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**Prolongs refractory period in accessory pathways
**Prolongs refractory period in accessory pathways
*Also has class I & II properties
*Also has class I & II properties
==Indications by Condition==
''The following table is automatically generated from disease/condition pages across WikEM.''
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|?Has Indication=Indication
|?Has Dose=Dose
|?Has Context=Context
|?Has Route=Route
|?Has Population=Population
|format=broadtable
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==See Also==
==See Also==

Revisión del 16:42 20 mar 2026

General

  • Type: Antiarrhythmics
  • Dosage Forms: injectable solution, tablet
  • Routes of Administration: IV, PO
  • Common Trade Names: Cordarone, Pacerone, Nexterone

Adult Dosing

V-fib/pulseless V-tach

  • Loading dose = 300mg IV bolus followed by 150mg bolus PRN

Stable wide complex tachycardia (e.g. V-tach) or SVT

  • 150 mg in 100mL D5W over 10min (15 mg/min), followed by 1 mg/min drip over 6hrs (360 mg total)[1]
    • Then 0.5 mg/min drip over next 18 hrs (540 mg total)
    • Oral dosage after IV infusion is 400 -800 mg PO daily

Pediatric Dosing

Special Populations

Indications

  • Ventricular and supraventricular arrhythmias
  • 1st line for pulseless V-tach/V-fib
  • Used for atrial arrhythmias in patients with decreased EF

Contraindications

  • Allergy to class/drug
  • Iodine or shellfish allergy
  • Pregnancy

Adverse Reactions

Amiodarone Adverse Effects

  • Bradycardia
  • Hypotension with older solvent-based formulation. Uncommon with newer aqueous formulation.
  • Prolonged QT
  • Thyrotoxicosis[2]
    • Between 5-20% of patients treated with amiodarone have thyrotoxicosis (higher in areas of iodine deficiency)
  • Iodine-induced hyperthyroidism
    • It is thought that the iodine load may unmask hyperthyroidism in patients with multinodular goiter and subclinical Graves’ disease
  • Drug-induced destructive thyroiditis
    • More commonly, the cytotoxic effects of amiodarone destroy thyroid cells, resulting in a release of preformed hormone.
  • Amiodarone pulmonary toxicity
  • Hyperpigmentation rash
    Amiodarone hyperpigmentation.jpg

Pharmacology

  • Half-life: 58 days
  • Metabolism: Liver extensively
  • Excretion: Bile primarily

Mechanism of Action

  • Class III - Inhibits potassium channels
    • Impairs SA and AV node conduction
    • Decreases automaticity
    • Prolongs refractory period in accessory pathways
  • Also has class I & II properties


Indications by Condition

The following table is automatically generated from disease/condition pages across WikEM.

 IndicationDoseContextRoutePopulation
Atrial fibrillation (main)#Amiodarone Rhythm control (if hypotension or advanced HF) AdultAtrial fibrillation (main)150 mg IV over 10 min, then 1 mg/min x6h, then 0.5 mg/min x18hRhythm control (if hypotension or advanced HF)IV dripAdult
Atrial fibrillation with RVR#Amiodarone Unstable AF; rate/rhythm control when other agents fail AdultAtrial fibrillation with RVR150mg over 10min, up to 6 dosesUnstable AF; rate/rhythm control when other agents failIVAdult
Atrial flutter#Amiodarone Rate control (alternative) AdultAtrial flutter150 mg over 10 minRate control (alternative)IVAdult
Electrical storm#Amiodarone First-line antiarrhythmic AdultElectrical storm150mg IV over 10 min, may repeat x1; then 1mg/min x6hr, then 0.5mg/min x18hrFirst-line antiarrhythmicIVAdult
Junctional tachycardia#Amiodarone First-line antiarrhythmic AdultJunctional tachycardia2mg/kg bolus, then 10-15mcg/kg/min continuous infusion if neededFirst-line antiarrhythmicIVAdult
Polymorphic ventricular tachycardia#Amiodarone Non-torsades PMVT, AMI or LV dysfunction AdultPolymorphic ventricular tachycardia150mg IV over 10min, then 1mg/min x6hr, then 0.5mg/min x18hrNon-torsades PMVT, AMI or LV dysfunctionIVAdult
Polymorphic ventricular tachycardia#Amiodarone Non-torsades PMVT PediatricPolymorphic ventricular tachycardia5mg/kg (max 300mg) IV, may repeat x2Non-torsades PMVTIVPediatric
Pulseless arrest#Amiodarone 1st line antiarrhythmic AdultPulseless arrest300 mg 1st dose, 150 mg repeat1st line antiarrhythmicIVPAdult

See Also

References

  1. Amiodarone. GlobalRPH. http://www.globalrph.com/amiodarone_dilution.htm.
  2. Rosen's 8th Edition