease usual dose by 25% to 50% in severe renal impairment. Followed by Slow: 360 mg over the NEXT 6 hours (1 mg/min). The primary treatment for pulmonary toxicity is withdrawal of amiodarone and provision of supportive care and, in some cases, corticosteroids. Monitor apical pulse daily.. Onset/peak: IV: 5-30min/ 1-4hrs Oral: 1-2hrs/ 2-8 hrs. endstream HtT0}WvlF v@$)IV>/_rif9s3' There has been limited experience in patients receiving intravenous amiodarone for longer than 3 weeks. In some cases, hypotension may be refractory resulting in fatal outcome (see package insert for ADVERSE REACTIONS, Postmarketing Reports). Unauthorized use of these marks is strictly prohibited. Amiodarone Dosage Guide + Max Dose, Adjustments Amiodarone injection is contraindicated in patients with known hypersensitivity to any of the components of amiodarone injection, including iodine, or in patients with cardiogenic shock, marked sinus bradycardia, and second- or third-degree AV block unless a functioning pacemaker is available. Infusion*: <1 week Supplied: 50 mg, 100 mg, 150 mg tablet. Reconstitution/preparation techniques: The manufacturer product information should be consulted. CONTRAINDICATIONS [Loading: 10 to 15 mcg/kg IBW in divided doses (q4-8h) over 12-24hrs.] Amiodarone is metabolized to desethylamiodarone by the cytochrome P450 (CYP450) enzyme group, specifically cytochrome P450 3A4 (CYP3A4) and CYP2C8. ---------------------------------------Supplied: Injection, powder for reconstitution: Digibind: 38 mg. ========================= Dilution: Prescribed dose/ 50 ml NS. Pharmacokinetics and Metabolism The patient is now taking nothing by mouth (NPO), and the physician would like to switch to intravenous (IV) amiodarone. Safety outcomes include occurrence of bradycardia or hypotension while on amiodarone. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Renal Dosing: CRCL 30-40 ml/minute: 100mg every 8 hours CRCL 15-30 ml/minute: 100mg every 12 hours CRCL <15 ml/minute: 100mg every 24 hours, Supplied: (Norpace): Capsule 100 mg, 150 mg (Norpace CR): Capsule (controlled release) 100 mg, 150 mg. A-fib/Flutter: Dosing (adults):: Usual initial dose: 500 mcg orally twice daily. To comment please, Comments on Medscape are moderated and should be professional in tone and on topic. WebLowest effective dose, ideally 200 mg or less orally once per day or in divided doses. Neonatal Hypo- or Hyperthyroidism Web[IV route] Dose: 150 mg IV x1 over 10min, then 1 mg/min IV x6h, then 0.5 mg/min IV x18h [PO route] Dose: 400 mg PO qd; Start: load 800-1600 mg PO qd x1-3wk until response, then Renal Dosing Ventricular arrhythmias (Betapace): Crcl >60 ml/min: Administer every 12 hours. Dosage for toxicity during chronic therapy : for adults, 6 vials (228mg) usually is adequate to reverse most cases of toxicity. *Assuming a 720 mg/day infusion (0.5 mg/min). Small doses (infants/small children) may be administered using tuberculin syringe. and transmitted securely. Bradycardia, QT prolongation, GI upset, constipation; rarely, torsades de pointes, 600 to 800 mg per day in divided doses until a total of 10 g has been given (may use higher initial dosage or IV dosing in unstable inpatients); then 200 mg per day, Chest radiograph; pulmonary function tests, including Dlco. based on a 1:2.5 conversion from IV to PO: = Link to online calculator. Onset of action: 2-10 minutes. Although the U.S. Food and Drug Administration (FDA) has labeled amiodarone only for the treatment of life-threatening ventricular arrhythmias, the drug also is used to treat atrial fibrillation. However, recent studies have shown that aggressive attempts to maintain sinus rhythm using amiodarone or other drugs do not improve outcomes in relatively asymptomatic patients.13,14 Therefore, long-term amiodarone therapy, with its potential for toxicity, does not appear to be justified in patients who are taking anticoagulant drugs if rate-control strategies can provide satisfactory symptomatic improvement. Renal Dosing Crcl <10 ml/minute: Administer 75% of normal dose. Ingestion of more than 10 mg of digoxin in previously healthy adults or 4 mg of digoxin in previously healthy children, or ingestion causing steady-state serum concentrations greater than 10 ng/mL, often results in cardiac arrest. Amiodarone is more effective than sotalol or propafenone in preventing recurrent atrial fibrillation in patients for whom a rhythm-control strategy is chosen. Oral Loading - Half-life elimination: 40-55 days (range: 26-107 days); The negative chronotropic effect of amiodarone in nodal tissues is similar to the effect of class IV drugs. The time at which a previously controlled life-threatening arrhythmia will recur after discontinuation or dose adjustment is unpredictable, ranging from weeks to months. Please see our, 2010synthroid-levoxyl-levothyroxine-342732. MeSH Disclaimer. Alqahtani A. Atrial fibrillation post cardiac surgery trends toward management. May repeat x 1. Patients who received intravenous amiodarone for less than one week should take 800 to 1,600 mg oral amiodarone per day. 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: CORDARONE I.V. DOSE RECOMMENDATIONS FIRST 24 HOURS Loading infusions First Rapid: 150 mg over the FIRST 10 minutes (15 mg/min). The authors report no conflicts of interest. Total volume: 106 mL. Half-life: 38-48 hrs. ER Tab: 500 mg, 750 mg, 1000 mg. Injection: 100 mg/ml (10 ml); 500 mg/ml (2 ml). If you believe a loading dose is appropriate, then start him/her on IV loading while NPO. The Fab fragment-digoxin complex accumulates in the blood, from which it is excreted by the kidney. The dosage in cats is 0.10.4 mg/kg, IV bolus over ~1 min, then increase to a total dose of 0.251 mg/kg, IV slowly, if no response. is about 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: First Rapid: 150 mg 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. Onset of the antiarrhythmic effect of intravenous amiodarone occurs in less than 30 minutes.15, In the Advanced Cardiac Life Support (ACLS) guidelines published in 2000, amiodarone and procainamide are recommended for the initial treatment of hemodynamically stable wide-complex tachycardia.16 However, these guidelines list amiodarone as being only possibly effective for the treatment of refractory pulseless ventricular tachycardia or ventricular fibrillation. Loading Dose (Daily): (Ventricular Arrhythmias) 800 to 1,600 mg x 1-3 weeks, then 600 to 800 mg x ~1 month, then start maintenance of 400mg/day. Amiodarone administered orally or intravenously - the Sotalol does not have partial agonist or membrane stabilizing activity.
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