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Amiodarone Intravenous for Adults
Who can administer
May be administered by registered competent doctor or nurse/midwife
Important information
- Flush line before and after with Glucose 5% as amiodarone is incompatible with Sodium Chloride 0.9%
- When repeated or continuous infusion is anticipated, administration by a central venous catheter is recommended (repeated or continuous infusion via the peripheral veins may lead to injection site reactions) (ref 1)
- There are numerous important interactions - check latest BNF
- Mini-jet formulation is occasionally unavailable. If minijet is not available, the dose may be drawn from the ampoule and diluted to 10mls with Glucose 5%
- Too rapid administration can cause circulatory collapse
- Where possible, administer via a central line to minimise vein irritation. However, it may be given via a large peripheral vein if a patient does not have central access (ref 1)
- For Y-site compatibility see below
Available preparations
Cordarone X 150mg per 3mL ampoule
Amiodarone 150mg per 3mL vial (Mylan)
Amiodarone 300mg in 10ml pre-filled syringe (for resuscitation trolley)
Reconstitution
Already in solution
Dilute further prior to administration
Use a 5 micron filter needle when drawing up contents of ampoule
Infusion fluids
Glucose 5%
Methods of intravenous administration
Flush line before and after with Glucose 5%.
See under 'Important information' re central vs peripheral line
Intermittent intravenous infusion (Loading dose only)(administer using an electronically controlled infusion device)
- Add to 250ml infusion fluid and administer over 60 minutes (20 to 120 minutes is acceptable)
Continuous intravenous infusion (Maintenance dose) (administer using an electronically controlled infusion device)
- Add required dose to 500ml infusion fluid and administer over 24 hours (23 hours on day 1)
- Avoid equipment containing the plasticizer DEPH which may cause leaching (however, the clinical significance of this is uncertain (ref 1))
Central line administration only (ref 1)
- Loading dose may be given in 50 to 100mL infusion fluid over 60 minutes (20 to 120 minutes is acceptable)
- Maintenance dose: Add required dose to make total volume of 50ml for infusion via syringe driver over 24 hours
Ventricular fibrillation
- May be given faster in such circumstances (see under dose)
Dose in adults
Usual dose
Loading dose
- Administer 5mg/kg
Maintenance dose
- Administer 15mg/kg (maximum dose is 1200mg (including loading dose) over twenty-four hours
- See under Further information for guidance on how to change over from IV to oral therapy
Ventricular fibrillation/pulseless ventricular tachycardia (i.e.extreme clinical emergency)
- 150 to 300mg (using the 300mg/10ml minijet) as a slow bolus injection over at least 3 minutes
- Mini-jet formulation is occasionally unavailable. If minijet is not available, the dose may be drawn from the ampoule and diluted to 10mls with Glucose 5%
- Flush the line or inject into fast-running infusion to ensure delivery of the drug
- The dose should not be repeated for at least fifteen minutes
- Patients treated in this way must be closely monitored, for example in an intensive care unit
Monitoring
- ECG and blood pressure monitoring is required
- Monitor site of infusion- can cause thrombophlebitis and extravasation may cause tissue damage
- Monitor LFTs closely. Amiodarone dose should be reduced or stopped if transaminases increase to greater than three times the normal range
- Facilities for cardiac monitoring, defibrillation and cardiac pacing should be available
- Monitor thyroid function
- Interstitial pneumonitis has been rarely reported
Further information
- Infusion solutions containing less than 0.6mg/ml (e.g. 300mg in 500ml) are unstable and should not be used
- Amiodarone injection contains iodine
- Injection solution contains benzyl alcohol
- As soon as an adequate response has been obtained with intravenous amiodarone, oral therapy should be initiated concomitantly at the usual loading dose (i.e. 200mg three times daily). The Intravenous dose should then be phased out gradually.
- While the manufacturers suggest that low adsorption administration sets are preferable, other sources say that the clinical significance of this issue is uncertain (ref 1)
Storage
Store below 250C
References
SPC March 2022
1. Injectable Medicines Administration Guide UCL Medusa Downloaded 02/05/2025
Therapeutic classification
Drugs for arrhythmias