Download Amiodarone Infusion Guideline

Amiodarone Infusion Guideline
AMIODARONE INFUSION
1 ampoule = 150mg Amiodarone hydrochloride in 3mL, fine white crystalline powder
Amiodarone infusion should only be initiated under hospital or specialist supervision.
Indications:
• All types of tachyarrhythmia’s including:
o paroxysmal supraventricular,
o nodal and ventricular tachycardias;
o atrial fibrillation and flutter;
o ventricular fibrillation
•
Tachyarrhythmia’s associated with Wolff-Parkinson-White syndrome
•
Arrhythmia’s when all other agents cannot be used.
Dose:
Initial Bolus Dose
Then 23 hour infusion
Tachyarrhythmia’s • Add 300mg
• Add 450mg amiodarone to
amidodarone to 250mL
250mL 5% Dextrose
 infuse over 11.5 hours
5% Dextrose.
• Infuse over 1 hour
• then add a further 450mg
amiodarone to 250mL 5%
Dextrose
 infuse over 11.5 hours
Max. Dose
1200mg in
24 hours
 Infuse both at 22mL/hour
Note: use non-PVC (excel) 250mL 5% Dextrose Injection USP bags
Note: Oral therapy should be initiated as soon as possible after adequate response is obtained. Overlap of
oral and intravenous medication is recommended for two days to prevent plasma levels falling and
efficacy being lost.
Administration:
• Solution must be diluted before administration
•
Compatible with 5% Dextrose ONLY.
•
Use non-PVC (excel) 250mL 5% Dextrose Injection USP bags and low-sorbing PE/PVC tubing.
•
Add required dose to 250mL of 5% Dextrose Injection USP non-PVC (excel) bag.
•
Administration via a large bore vein or by a central venous catheter is recommended.
Amiodarone Infusion Guideline
Document Owner: Medication Safety Committee
WCDHB-MSC Version 1, Issued 19/12/13
Page 1 of 3
Master Copy is Electronic
Amiodarone Infusion Guideline
Observation and Monitoring:
• Continuous cardiac monitoring is required with daily ECG and QT interval checks.
• BP and heart rate hourly for the first 4 hours, then 4 hourly until confusion complete.
If hypotension occurs, slowing or stopping the infusion temporarily is usually adequate.
• Doctors must chart acceptable clinical parameters on the prescription sheet as severe
hypotension and/or bradycardia may occur.
Mechanism of action:
Amiodarone is a Class III antiarrythmic agent which inhibits adrenergic stimulation (alpha-and betablocking properties). It prolongs the action potentional and refractory period in myocardial tissue through
its effect on sodium, potassium and calcium channels; and, it further decreases AV conduction and sinus
node function.
Contraindications:
• Known hypersensitivity to iodine or amiodarone.
• Sinus bradycardia, sino-atrial heart block
• Unless pacemaker fitted avoid in severe conduction disturbances or sinus disease node
• Severe respiratory failure, circulatory collapse, or severe arterial hypotension
• Thyroid dysfunction
• Avoid bolus injection in congestive failure or cardiomyopathy
• Lactation
• Combined therapy with medicines that may induce ‘Torsades de Pontes’
Precautions:
• In patients with hypotension, uncompensated or severe heart failure.
• Patients with pacemakers/implantable defibrillators
• In patients with cardiac disorders – may occasionally worse existing heart failure
 Discontinue in patients with 2nd or 3rd degree AV block, sinoatrial block,
bifascicular or trifascicular block
 in patients with previous history of atypical ventricular tachycardia
• Deranged LFTs
• Pregnancy –use only if no alternative
• Patients with history of thyroid dysfunction
• Concomitant use with medications that prolong QT interval
• Chronic renal failure; electrolyte imbalance (e.g. Hypokalaemia, hypomagnesaemia); may lead to
reduced effectiveness or arrhythmia
Possible adverse effects:
• Common  decrease in blood pressure (moderate and transient), hot flushes sweating or nausea,
taste disturbances,
• Less common  onset or worsening of arrhythmia, conduction disturbances, peripheral
neuropathy, myopathy
• Very rare  acute liver disorders with elevated serum transaminases and/or jaundice; interstitial
pneumonitis, headache, ataxia, thrombocytopenia, rash, haemolytic or aplastic anaemia
Amiodarone Infusion Guideline
Document Owner: Medication Safety Committee
WCDHB-MSC Version 1, Issued 19/12/13
Page 2 of 3
Master Copy is Electronic
Amiodarone Infusion Guideline
Drug interactions:
Medications
Antipsychotics
Citalopram
Dabigatran
Statins
Digoxin
Anti-coagulants
Interaction
Can lead to dangerous QT prolongation if used together; potentially fatal
torsade de pointes arrhythmia.
Risk of QT prolongation if used together
Plasma concentration of Dabigatran may be raised
Risk of muscular toxicity is increased when given in combination with
statins metabolised by CYP 3A4.
Amiodarone can double digoxin levels
Metabolism inhibited by Amiodarone and INR levels may increase
Storage:
Store below 30oC. Protect from light. Do not refrigerate.
Discard any unused solution after 12 hours.
List of excipients:
Polysorbate 80, benzyl alcohol and water for injections, as well as hydrochloric acid and sodium
hydroxide for pH adjustment.
Note: Amiodarone contains 2 atoms of iodine and bears a structural resemblance to the molecule of
thyroxine. Each 3ml ampoule contains approximately 56mg iodine
References:
References
1
2
Title/Description
Drug information handbook 21st Ed. 2012-1013
Notes on Injectable Drugs 6th Ed. 2010
3
4
5
6
British National Formulary 64th Ed. Published September 2012.
Amiodarone Hydrochloride injection Datasheet. Available from www.medsafe.govt.nz
Drugs in Pregnancy and Lactation 8th Ed. Briggs, G. Freeman, R. Yaffe S
Stockleys Drug Interactions 7th Ed. Pharmaceutical Press
Amiodarone Infusion Guideline
Document Owner: Medication Safety Committee
WCDHB-MSC Version 1, Issued 19/12/13
Page 3 of 3
Master Copy is Electronic