*Assuming a 720 mg/day infusion (0.5 mg/min). Any report from the patient of worsening dyspnea or cough should elicit a prompt assessment for pulmonary toxicity. Treatment with Class I or III antiarrhythmics (e.g., amiodarone, flecainide, propafenone, quinidine, disopyramide, dofetilide, sotalol) or drugs that are strong inhibitors of CYP3A (e.g., ketoconazole) must be stopped before starting MULTAQ, HOW SUPPLIED MULTAQ 400-mg tablets are provided as white film-coated tablets for oral administration, oblong-shaped, engraved with a double wave marking on one side and "4142" code on the other side in:Bottles of 60 tablets, NDC 0024-4142-60 Bottles of 180 tablets, NDC 0024-4142-18 Bottles of 500 tablets NDC 0024-4142-50 Box of 10 blisters (10 tablets per blister) NDC 0024-4142-10. Cordarone IV may be used alone or with other A causal relationship is not well established. 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: Amiodarone is an iodinated benzofuran derivative that was synthesized and tested as an antianginal agent in the 1960s but was later discovered to have antiarrhythmic Maintenance dose: Digoxin clearance= [CRCL + 40] x 1.44 (add 20 instead of 40 if pt has CHF). A steady state will be achieved after five cycles of the drug half-life (T1/2), which is approximately 7 to 10 days in the average subject. If neither amount ingested nor drug level are known, dose empirically as follows: For acute toxicity: 20 vials, administered in 2 divided doses to decrease the possibility of a febrile reaction, and to avoid fluid overload in small children. Intravenously administered amiodarone is effective for the emergency treatment of ventricular tachyarrhythmias. Attempts to substitute other antiarrhythmic agents when this drug must be stopped will be made difficult by the gradually, but unpredictably, changing body burden of this drug. 8600 Rockville Pike Routine screening for adult respiratory distress syndrome is of limited value, because pulmonary toxicity can develop rapidly with no antecedent abnormalities on chest radiographs or pulmonary function tests. ---------------------------------------Supplied: Injection, powder for reconstitution: Digibind: 38 mg. ========================= Dilution: Prescribed dose/ 50 ml NS. See table. Major adverse reactions: proarrhythmic events: VT, PVC's, BC, AV block, torsades de pointes, etc. 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). infusion over >/= 30 minutes is preferred. Dosage modification: c interval should be measured 2-3 hours after the initial dose. The systemic availability of oral amiodarone in healthy subjects ranges between 33% and 65%. If side effects become excessive, the dose should be reduced. Use carton to protect contents from light until used. MeSH May consider giving 10 vials, observing the patient's response, and following with an additional 10 vials. Data sources include IBM Watson Micromedex (updated 1 May 2023), Cerner Multum (updated 17 Apr 2023), ASHP (updated 10 Apr 2023) and others. Initiate this drug in a clinical setting where continuous ECGs and cardiac resuscitation are available. WebA = Airway - Assess for airway obstruction, assess for breathing, perform intubation B = Breathing - Ventilate with 100% oxygen, 10-24 breaths/minute C = Circulation - Assess for heart beat and pulses if absent, begin chest compressions, 100-120 compressions/minute Begin ADVANCED life support Obtain Electrocardiogram and Determine Arrest Rhythm Last updated on Sep 13, 2022. Slow digoxin loading Slow oral digitalization, generally preferred for most patients, can be achieved by starting a maintenance dose of 0.125 to 0.25 mg daily. High-resolution computed tomographic scanning can be helpful in making a diagnosis. From in vitro studies, the protein binding of amiodarone is >96%. 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. When long-term amiodarone therapy is used, potential drug toxicity and interactions must be considered. Such patients should not be given dronedarone. <> 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. Many factors (ie, age, weight, sex, other comorbid conditions, indication for amiodarone use [atrial vs ventricular arrhythmias as well as treatment vs prophylaxis for an arrhythmia], and history of prior antiarrhythmic use) need to be considered to weigh risk vs benefit of amiodarone use as well as a decision to load or not to load. 