amiodarone iv to po calculator
Adverse reactions: Severe hypotension; bradycardia; ventricular standstill in digitalized patients; asystole; respiratory failure. endobj Although amiodarone use during pregnancy is uncommon, there have been a small number of published reports of congenital goiter/hypothyroidism and hyperthyroidism associated with its oral administration. Eur J Cardiothorac Surg. Despite such measures, bradycardia was progressive and terminal in 1 patient during the controlled trials. 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). 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). All of these events should be manageable in the proper clinical setting in most cases. Bradycardia should be treated by slowing the infusion rate or discontinuing amiodarone. 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. Hypotension }v~/lceM-. The negative chronotropic effect of amiodarone in nodal tissues is similar to the effect of class IV drugs. Supplied: 80 mg, 120 mg, 160 mg, 240 mg tablet ---------- Drug UPDATES: SOTYLIZE (sotalol hydrochloride) oral solution Initial U.S. Approval: 1992 [Drug information / PDF] Dosing: Click (+) next to Dosage and Administration section (drug info link). FATAL TOXICITY: This drug is intended for use only in patients with the indicated life-threatening arrhythmias because its use is accompanied by substantial toxicity. 1.Desired Dose. Organophosphate or carbamate poisoning: 2 mg IV, followed by 2 mg every 15 minutes until adequate response (initial doses of up to 6 mg may be used in life-threatening cases). Gastrointestinal side effects of amiodarone include nausea, anorexia, and constipation. When long-term amiodarone therapy is used, potential drug toxicity and interactions must be considered. Federal government websites often end in .gov or .mil. [720 mg / 500 ml ] [See comments] 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. Advise patients to avoid consumption of grapefruit juice during treatment with this drug. In a placebo-controlled study in patients with severe heart failure requiring recent hospitalization or referral to a specialized heart failure clinic for worsening symptoms (the ANDROMEDA Study), patients given dronedarone had a greater than two-fold increase in mortality. Amiodarone and DEA cross the placenta and both appear in breast milk. Malignant Arrhythmia and Cardiac Arrest in the Operating Room. Adenosine is thought to exert its pharmacological effects through activation of purine receptors (cell-surface A1 and A2 adenosine receptors). 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. The bioavailability of amiodarone is variable but generally poor, ranging from 22 to 95 percent.1 Absorption is enhanced when the drug is taken with food.2 Amiodarone is highly lipid soluble and is stored in high concentrations in fat and muscle, as well as in the liver, lungs, and skin. Dilution Amiodarone - GlobalRPH 2017;52:665672. Crcl 30-60 ml/min: Administer every 24 hours. The affinity of DIGIBIND for digoxin is in the range of 109 to 1011 M-1, which is greater than the affinity of digoxin for (sodium, potassium) ATPase, the presumed receptor for its toxic effects. Cordarone IV may be used alone or with other Dosing (adults): IVPB: 0 to 1 mg/50 ml D5W or NS over 10 minutes. (Enter numeric value only. This retrospective, observational, single-center study included cardiothoracic surgery patients who were initiated on IV amiodarone for supraventricular arrhythmia and subsequently transitioned to oral amiodarone. Typical dosing regimens are provided in Table 1.10 Because dosages below 300 mg per day are associated with a reduced incidence of pulmonary adverse effects, physicians should aim for a long-term maintenance dosage of 200 mg per day or less.18. Add 3 mL of Cordarone I.V. For chronic toxicity: 6 vials; for infants and small children Amiodarone Loading Dose Regimen Infusion: >3 weeks Webbetween PO and IV (64% vs. 68%, respectively; p=NS) 223 patients with symptomatic atrial fibrillation on digoxin PO amiodarone 600 mg in3 divided doses vs. IV amiodarone 5mg/kg Half life: 9 minutes. Use of these drugs would be most appropriate in patients with recurrent hemodynamically unstable atrial fibrillation.10 Amiodarone may be particularly beneficial in patients with rapid ventricular rates or impaired renal function. Hypotension necessitating alterations in intravenous amiodarone therapy was reported in 3% of patients, with permanent discontinuation required in less than 2% of patients. Dosing (adults): Ventricular arrhythmias: Oral: 1200-1800 mg/day in 3 divided doses, up to 2400 mg/day. Half-life: 38-48 hrs. Infuse 100 mL over 10 minutes. Amiodarone may subsequently be continued until the patient has recovered from their critical illness (e.g., for 1-2 weeks). 4 0 obj Followed by Slow: 360 mg over the NEXT 6 hours (1 mg/min). Hepatic impairment: Maximum daily dose: 1200 mg. Amiodarone is metabolized to desethylamiodarone by the cytochrome P450 (CYP450) enzyme group, specifically cytochrome P450 3A4 (CYP3A4) and CYP2C8. Use Alaris LVP with Guardrails and select amIODAROne LOAD - = 60 kg in Critical Care Adult or Coronary Care Unit profile. Amiodarone Hydrochloride Injection, 50 mg/mL is supplied in: PROARRHYTHMIC EFFECTS: Like other antiarrhythmics, this drug can exacerbate the arrhythmia, e.g., by making the arrhythmia less well tolerated or more difficult to reverse. 