amiodarone iv to po calculator

In addition to blocking sodium channels, amiodarone blocks myocardial potassium channels, which contributes to slowing of conduction and prolongation of refractoriness. Various practice guidelines recommend amiodarone as a second-line drug in the long-term treatment of atrial fibrillation in patients with structural heart disease and in highly symptomatic patients without heart disease.10 Several smaller studies have shown that amiodarone is similar to quinidine and sotalol in the treatment of atrial fibrillation in these patients.11,12 In one randomized controlled trial (RCT),12 sinus rhythm was maintained successfully for 16 months in 65 percent of patients treated with amiodarone, compared with 37 percent of patients treated with sotalol or propafenone (ARR, 28 percent; NNT, 3.6). When the maintenance dose is given IV, the onset and peak will occur earlier, however the duration of action is the same. On the other hand, it is possible that this is a very lightweight, elderly woman, and the physician is being extremely cautious on the loading or there are other comorbid conditions that could increase the risk of amiodarone toxicity. Followed by Slow: 360 mg over the NEXT 6 hours (1 mg/min). Add 3 ml of Cordarone I.V. Supplied: 225 mg, 325 mg, 425 mg extended release cap. WebIV Drip Rate Calculator. A reduction of the resting heart rate due to the beta-blocking effect of sotalol is observed at daily doses >/=90 mg/m2 in children. Amiodarone injection belongs to the group of medicines known as antiarrhythmics. dose. A similar problem exists when this drug is not effective; it still poses the risk of an interaction with whatever subsequent treatment is tried. 2011;92:11441152. Amiodarone: I.V. Clipboard, Search History, and several other advanced features are temporarily unavailable. E.T. Peak serum concentrations after 15-minute infusions in healthy volunteers range from 5 to 41 mg/L. How many mL is 300 mg of amiodarone? (900 mg) to 500 ml D 5 W (conc = 1.8 mg/ml). Disclaimer. The North American Society for Pacing and Electrophysiology (NASPE) recommends amiodarone as the antiarrhythmic agent of choice in patients who have survived sustained ventricular tachyarrhythmias, particularly those with left ventricular dysfunction.4. Intravenous amiodarone administration prolongs intranodal conduction (Atrial-His, AH) and refractoriness of the atrioventricular node (ERP AVN), but has little or no effect on sinus cycle length (SCL), refractoriness of the right atrium and right ventricle (ERP RA and ERP RV), repolarization (QTc), intraventricular conduction (QRS), and infranodal conduction (His-ventricular, HV). Supplied: 80 mg, 120 mg, 160 mg, 240 mg tablet ---------- Drug UPDATES: SOTYLIZE (sotalol hydrochloride) oral solution Initial U.S. Approval: 1992 [Drug information / PDF] Dosing: Click (+) next to Dosage and Administration section (drug info link). Hypotension, bradycardia, atrioventricular block. Patients with the indicated arrhythmias must be hospitalized while the loading dose is given, and a response generally requires at least one week, usually two or more. Approved for acute termination. Unable to load your collection due to an error, Unable to load your delegates due to an error. Dosage for acute ingestion of unknown amount: 20 vials (760mg) of Digibind is adequate to treat most life-threatening ingestions. The initial infusion rate should not exceed 30 mg/min. Mechanisms of Action Monitoring: Pacerone, Cordarone, Nexterone, Cordarone IV. Do Not Copy, Distribute or otherwise Disseminate without express permission. PROARRHYTHMIC EFFECTS: Like other antiarrhythmics, this drug can exacerbate the arrhythmia, e.g., by making the arrhythmia less well tolerated or more difficult to reverse. Greenberg JW, Lancaster TS, Schuessler RB, et al. 2010;11:5763. Monitoring: Obtain blood samples at least 4 hrs after IV dose and 6-8hrs after oral dose. Lidocaine (xylocaine ) Ventricular arrhythmia: 1-1.5 mg/kg IV bolus over 2-3 minutes; may repeat doses of 0.5-0.75 mg/kg in 5-10 minutes up to a total of 3 mg/kg; Assistance in calculating accurate rates of medication administration. Crcl 10-30 ml/min: