{"id":1630,"date":"2023-06-25T17:28:42","date_gmt":"2023-06-25T17:28:42","guid":{"rendered":"https:\/\/kidneydiseaseclinic.net\/kdc\/amiodarone-hydrochloride\/"},"modified":"2023-06-25T19:58:24","modified_gmt":"2023-06-25T19:58:24","slug":"amiodarone-hydrochloride","status":"publish","type":"post","link":"https:\/\/kidneydiseaseclinic.net\/kdc\/amiodarone-hydrochloride\/","title":{"rendered":"Amiodarone hydrochloride"},"content":{"rendered":"

<\/p>\n

Amiodarone hydrochloride<\/h1>\n

CLINICAL USE<\/h3>\n

Cardiac arrhythmias<\/p>\n

DOSE IN NORMAL RENAL FUNCTION<\/h3>\n
  • Oral: 200 mg 3 times a day for 1 week, thentwice a day for 1 week, then 200 mg daily
    \nmaintenance dose or minimum required
    \nto control arrhythmia<\/li>\n
  • IV: via central catheter \u2013 5 mg\/kg(maximum 1.2 g in 24 hours)<\/li>\n
  • Ventricular arrhythmias or pulselessventricular tachycardias: 300 mg over at
    \nleast 3 minutes<\/p>\n

    PHARMACOKINETICS<\/h3>\n<\/li>\n
  • Molecular weight                           :
    \n681.8<\/li>\n
  • %Protein binding                           :
    \n96<\/li>\n
  • %Excreted unchanged in urine     :
    \n<5<\/li>\n
  • Volume of distribution (L\/kg)       :
    \n70\u2013140<\/li>\n
  • half-life \u2013 normal\/ESRD (hrs)      :
    \n20\u2013100 days\/
    \nUnchanged<\/p>\n

    DOSE IN RENAL IMPAIRMENT<\/h3>\n

    GFR (mL\/MIN)<\/h4>\n<\/li>\n
  • 20 to 50     : Dose as in normal renal function<\/li>\n
  • 10 to 20     : Dose as in normal renal function<\/li>\n
  • <10           :
    \nDose as in normal renal function<\/p>\n

    DOSE IN PATIENTS UNDERGOING RENAL REPLACEMENT THERAPIES<\/h3>\n<\/li>\n
  • CAPD                :
    \nNot dialysed. Dose as in normal renal function<\/li>\n
  • HD                     :
    \nNot dialysed. Dose as in normal renal function<\/li>\n
  • HDF\/high flux   :
    \nUnknown dialysability. Dose as in
    \nnormal renal function<\/li>\n
  • CAV\/VVHD      :
    \nNot dialysed. Dose as in normal renal function<\/p>\n

