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AMIODARONE (Cordarone)

CLASS:

  • Class III Antidysrhythmic - * Sodium, calcium, and K+ channel blocking effects, and beta blocker

    effects.

ACTIONS:

  • Prolongs duration of myocardial cell action potential and refractory period by acting directly on all cardiac tissue and decreases AV and SA node function

  • Blocks Na+ channels like class I antiarrhythmics

  • Like beta blockers, it exerts noncompetitive anti-sympathetic action

  • Blocks myocardial K+ channels - slowing conduction and prolonging refractoriness.

  • The antisympathetic action and the block of Ca++ and K+ channels are responsible for the negative dromotropic effects on SA and for slowing of conduction and prolongation of refractoriness in the AV node.

INDICATIONS:

  • VF or VT cardiac arrest

  • Control of hemodynamically stable VT, polymorphic VT, and wide-complex tachycardia of uncertain origin

  • Refractory PSVTs, atrial tachycardia, and pharmacological cardioversion of AF

  • Control rapid ventricular rate due to accessory pathway conduction in pre-excited atrial arrhythmias

CONTRAINDICATIONS:

  • Hypersensitivity

  • Sinus Node dysfunction (SSS)

  • 2nd, 3rd degree AV blocks

  • Hypotension / Cardiogenic shock

  • Severe hepatic disease

  • Pulmonary congestion

STANDARD PREPS:

  • 150 mg / 3 cc

DOSAGES/ROUTES:

  • VF/VT cardiac arrest: 300 mg IV followed by 10 cc NS flush if conversion 150mg mixed in 100cc NS, run over 10min (15mg/min)

  • For patient not in cardiac arrest: 150 mg IV over 10 minutes (15 mg/min) may repeat as needed q 10 min., followed by infusion of
    1 mg/min over 6 hrs

THEN

  • 0.5 mg/min IV infused over 18 hours

  • Recurrent Ventricular Arrhythmias - maximum cumulative dose: 2.2g IV/24 h.

PEDIATRIC DOSE:

  • Pulseless V-Tach/Fib- 5mg/kg IV or IO followed by 5ml NS flush

  • PALS Ped- refractoryVF, pulselessV-Tach 5mg/kg IV/IO bolus: can repeat the 5mg/kg IV/IO bolus up to a total dose of 15mg/kg IV per 24hrs. Max single dose: 300mg

SIDE EFFECTS:

  • Bradycardia / Hypotension

  • Cardiogenic shock, AV blocks

  • Proarrhythmias (torsades)

  • Hepatotoxicity

  • CHF, pulmonary fibrosis

  • Dizziness, N/V

  • Misc.: flushing, abnormal salivation

PRECAUTIONS:

  • Do not shake vial because it will foam

  • Prolonged QT