Administer every 36-48 hours. This dose can be used in patients in acute distress or when a serum concentration is not available. However, recent studies have shown that aggressive attempts to maintain sinus rhythm using amiodarone or other drugs do not improve outcomes in relatively asymptomatic patients.13,14 Therefore, long-term amiodarone therapy, with its potential for toxicity, does not appear to be justified in patients who are taking anticoagulant drugs if rate-control strategies can provide satisfactory symptomatic improvement. Loading infusions: 150 mg over the first 10 minutes (15 mg/min), followed by 360 mg over the next 6 hours (1 mg/min), Maintenance infusion: 540 mg over the remaining 18 hours (0.5 mg/min), Supplemental infusions: 150 mg over 10 minutes (15 mg/min) for breakthrough episodes of ventricular fibrillation (VF) or hemodynamically unstable ventricular tachycardia (VT). Decrease dose by 30-50% in hepatic insufficiency. Applies to the following strengths: 50 mg/mL; 200 mg; 300 mg; 100 mg; 400 mg; 150 mg/150 mL-D0.5%; 900 mg/500 mL-D5%; 450 mg/250 mL-D5%; 150 mg/100 mL-D5%; 360 mg/200 mL-D5%. Long-Term Use Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. > 3 weeks. National Institutes of Health, U.S. National Library of Medicine, DailyMed Database. Supplied: Adenocard: 3 mg/ml (2 ml, 4 ml) Adenoscan: 3 mg/ml (20 ml, 30 ml). Amiodarone : I.V. DOSE RECOMMENDATIONS -- FIRST 24 HOURS -- Loading infusions. The recommended starting dose of Cordarone I.V. is about 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: First Rapid: 150 mg over the FIRST - 10 minutes (15 mg/min). Add 3 mL of Cordarone I.V. (150 mg) to 100 mL D5W. Effective in @30% of patients. <>stream This content is owned by the AAFP. A local search option of this data can be found here. official website and that any information you provide is encrypted Replacement therapy may not be necessary in such patients if oral therapy is discontinued for a period <2 weeks, since any changes in serum amiodarone concentrations during this period may not be clinically significant. Copyright 2003 by the American Academy of Family Physicians. The primary treatment for pulmonary toxicity is withdrawal of amiodarone and provision of supportive care and, in some cases, corticosteroids. Because absorption and elimination are variable, maintenance-dose selection is difficult, and it is not unusual to require dosage decrease or discontinuation of treatment. Safety outcomes include occurrence of bradycardia or hypotension while on amiodarone. Amiodarone is generally considered a class III antiarrhythmic drug, but it possesses electrophysiologic characteristics of all four Vaughan Williams classes. > 3 weeks. IV compatibility: The manufacturer product information should be consulted. Initial Daily Dose of Oral Cordarone 1 week 800-1600 mg 1-3 weeks 600-800 mg >3 weeks* 400 mg # Assuming a 720 mg/day infusion (0.5 mg/min). * Cordarone I.V. is not intended for maintenance treatment. HOW SUPPLIED Cordarone I.V. (amiodarone HCl) is available in packages of 10 ampuls (2 cartons each containing 5 ampuls), 3 mL each, as follows: Also, an in-line filter should be used during administration. CONTRAINDICATIONS 324 mg extended release tab (gluconate). Photosensitivity is common in patients receiving amiodarone therapy. Despite such measures, bradycardia was progressive and terminal in 1 patient during the controlled trials. WebUse oral administration wherever possible. of vials = level (ng/mL) x body weight (kg) divided by 100, Digitoxin: No. endobj Atrial fibrillation/flutter (Betapace AF): Crcl >60 ml/min: Administer every 12 hours. based on a 1:2.5 conversion from IV to PO: = Link to online calculator. A loading regimen (i.e., use of a relatively high dosage at the beginning of therapy) can shorten the delay. Although the frequency of such proarrhythmic events does not appear greater with this drug than with many other agents used in this population, the effects are prolonged when they occur. Typical amiodarone dosages in the ACLS setting are provided in Table 1.2,10 In patients who require long-term treatment, intravenous dosing should be switched to oral