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. Supplied: 200 mg, 300 mg tab (sulfate). Because phlebitis may occur, the drug should be given through a central venous line when possible. 3 0 obj %PDF-1.7 concentrations greater than 2 mg/ml should be administered via a central venous catheter). The recommended starting dose of Cordarone I.V. 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. Cordarone IV HHS Vulnerability Disclosure, Help IV compatibility: The manufacturer product information should be consulted. Obtain baseline and periodic liver transaminases and discontinue or reduce dose if the increase exceeds three times normal, or doubles in a patient with an elevated baseline. Number of vials needed =[(steady state serum digoxin level (ng/ml) x weight (kg)] / 100. amiodarone: Dosing, contraindications, side effects, and pill WebWhen appropriate, monitor and adjust IV dose as necessary. Therefore, physicians must use the lowest possible dosage of amiodarone and, if possible, discontinue treatment if adverse effects occur. The systemic availability of oral amiodarone in healthy subjects ranges between 33% and 65%. In patients with extended and recurrent sun exposure, bluish skin discoloration may develop in exposed areas. Commenting is limited to medical professionals. WebCriteria required for IV antibiotics prior to PO conversion: Tmax < 100.4F in the previous 24 hours WBC is normalizing Absence of neutropenia (defined as ANC < 500/mm3) Meets no exclusion criteria Exclusion Criteria Patient is NPO, meaning at least one of the following: Active NPO order in the chart All medications by the non-oral route This drug should be used at the lowest effective dose in order to prevent the occurrence of side effects. Intravenous amiodarone therapy should not be used in patients with bradycardia or heart block who do not have a pacemaker. WebAmiodarone (Cordarone) 150 mg IV over 10 minutes, then 30 to 60 mg IV per hour; 200 to 400 mg orally every day as a maintenance dose after loading: 43 to 68: 8 to 24 hours: 55 to Copyright 2022 Wolters Kluwer Health, Inc. All rights reserved. Renal Dosing Crcl <10 ml/minute: Administer 75% of normal dose. In clinical trials, treatment-emergent, drug-related hypotension was reported as an adverse effect in 288 (16%) of 1836 patients treated with intravenous amiodarone. Bradycardia: 0.5 mg I.V every 5 minutes, not to exceed a total of 3 mg or 0.04 mg/kg; may give intratracheal in 1 mg/10 ml dilution only, intratracheal dose should be 2-2.5 times the I.V. levothyroxine: Dosing, contraindications, side effects, and pill 324 mg extended release tab (gluconate). Total volume: 106 mL. Patients' on the "floors" may receive once daily IV maintenance doses, however, IV loading regimens (multiple doses) are restricted to pts on a monitor- ICU's. Click the topic below to receive emails when new articles are available. Copyright 2023 American Academy of Family Physicians. Monitor ECG for at least 4hr . = Link to Medscape monograph about a drug. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. You will receive email when new content is published. Pharmacokinetics Interactions with warfarin and digoxin are the most clinically important. Alternatively, maint dose= Loading dose x [0.14 x crcl / 500 ] Avoid IM injections-can lead to severe pain (If it must be given by this route, give deep IM followed by massage). 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: The patient is now taking nothing by mouth (NPO), and the physician would like to (Must use 0.22 micron filter) Improvement in signs and symptoms usually begins in 30 minutes or less.Stability: Use promptly after mixing (may refrigerate up to 4 hours). Effective in @30% of patients. When the maintenance dose is given IV, the onset and peak will occur earlier, however the duration of action is the same. Administration advice: The manufacturer product information should be consulted. 4i$h>B/>tJ1g'nS-84]h9L\\: Intravenously administered amiodarone is effective for the emergency treatment of ventricular tachyarrhythmias. A loading regimen (i.e., use of a relatively high dosage at the beginning of therapy) can shorten the delay. WebUse oral administration wherever possible. Amiodarone This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. 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. Last updated on Sep 13, 2022. 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. The Fab fragment-digoxin complex accumulates in the blood, from which it is excreted by the kidney. A naive look at this scenario gives the impression that the patient has not been started on an oral loading dose of amiodarone. Slow digoxin loading Slow oral digitalization, generally preferred for most patients, can be achieved by starting a maintenance dose of 0.125 to 0.25 mg daily. Infuse over 30 minutes-- must use 0.22 micron filter. IV Drip Rate Calculator Fernando HC, Jaklitsch MT, Walsh GL, et al. Hepatic impairment: Reduce dose by 50%. The long half-life is thought to be a result of the drug's slow release from lipid-rich tissues.2. CLINICAL PHARMACOLOGY After intravenous injection of Digoxin Immune Fab (Ovine) in the baboon, digoxin-specific Fab fragments are excreted in the urine with a biological half-life of about 9 to 13 hours.1 In humans with normal renal function, the half-life appears to be 15 to 20 hours.2 Experimental studies in animals indicate that these antibody fragments have a large volume of distribution in the extracellular space, unlike whole antibody which distributes in a space only