Amiodarone IV Management: Emergency Use, Dosage, Monitoring, and Transition

🩺 Amiodarone IV Management Overview

1. Indication

• Stable or unstable ventricular tachycardia (VT)

• Ventricular fibrillation (VF) unresponsive to defibrillation

• Atrial fibrillation refractory to rate/rhythm control

• Part of ACLS for pulseless VT/VF or wide-complex tachycardia with a pulse
  

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2. Standard IV Regimens

ACLS Emergency Protocol:

• Pulseless VT/VF (after CPR and defibrillation):

  • First dose: Amiodarone 300 mg IV push

  • Second dose (if needed): 150 mg IV push

  • Follow with flush (20–30 mL of NS)

With pulse (e.g., stable VT):

• Loading dose: 150 mg in 100 ml D5W over 10 minutes

• Then continuous infusion:

  • 1 mg/min (360 mg over 6 hours)

  • Followed by 0.5 mg/min (720 mg over next 18 hours)

Maintenance Infusion Example:

• 600 mg in 500 ml D5W over 24 hours

  • Approx. 0.42 mg/min: acceptable for post-stabilization infusion

  • Useful when the patient is hemodynamically stable but needs rhythm maintenance
    

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3. Duration of IV Amiodarone Use

• Acute phase: 24–48 hours depending on arrhythmia type and response

• Transition: If rhythm is controlled and stable:

  • Switch to oral amiodarone: Start 200 mg BID or 400 mg daily depending on loading need
    

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4. Transition to Oral Therapy

• Oral regimen:

  • Loading: 800–1200 mg/day divided doses for 1–2 weeks

  • Maintenance: 200–400 mg/day

• Duration: Long-term therapy for AF or ventricular arrhythmias as needed

  
  

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🧪 Monitoring Protocols During Amiodarone Use

During Infusion (especially IV)

• Continuous cardiac monitoring (ECG)

• Watch for:

  • Bradycardia

  • QT prolongation

  • Hypotension (especially with bolus dosing)

Baseline & Routine Labs:

• Thyroid Function Test (TFT): Risk of hypo-/hyperthyroidism

• Liver Function Test (LFT): Risk of hepatotoxicity

• Pulmonary function test (PFT): Risk of pulmonary fibrosis

• Electrolytes: Hypokalemia or hypomagnesemia increases torsades risk
  

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💊 Additional Regimens Summary

Indication	IV Amiodarone Regimen
Ventricular arrhythmia	300 mg IV over 1 hour, then 1 mg/min x 6 hrs, then 0.5 mg/min x 18 hrs
Atrial fibrillation	150 mg IV over 10 min → 1 mg/min x 6 hrs → 0.5 mg/min x 18 hrs
Maintenance	600–900 mg/day IV in D5W (e.g., 600 mg in 500 ml over 24 hrs)

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🔒 Safety Tips (ACLS + Long-Term Use Considerations)

• Always infuse with 5% Dextrose (NOT NS – risk of precipitation)

• Central line preferred for long-term infusion

• Avoid exceeding 24-hour limit in peripheral lines due to phlebitis

• Use in-line filter during infusion

• Stop if signs of:

  • Hypotension

  • Bradyarrhythmia

  • Acute lung toxicity
    

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✅ When to Stop IV and Convert to Oral?

Transition after:

• Hemodynamic stability

• Stable rhythm for 24–48 hours

• Completion of loading phase
  

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✅ Summary Table

Phase	Dosage	Duration
ACLS Acute	300 mg → 150 mg IV bolus	During arrest
Loading (non-ACLS)	150 mg over 10 min	Once
Continuous	1 mg/min x 6 hr → 0.5 mg/min x 18 hr	24 hrs
Maintenance Infusion (In my local order)	600 mg in 500 ml D5W over 24 hr	Maintenance infusion
Oral Conversion	200–400 mg/day	Long-term rhythm control