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. The beta-blocking effect of sotalol is non-cardioselective, half maximal at an oral dose of about 80 mg/day and maximal at doses between 320 and 640 mg/day. Once inside the cell, adenosine is rapidly phosphorylated by adenosine kinase to adenosine monophosphate, or deaminated by adenosine deaminase to inosine. Supplied: 250 mg, 500 mg capsule. The maintenance of normal sinus rhythm in patients with highly symptomatic atrial fibrillation/flutter (AFIB/AFL)HOW SUPPLIED: 5 mg/mL oral solution, Renal Dosing: Crcl <30 ml/min: Administer 50% of normal dose or 600 mg once daily. Corneal microdeposits are visible on slit-lamp examination in nearly all patients treated with amiodarone.19 These deposits seldom affect vision and rarely necessitate discontinuation of the drug. Add 3 mL of Cordarone I.V. Peak concentrations after 10-minute infusions of 150 mg intravenous amiodarone in patients with ventricular fibrillation (VF) or hemodynamically unstable ventricular tachycardia (VT) range between 7 and 26 mg/L. If progressive hepatic injury or hepatomegaly occurs or hepatic enzyme levels increase to greater than 3 times normal (or double in a patient with elevated baseline levels): Consider dose reduction or discontinuation. How long does it take for oral amiodarone to work? Peak levels after 150 mg of supplemental infusions in patients with VT/VF range between 7 and 26 mg/L. The drug prevents the recurrence of life-threatening ventricular arrhythmias and produces a modest reduction of sudden deaths in high-risk patients. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. HONcode standard for trust- worthy health, Skeletal Muscle Index And Ovarian Cancer Prognosis: A Meta-Analysis, 7 Natural Remedies for Rheumatoid Arthritis. ). endobj and transmitted securely. Monitoring: Pacerone, Cordarone, Nexterone, Cordarone IV. Obtain baseline and periodic liver transaminases and discontinue or reduce dose if the increase exceeds three times normal, or doubles in a patient with an elevated baseline. 2010;55:13701376. Copyright 2023 American Academy of Family Physicians. Approved for acute termination. Do Not Copy, Distribute or otherwise Disseminate without express permission. -----------------------------------Dosage Each vial of Digibind 38 mg or DigiFab 40 mg will bind ~0.5 mg of digoxin or digitoxin. Amiodarone and DEA cross the placenta and both appear in breast milk. 1.Desired Dose. N-desethylamiodarone (DEA) is the major active metabolite of amiodarone in humans. WebAdd 3 mL of Cordarone I.V. The discoloration resolves over several months after amiodarone is discontinued. The recommended starting dose of Cordarone I.V. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. J Am Coll Cardiol. 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). Number of vials needed =[(steady state serum digoxin level (ng/ml) x weight (kg)] / 100. After absorption, the drug undergoes extensive enterohepatic circulation. Although the exact mechanism by which adenosine receptor activation relaxes vascular smooth muscle is not known, there is evidence to support both inhibition of the slow inward calcium current reducing calcium uptake, and activation of adenylate cyclase through A2 receptors in smooth muscle cells. (loading dose only): 2 to 2.5 times the IV dose. concentrations greater than 2 mg/ml should be administered via a central venous catheter). CONTRAINDICATIONS There are no known contraindications to the use of DIGIBIND. Before Maintenance dose should be determined according to antiarrhythmic effect as assessed by patient tolerance as well as symptoms, Holter recordings, and/or programmed electrical stimulation; some patients may require up to 600 mg/day while some can be controlled on lower doses. Half life: 9 minutes. 3.Drug in bag. Prevention of ventricular fibrillation: Initial bolus: 0.5 mg/kg; repeat every 5-10 minutes to a total dose of 2 mg/kg. Adverse reactions: Severe hypotension; bradycardia; ventricular standstill in digitalized patients; asystole; respiratory failure. Hypotension A patient started on oral (PO) amiodarone approximately 1 week ago (400 mg/day). = Link to Medscape monograph about a drug. Onset of action: 2-10 minutes. Obtain first level within 24 hours of digitalization. Supplied: 225 mg, 325 mg, 425 mg extended release cap. CRCL 40-60 ml/min: Administer 250 mcg twice daily. All of these events should be manageable in the proper clinical setting in most cases. Intraoperative tachycardia and/or hypertension (immediate control): Initial bolus: 80 mg IV (~1 mg/kg) over 30 seconds, followed by a 150 mcg/kg/minute infusion, if necessary. IV to oral transition (infusion duration [assuming 0.5 mg/min infusion]: initial oral daily dose). 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). This can be followed by a CRI (1020 mcg/kg/min). Amiodarone is an iodine-containing compound with some structural similarity to thyroxine. Followed by Slow: 360 mg over the NEXT 6 hours (1 mg/min). Photosensitivity is common in patients receiving amiodarone therapy. The relative efficacy of amiodarone and ICDs in preventing sudden death in patients without coronary disease is under investigation. 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. Oral Loading - Half-life elimination: 40-55 days (range: 26-107 days); Administration of Cordarone in divided doses with meals is suggested for total daily doses of 1,000 mg or higher, or when gastrointestinal intolerance occurs.) The dosage of amiodarone should be kept at the lowest effective level. WebThere were no significant differences in amiodarone dosing, electrolyte abnormalities, volume status or concomitant cardiac medications at the time of IV to PO transition. Laboratory studies to assess liver and thyroid function should be performed at least every six months. 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. 