dosing. Dosing (adults): IVPB: 0 to 1 mg/50 ml D5W or NS over 10 minutes. Amiodarone may subsequently be continued until the patient has recovered from their critical illness (e.g., for 1-2 weeks). WebThis calculator is not appropriate for the following patient populations: Significant drug interactions (eg, amiodarone, quinidine, verapamil, or macrolide antibiotics) End-stage Supplied: 250 mg, 500 mg capsule. Note: Decrease dose in patients with CHF, elderly, hepatic disease. Treatments of amiodaroneinduced hyperthyroidism include the withdrawal of amiodarone (if this can be done safely), the addition of antithyroid medications or prednisone, and surgical thyroidectomy.20, Liver toxicity, manifested by elevation of liver transaminase levels, is common in patients who are receiving long-term amiodarone therapy. If side effects become excessive, the dose should be reduced. Please enable it to take advantage of the complete set of features! No significant association was found between various overlap durations and AF recurrence (odds ratio (OR) 1.00, 95% CI 1.00-1.01, P = 0.9). In some cases, hypotension may be refractory resulting in fatal outcome (see package insert for ADVERSE REACTIONS, Postmarketing Reports). Amiodarone reduces warfarin clearance and can lead to sudden and pronounced increases in the prothrombin time and International Normalized Ratio.21 The peak effects of interaction occur approximately seven weeks after initiation of therapy. Hypotension is the most common adverse effect seen with intravenous amiodarone. 2017;52:665672. Studies on the use of amiodarone for the primary prevention of sudden death in high-risk patients have had mixed results. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Click the topic below to receive emails when new articles are available. Unauthorized use of these marks is strictly prohibited. Consider stopping amiodarone; causal relationship is uncertain. and transmitted securely. Commenting is limited to medical professionals. If side effects become excessive, the dose should be reduced. If this drug is used during pregnancy, or if the patient becomes pregnant while taking this drug, the patient should be apprised of the potential harm to the fetus. High-resolution computed tomographic scanning can be helpful in making a diagnosis. Followed by Slow: 360 mg over the NEXT 6 hours (1 mg/min). In patients with extended and recurrent sun exposure, bluish skin discoloration may develop in exposed areas. Cordarone I.V is not intended for maint therapy. WARNINGS Medically reviewed by Drugs.com. >50 kg: 150 mg every 6 hours or 300 mg every 12 hours (controlled release); if no response, may increase to 200 mg every 6 hours; maximum dose required for patients with severe refractory ventricular tachycardia is 400 mg every 6 hours. Overt liver disease can occur, however, and has been fatal in a few cases. The relationship between plasma amiodarone concentrations and effect, as well as the contribution of the metabolite DEA, is not well established.2 Routine monitoring of the amiodarone plasma level is not recommended.4 [Evidence level C, consensus/expert guidelines], Amiodarone is approved for use in the secondary prevention of life-threatening ventricular arrhythmias. All Rights Reserved. A-fib: 10 to 15 mcg/kg IBW given as above. Eur J Cardiothorac Surg. Ann Thorac Surg. Switching to oral amiodarone after IV administration: Use the following as a guide: <1-week IV infusion: 400 to 1,200 mg daily in divided doses until loading dose of ~6 Pharmacokinetics Dose Adjustments. Advise patients to moderate alcohol consumption while taking this drug. is about 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: First Rapid: 150 mg Questions. WebDose: individualize dose PO qd; Start: 2-3 mcg/kg/dose PO qd, then adjust dose q2wk; Info: adjust dose based on TFTs; start 25% full replacement dose, then incr. Restated: Duration of IV infusion < 1 week: 800-1600mg/day po initially x 1-2 weeks or complete current week; 1-3 weeks: 600-800mg/day po initially - total therapy ~ 1 month counting IV infusion ; >3 weeks: 400mg po qd initially. WebIntravenous procainamide (Procainamide Hydrochloride Injection) is effective in cardioversion in up to 60 percent of patients in uncontrolled series. 