about twice the plasma volume.1 Ordinarily, following administration of DIGIBIND, improvement in signs and symptoms of digitalis intoxication begins within one-half hour or less.2,3,4,5. Duration of Cordarone I.V. One of its main effects, with prolonged administration, is to lengthen the cardiac action potential, a class III effect. Decrease dose by 30-50% in hepatic insufficiency. The major metabolite of amiodarone is desethylamiodarone (DEA), which is known to have antiarrhythmic properties. Monitor apical pulse daily.. Onset/peak: IV: 5-30min/ 1-4hrs Oral: 1-2hrs/ 2-8 hrs. Assistant Professor of Pharmacy Practice /Assistant Professor of Medicine, Schools of Pharmacy & Medicine, Loma Linda University, Loma Linda, California; Co-Director, Lipid Clinic, VA Loma Linda Healthcare System, Loma Linda, California. Any patient who notes changes in visual acuity or peripheral vision should be referred for ophthalmologic evaluation. WebLidocaine is rarely indicated in cats, because clinically significant or life-threatening ventricular arrhythmias are rare in this species. 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. > 3 weeks. J Thorac Cardiovasc Surg. The recommended starting dose of Cordarone I.V. Please see our, 2010synthroid-levoxyl-levothyroxine-342732. A much less common presentation is adult respiratory distress syndrome. <> 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. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. Laboratory studies to assess liver and thyroid function should be performed at least every six months. Please enable it to take advantage of the complete set of features! Mechanism of Action Adenosine is a potent vasodilator in most vascular beds, except in renal afferent arterioles and hepatic veins where it produces vasoconstriction. Manifestations of life-threatening toxicity include severe ventricular arrhythmias such as ventricular tachycardia or ventricular fibrillation, or progressive bradyarrhythmias such as severe sinus bradycardia or second or third degree heart block not responsive to atropine. Maintenance dose should be determined according to antiarrhythmic effect as assessed by patient tolerance as well as symptoms, Holter recordings, and/or programmed electrical stimulation; some patients may require up to 600 mg/day while some can be controlled on lower doses. Amiodarone crosses the placenta and reaches measurable levels in breast milk. A meta-analysis11 of double-blind trials found the frequency of adult respiratory distress syndrome to be 1 percent annually. HOW SUPPLIED ---------------------- The recommended starting dose of Cordarone I.V. Once inside the cell, adenosine is rapidly phosphorylated by adenosine kinase to adenosine monophosphate, or deaminated by adenosine deaminase to inosine. Various practice guidelines recommend amiodarone as a second-line drug in the long-term treatment of atrial fibrillation in patients with structural heart disease and in highly symptomatic patients without heart disease.10 Several smaller studies have shown that amiodarone is similar to quinidine and sotalol in the treatment of atrial fibrillation in these patients.11,12 In one randomized controlled trial (RCT),12 sinus rhythm was maintained successfully for 16 months in 65 percent of patients treated with amiodarone, compared with 37 percent of patients treated with sotalol or propafenone (ARR, 28 percent; NNT, 3.6). Copyright 1993-2021 Neither amiodarone nor DEA is dialyzable. Supplied: 250 mg, 500 mg capsule. Serum levels: 0.5 to 2.0 ng/ml. Restated: Duration of IV infusion < 1 week: 800-1600mg/day po initially x 1-2 weeks or complete current week; 1-3 weeks: 600-800mg/day po initially - total therapy ~ 1 month counting IV infusion ; >3 weeks: 400mg po qd initially. Dosage for acute ingestion of unknown amount: 20 vials (760mg) of Digibind is adequate to treat most life-threatening ingestions. Due to rapid distribution, serum concentrations decline to 10% of peak values within 30 to 45 minutes after the end of the infusion. government site. Inform patients administering this drug to do so consistently with regard to meals. Bookshelf In some cases, hypotension may be refractory resulting in fatal outcome (see package insert for ADVERSE REACTIONS, Postmarketing Reports). Intravenously administered amiodarone causes heart block or bradycardia in 4.9 percent of patients and hypotension in 16 percent.2 If these conditions occur, infusion of the drug should be discontinued, or the rate of infusion should be reduced. 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. 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. Initiate this drug in a clinical setting where continuous ECGs and cardiac resuscitation are available. Disclaimer. Amiodarone (Cordarone) is a complex antiarrhythmic agent with multiple electrophysiologic effects, unusual pharmacokinetics, and numerous potentially harmful drug interactions and adverse effects. Pre- and post-treatment with amiodarone may promote successful and sustained cardioversion. Replacement therapy may not be necessary in such patients if oral therapy is discontinued for a period <2 weeks, since any changes in serum amiodarone concentrations during this period may not be clinically significant. Infusion: >3 weeks Initial Daily Dose of Oral Cordarone : 400 mg *Assuming a 720 mg/day infusion (0.5 mg/min). [Loading: 10 to 15 mcg/kg IBW in divided doses (q4-8h) over 12-24hrs.] Pharmacologic stress agent (Adenoscan): Continuous I.V.
