Amiodarone hydrochloride

CLINICAL USE

Cardiac arrhythmias

DOSE IN NORMAL RENAL FUNCTION

  • Oral: 200 mg 3 times a day for 1 week, thentwice a day for 1 week, then 200 mg daily
    maintenance dose or minimum required
    to control arrhythmia
  • IV: via central catheter – 5 mg/kg(maximum 1.2 g in 24 hours)
  • Ventricular arrhythmias or pulselessventricular tachycardias: 300 mg over at
    least 3 minutes

    PHARMACOKINETICS

  • Molecular weight                           :
    681.8
  • %Protein binding                           :
    96
  • %Excreted unchanged in urine     :
    <5
  • Volume of distribution (L/kg)       :
    70–140
  • half-life – normal/ESRD (hrs)      :
    20–100 days/
    Unchanged

    DOSE IN RENAL IMPAIRMENT

    GFR (mL/MIN)

  • 20 to 50     : Dose as in normal renal function
  • 10 to 20     : Dose as in normal renal function
  • <10           :
    Dose as in normal renal function

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES

  • CAPD                :
    Not dialysed. Dose as in normal renal function
  • HD                     :
    Not dialysed. Dose as in normal renal function
  • HDF/high flux   :
    Unknown dialysability. Dose as in
    normal renal function
  • CAV/VVHD      :
    Not dialysed. Dose as in normal renal function

    IMPORTANT DRUG INTERACTIONS

    Potentially hazardous interactions with other drugs

  • Anti-arrhythmics: additive effect andincreased risk of myocardial depression;
    increased risk of ventricular arrhythmias
    with disopyramide – avoid; increased
    flecainide concentration – halve
    flecainide dose; increased procainamide
    concentration – avoid
  • Antibacterials: increased risk ofventricular arrhythmias with parenteral
    erythromycin, co-trimoxazole and
    moxifloxacin – avoid concomitant use
  • Anticoagulants: metabolism inhibited(increased anticoagulant effect)
  • Antidepressants: increased risk ofventricular arrhythmias with tricyclic
    antidepressants – avoid concomitant use
  • Anti-epileptics: phenytoin metabolisminhibited (increased plasma concentration)
  • Antihistamines: increased risk ofventricular arrhythmias with mizolastine
    – avoid
  • Antimalarials: increased risk ofventricular arrhythmias with chloroquine,
    hydroxychloroquine, mefloquine and
    quinine – avoid concomitant use; avoid
    concomitant use with artemether/
    lumefantrine
  • Antipsychotics: increased riskof ventricular arrhythmias with
    antipsychotics that prolong the QT
    interval; increased risk of ventricular
    arrhythmias with amisulpride, haloperidol,
    phenothiazines, pimozide or sertindole –
    avoid
  • Antivirals: increased risk of ventriculararrhythmias with amprenavir, nelfinavir
    and ritonavir – avoid concomitant use;
    concentration possibly increased by
    atazanavir; avoid with indinavir
  • Atomoxetine: increased risk of ventriculararrhythmias
  • Beta-blockers, diltiazem, verapamil:increased risk of bradycardia, AV block
    and myocardial depression; increased risk
    of ventricular arrhythmias with sotalol –
    avoid
  • Ciclosporin: increased levels of ciclosporinpossible
  • Digoxin: increased plasma concentration(halve digoxin maintenance dose)
  • 5HT3 antagonists: increased risk of
    ventricular arrhythmias with dolasetron
    – avoid concomitant use; caution with
    tropisetron
  • Ivabradine: increased risk of ventriculararrhythmias – avoid concomitant use
  • Lipid-lowering drugs: increased riskof myopathy with simvastatin – do not
    exceed 20 mg of simvastatin.1
  • Lithium: increased risk of ventriculararrhythmias – avoid concomitant use
  • Pentamidine: increased risk of ventriculararrhythmias – avoid concomitant use
  • Grapefruit juice: may increaseconcentration of amiodarone – avoid
    concomitant use

    ADMINISTRATION

    Reconstition

    –

    Route

  • Oral, IV via central catheter orperipherally in veins with good blood flow

    Rate of Administration

  • 20–120 minutes (max 1.2 g in up to 500 mLglucose 5% in 24 hours)

    Comments

  • Add dose to 250 mL glucose 5%
  • Solutions containing less than 300 mg in500 mL glucose 5% should not be used, as
    unstable
  • Minimum volumes for central use only areup to 900 mg in 48–50 mL.

    OTHER INFORMATION

  • Amiodarone and desethylamiodaronelevels can be monitored to assess
    compliance
  • In extreme clinical emergency, may begiven by slow IV bolus using 150–300 mg
    in 10 to 20 mL glucose 5% over a minimum
    of 3 minutes with close monitoring.
    This should not be repeated for at least
    15 minutes
  • Incompatible with sodium chloride 0.9%.
  • Rapid IV administration has beenassociated with anaphylactic shock, hot
    flushes, sweating, and nausea
    • Tags:

    Related News

    ffddfd

    Hyperlipidemia