5 0 obj 3.Drug in bag. Restated: Duration of IV infusion < 1 week: 800-1600mg/day po initially x 1-2 weeks or complete current week; 1-3 weeks: 600-800mg/day po initially - total therapy ~ 1 month counting IV infusion ; >3 weeks: 400mg po qd initially. See permissionsforcopyrightquestions and/or permission requests. Duration of Cordarone I.V. If severe, stop amiodarone or insert pacemaker. Advise patients that most manufacturers of corneal refractive laser surgery devices consider corneal refractive laser surgery contraindicated in patients taking this drug. Because implantable cardioverter-defibrillators (ICDs) are more effective than amiodarone in reducing mortality in high-risk patients with previous myocardial infarction, primary treatment should be an ICD.69 [Reference6 Evidence level A, meta-analysis] In these patients, amiodarone may be used as an adjunct to reduce the frequency of ICD shocks or to control atrial fibrillation in selected highly symptomatic patients. HtT0}WvlF v@$)IV>/_rif9s3' A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. Digitalis-induced progressive elevation of the serum potassium concentration also suggests imminent cardiac arrest. 6 0 obj Cite this: Reza Taheri. One of its main effects, with prolonged administration, is to lengthen the cardiac action potential, a class III effect. The highly variable systemic availability of oral amiodarone may be attributed potentially to large interindividual variability in CYP3A4 activity. Renal impairment does not influence the pharmacokinetics of amiodarone. Patients treated with amiodarone should be followed regularly to assess ongoing need for amiodarone, efficacy of the drug, appropriateness of dosage, adverse effects, and potential drug interactions. (loading dose only): 2 to 2.5 times the IV dose. Infusion*: <1 week If rounding is required, round to the nearest tenth.) Inhibit salivation and secretions (preanesthesia): 0.4-0.6 mg (IM, IV, SQ) 30 to 60 minutes preop - repeat every 4-6 hours as needed. is not recommended as incompatibility with a buffer in the container may cause precipitation. Renal Dosing: crcl 10-50 ml/minute: Administer every 6-12 hours. Patients' on the "floors" may receive once daily IV maintenance doses, however, IV loading regimens (multiple doses) are restricted to pts on a monitor- ICU's. In most instances, the toxicity is reversible. Intravenous amiodarone is a class III antiarrhythmic agent which has been reported to be safe and most effective in various clinical settings, without an associated increase in mortality rate. The dosage in cats is 0.10.4 mg/kg, IV bolus over ~1 min, then increase to a total dose of 0.251 mg/kg, IV slowly, if no response. J Thorac Cardiovasc Surg. Maintenance infusion: 540 mg over the REMAINING 18 hours (0.5 mg/min). HEPATOTOXICITY: Liver injury is common with this drug, but is usually mild and evidenced only by abnormal liver enzymes. The intracellular uptake of adenosine is mediated by a specific transmembrane nucleoside transport system. Steady-state amiodarone concentrations of 1 to 2.5 mg/L have been associated with antiarrhythmic effects and acceptable toxicity following chronic oral amiodarone therapy. F~GMlILIvau88}]nv9W_%o"v2=Wo- hh The dosage of amiodarone should be kept at the lowest effective level. Any patient who notes changes in visual acuity or peripheral vision should be referred for ophthalmologic evaluation. Recommendations for conversion to intravenous amiodarone after oral administration: During long-term amiodarone therapy (ie, 4 months), the mean plasma-elimination half-life of the active metabolite of amiodarone is 61 days. Assistant Professor of Pharmacy Practice /Assistant Professor of Medicine, Schools of Pharmacy & Medicine, Loma Linda University, Loma Linda, California; Co-Director, Lipid Clinic, VA Loma Linda Healthcare System, Loma Linda, California. Each vial contains 38 mg which will bind approximately 0.5 mg of digoxin. In a placebo-controlled study in patients with severe heart failure requiring recent hospitalization or referral to a specialized heart failure