    IMPORTANT DRUG INTERACTIONS<\/h3>\n

    Potentially hazardous interactions with other drugs<\/li>\n

  • Anti-arrhythmics: additive effect andincreased risk of myocardial depression;
    \nincreased risk of ventricular arrhythmias
    \nwith disopyramide \u2013 avoid; increased
    \nflecainide concentration \u2013 halve
    \nflecainide dose; increased procainamide
    \nconcentration \u2013 avoid<\/li>\n
  • Antibacterials: increased risk ofventricular arrhythmias with parenteral
    \nerythromycin, co-trimoxazole and
    \nmoxifloxacin \u2013 avoid concomitant use<\/li>\n
  • Anticoagulants: metabolism inhibited(increased anticoagulant effect)<\/li>\n
  • Antidepressants: increased risk ofventricular arrhythmias with tricyclic
    \nantidepressants \u2013 avoid concomitant use<\/li>\n
  • Anti-epileptics: phenytoin metabolisminhibited (increased plasma concentration)<\/li>\n
  • Antihistamines: increased risk ofventricular arrhythmias with mizolastine
    \n\u2013 avoid<\/li>\n
  • Antimalarials: increased risk ofventricular arrhythmias with chloroquine,
    \nhydroxychloroquine, mefloquine and
    \nquinine \u2013 avoid concomitant use; avoid
    \nconcomitant use with artemether\/
    \nlumefantrine<\/li>\n
  • Antipsychotics: increased riskof ventricular arrhythmias with
    \nantipsychotics that prolong the QT
    \ninterval; increased risk of ventricular
    \narrhythmias with amisulpride, haloperidol,
    \nphenothiazines, pimozide or sertindole \u2013
    \navoid<\/li>\n
  • Antivirals: increased risk of ventriculararrhythmias with amprenavir, nelfinavir
    \nand ritonavir \u2013 avoid concomitant use;
    \nconcentration possibly increased by
    \natazanavir; avoid with indinavir<\/li>\n
  • Atomoxetine: increased risk of ventriculararrhythmias<\/li>\n
  • Beta-blockers, diltiazem, verapamil:increased risk of bradycardia, AV block
    \nand myocardial depression; increased risk
    \nof ventricular arrhythmias with sotalol \u2013
    \navoid<\/li>\n
  • Ciclosporin: increased levels of ciclosporinpossible<\/li>\n
  • Digoxin: increased plasma concentration(halve digoxin maintenance dose)<\/li>\n
  • 5HT3 antagonists: increased risk of
    \nventricular arrhythmias with dolasetron
    \n\u2013 avoid concomitant use; caution with
    \ntropisetron<\/li>\n
  • Ivabradine: increased risk of ventriculararrhythmias \u2013 avoid concomitant use<\/li>\n
  • Lipid-lowering drugs: increased riskof myopathy with simvastatin \u2013 do not
    \nexceed 20 mg of simvastatin.1<\/li>\n
  • Lithium: increased risk of ventriculararrhythmias \u2013 avoid concomitant use<\/li>\n
  • Pentamidine: increased risk of ventriculararrhythmias \u2013 avoid concomitant use<\/li>\n
  • Grapefruit juice: may increaseconcentration of amiodarone \u2013 avoid
    \nconcomitant use<\/p>\n

    ADMINISTRATION<\/h3>\n

    Reconstition<\/h4>\n

    \u2013<\/p>\n

    Route<\/h4>\n<\/li>\n
  • Oral, IV via central catheter orperipherally in veins with good blood flow
    \n

    Rate of Administration<\/h4>\n<\/li>\n
  • 20\u2013120 minutes (max 1.2 g in up to 500 mLglucose 5% in 24 hours)
    \n

    Comments<\/h4>\n<\/li>\n
  • Add dose to 250 mL glucose 5%<\/li>\n
  • Solutions containing less than 300 mg in500 mL glucose 5% should not be used, as
    \nunstable<\/li>\n
  • Minimum volumes for central use only areup to 900 mg in 48\u201350 mL.
    \n

    OTHER INFORMATION<\/h4>\n<\/li>\n
  • Amiodarone and desethylamiodaronelevels can be monitored to assess
    \ncompliance<\/li>\n
  • In extreme clinical emergency, may begiven by slow IV bolus using 150\u2013300 mg
    \nin 10 to 20 mL glucose 5% over a minimum
    \nof 3 minutes with close monitoring.
    \nThis should not be repeated for at least
    \n15 minutes<\/li>\n
  • Incompatible with sodium chloride 0.9%.<\/li>\n
  • Rapid IV administration has beenassociated with anaphylactic shock, hot
    \nflushes, sweating, and nausea<\/li>\n","protected":false},"excerpt":{"rendered":"

    Amiodarone hydrochloride CLINICAL USE Cardiac arrhythmias DOSE IN NORMAL RENAL<\/p>\n","protected":false},"author":1,"featured_media":0,"comment_status":"closed","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[7],"class_list":["post-1630","post","type-post","status-publish","format-standard","hentry","category-blog","tag-post-by-auto-php"],"_links":{"self":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1630","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/comments?post=1630"}],"version-history":[{"count":1,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1630\/revisions"}],"predecessor-version":[{"id":2925,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/posts\/1630\/revisions\/2925"}],"wp:attachment":[{"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/media?parent=1630"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/categories?post=1630"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/kidneydiseaseclinic.net\/kdc\/wp-json\/wp\/v2\/tags?post=1630"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}