clinic for worsening symptoms (the ANDROMEDA Study), patients given dronedarone had a greater than two-fold increase in mortality. Normal subjects over 65 years of age show lower clearances (about 100 mL/hr/kg) than younger subjects (about 150 mL/hr/kg) and an increase in t1/2 from about 20 to 47 days. <> Use Alaris LVP with Guardrails and select amIODAROne LOAD - = 60 kg in Critical Care Adult or Coronary Care Unit profile. Reconstitution: Dissolve each vial with 4 ml sterile water (do not shake). -----------------------------------INDICATIONS AND USAGE DIGIBIND, Digoxin Immune Fab (Ovine), is indicated for treatment of potentially life-threatening digoxin intoxication.3 Although designed specifically to treat life-threatening digoxin overdose, it has also been used successfully to treat life-threatening digitoxin overdose.3 Since human experience is limited and the consequences of repeated exposures are unknown, DIGIBIND is not indicated for milder cases of digitalis toxicity. Onset of action: 2-10 minutes. Please see our, 2010synthroid-levoxyl-levothyroxine-342732. The recommended starting dose of Cordarone I.V. In clinical studies of 2 to 7 days, clearance of amiodarone after intravenous administration in patients with VT and VF ranged between 220 and 440 mL/h/kg. DOSE RECOMMENDATIONS -- FIRST 24 HOURS -- Loading infusions. Amiodarone is eliminated primarily by hepatic metabolism and biliary excretion and there is negligible excretion of amiodarone or DEA in urine. The elimination half-life of amiodarone is highly variable and unusually long, averaging about 58 days. Amiodarone is more effective than sotalol or propafenone in preventing recurrent atrial fibrillation in patients for whom a rhythm-control strategy is chosen. The patient is obviously at great risk during this time and may need prolonged hospitalization. However, the drug has many other effects: it slows heart rate and atrioventricular nodal conduction (via calcium channel and beta-receptor blockade), prolongs refractoriness (via potassium and sodium channel blockade), and slows intracardiac conduction (via sodium channel blockade). Reconstitution/preparation techniques: The manufacturer product information should be consulted. <> Not preferred drug for PSVT because it is not rapidly effective (may take up to 60 minutes). Dosing (adults): Arrhythmias: Oral: Initial: 200 mg every 8 hours with food (may load with 400 mg if necessary); adjust dose every 2-3 days; usual dose: 200-300 mg every 8 hours; maximum: 1.2 g/day (some patients respond to every 12-hour dosing). The systemic availability of oral amiodarone in healthy subjects ranges between 33% and 65%. Amiodarone injection is used to treat life-threatening heart rhythm problems called ventricular arrhythmias. Our study suggests following conversion to normal sinus rhythm; cardiothoracic surgery patients can effectively and safely be transitioned from IV to oral amiodarone without the need for specific overlap duration or transition strategy. If patient is < 60kg give 0.01 mg/kg over 10 minutes. Although significant beta-blockade occurs at oral doses as low as 25 mg, significant Class III effects are seen only at daily doses of 160 mg and above. After absorption, the drug undergoes extensive enterohepatic circulation. CRCL 40-60 ml/min: Administer 250 mcg twice daily. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. IV to oral transition (infusion duration Patients who received intravenous amiodarone for less than one week should take 800 to 1,600 mg oral amiodarone per day.2 Patients who received intravenous amiodarone for one to three weeks should take 600 to 800 oral amiodarone per day, and patients who received intravenous amiodarone for more than three weeks should take 400 mg oral amiodarone per day. endobj Congestive heart failure can mimic amiodarone pneumonitis and, thus, must be ruled out early in the evaluation. Dosing (adults): Ventricular arrhythmias: Oral: 1200-1800 mg/day in 3 divided doses, up to 2400 mg/day. 800 to 1,600 mg per day in divided doses until a total of 10 g has been given; then 200 to 400 mg per day. The maintenance infusion of up to 0.5 mg/min can be cautiously continued for 2 to 3 weeks regardless of the patient's age, renal function, or Left-ventricular function. % Neonatal Hypo- or Hyperthyroidism Like class I drugs, amiodarone blocks sodium channels at rapid pacing frequencies, and like class II drugs, it exerts a noncompetitive antisympathetic action. The relative efficacy of amiodarone and ICDs in preventing sudden death in patients without coronary disease is under investigation. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material. Repeat history, physical exam, and chest X-ray every 3 to 6 months. This site needs JavaScript to work properly. Prevention of ventricular arrhythmias in patients with ICDs to decrease risk of shocks. }v~/lceM-. WebAmiodarone shows beta blocker-like and calcium channel blocker-like actions on the SA and AV nodes, increases the refractory period via sodium- and potassium-channel effects, and slows intra-cardiac conduction of the cardiac action potential, via sodium-channel effects. Intravenously administered amiodarone causes heart block or bradycardia in 4.9 percent of patients and hypotension in 16 percent.2 If these conditions occur, infusion of the drug should be discontinued, or the rate of infusion should be reduced. IV: by 25% full replacement dose qwk if hyperactivity risk; give PO form on empty stomach, 30-60min before morning meal; IM/IV dose is 50-75% of PO dose [>12 yo, growth/puberty complete] Oral: 0.4 mg, may repeat every 4 to 6 hours. contains polysorbate 80, which is known to leach di-(2-ethylhexyl)phthalate (DEHP) from polyvinylchloride (PVC) (see DOSAGE AND ADMINISTRATION). Age, sex, renal disease, and hepatic disease (cirrhosis) do not have marked effects on the disposition of amiodarone or DEA. Sotalol hydrochloride is a racemic mixture of two isomers, both of which have similar Class III antiarrhythmic effects, while the l-isomer is responsible for virtually all of the beta-blocking activity. FDA-approved for acute termination of A-flutter/A-fib (may be alternative to cardioversion): 1mg IV over 10min. The antisympathetic action and the block of calcium and potassium channels are responsible for the negative dromotropic effects on the sinus node and for the slowing of conduction and prolongation of refractoriness in the atrioventricular (AV) node. One meta-analysis of 13 studies of patients with congestive heart failure or recent myocardial infarction showed a small reduction in total annual mortality, from 12.3 percent to 10.9 percent (absolute risk reduction [ARR], 2.4 percent; number needed to treat [NNT], 42).5 [Evidence level A, meta-analysis] The benefit of amiodarone therapy was more pronounced in the patients who had congestive heart failure, with treatment reducing the annual mortality rate from 24.3 percent to 19.9 percent (ARR, 4.4 percent; NNT, 23). Liver enzyme levels three times higher than normal. 10-15g of amiodarone is required to load a patient. A meta-analysis11 of double-blind trials found the frequency of adult respiratory distress syndrome to be 1 percent annually. Contraindications: V-fibrillation; hypokalemia; WPW syndrome with wide complex. Initial Daily Dose of Oral Cordarone : 800-1600 mg, Duration of Cordarone I.V. infusion over >/= 30 minutes is preferred. PULMONARY TOXICITY: This drug has several potentially fatal toxicities, the most important of which is pulmonary toxicity (hypersensitivity pneumonitis or interstitial/alveolar pneumonitis) that has resulted in clinically manifest disease at rates as high as 10% to 17% in some series of patients with ventricular arrhythmias given doses around 400 mg/day, and as abnormal diffusion capacity without symptoms in a much higher percentage of patients. 1 0 obj Subscribe to Drugs.com newsletters for the latest medication news, new drug approvals, alerts and updates. In the event of breakthrough episodes of VF or hemodynamically unstable VT, Give 150-mg/100 ml D5W over 10 minutes to minimize potential for hypotension. Organophosphate or carbamate poisoning: 2 mg IV, followed by 2 mg every 15 minutes until adequate response (initial doses of up to 6 mg may be used in life-threatening cases).

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