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). Amiodarone is a potent inhibitor of the hepatic and renal metabolism of several drugs (Table 3).4,2125 Amiodarone inhibits metabolism through several cytochrome P450 pathways, including CYP 2C9 (which metabolizes warfarin [Coumadin]), CYP 2D6 (which metabolizes several beta blockers and narcotics), and CYP 3A4 (which metabolizes cyclosporine [Sandimmune] and calcium channel blockers). This article reviews the pharmacology, indications, adverse effects, and drug interactions of amiodarone, and outlines a strategy for surveillance of patients who are taking this drug. WebLidocaine is rarely indicated in cats, because clinically significant or life-threatening ventricular arrhythmias are rare in this species. (900 mg) to 500 mL D5W (conc = 1.8 mg/mL). Renal Dosing Ventricular arrhythmias (Betapace): Crcl >60 ml/min: Administer every 12 hours. Stop amiodarone; initiate corticosteroid therapy. Patients with a known predisposition to bradycardia or AV block should be treated with intravenous amiodarone in a setting where a temporary pacemaker is available. Advise patients to avoid consumption of grapefruit juice during treatment with this drug. Hypotension should be treated initially by slowing the infusion; additional standard therapy may be needed, including the following: vasopressor drugs, positive inotropic agents, and volume expansion. [900 mg / 500 ml ] [See comments] IV compatibility: The manufacturer product information should be consulted. Please confirm that you would like to log out of Medscape. Each vial contains 38 mg which will bind approximately 0.5 mg of digoxin. How many mL is 300 mg of amiodarone? If the starting dose is 500 mcg twice daily, then adjust to 250 mcg twice daily. An official website of the United States government. All Rights Reserved. Dose Adjustments. Pharmacologic stress agent (Adenoscan): Continuous I.V. Congestive heart failure can mimic amiodarone pneumonitis and, thus, must be ruled out early in the evaluation. 2010;11:5763. Bronchospasm: 0.1-0.5 mg IM, SQ (1:1000): every 10-15 minutes to 4 hours. Pharmacokinetics Half-life: 38-48 hrs. If side effects become excessive, the dose should be reduced. You must declare any conflicts of interest related to your comments and responses. 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). (Enter numeric value only. of vials = level (ng/mL) x body weight (kg) divided by 100, Digitoxin: No. When switching from another antiarrhythmic, initiate a 200 mg dose 6-12 hours after stopping former agents, 3-6 hours after stopping procainamide. 1 0 obj is not recommended as incompatibility with a buffer in the container may cause precipitation. Serum levels: 0.5 to 2.0 ng/ml. In patients with severe left ventricular dysfunction, the pharmacokinetics of amiodarone are not significantly altered but the terminal disposition t1/2 of DEA is prolonged. Posology. 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. Infusion*: <1 week Sotalol does not have partial agonist or membrane stabilizing activity. Supplied: 0.02 mg/ml (10 ml); 0.2 mg/ml (1:5000) (1 ml, 5 ml). WebAmiodarone (Cordarone) 150 mg IV over 10 minutes, then 30 to 60 mg IV per hour; 200 to 400 mg orally every day as a maintenance dose after loading: 43 to 68: 8 to 24 hours: 55 to If the starting dose was 250 mcg twice daily, then adjust to 125 mcg twice daily. F~GMlILIvau88}]nv9W_%o"v2=Wo- hh Frendl G, Sodickson AC, Chung MK, et al. WebAmiodarone IV-Oral conversion and loading Calculation (s) used Determine the appropriate oral loading regime based on the cumulative dose received via the IV route, as follows: - Patients taking amiodarone should not eat grapefruit or drink grapefruit juice because it can inhibit the conversion of amiodarone to an active metabolite. Administration advice: The manufacturer product information should be consulted. > 3 weeks. J Thorac Cardiovasc Surg. Amiodarone injection is contraindicated in patients with known hypersensitivity to any of the components of amiodarone injection, including iodine, or in patients with cardiogenic shock, marked sinus bradycardia, and second- or third-degree AV block unless a functioning pacemaker is available. Web[IV route] Dose: 150 mg IV x1 over 10min, then 1 mg/min IV x6h, then 0.5 mg/min IV x18h [PO route] Dose: 400 mg PO qd; Start: load 800-1600 mg PO qd x1-3wk until response, then After the first 24 hours, the maintenance infusion rate of 0.5 mg/min (720 mg/24 hours) should be continued utilizing a concentration of 1 to 6 mg/ml (Cordarone I.V. In addition, no significant association was found between duration of overlap and rates of bradycardia (OR 1.00, 95% confidence interval (CI) 0.99-1.00, P = 0.08) or hypotension (OR 1.00, 95% CI 0.99-1.00, P = 0.21), which occurred in 35.9% and 47.3% of patients, respectively. Adenosine may also lessen vascular tone by modulating sympathetic neurotransmission. 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). Use of evacuated glass containers for admixing Cordarone I.V. Copyright 2022 Wolters Kluwer Health, Inc. All rights reserved. /QU+(R% $Kh=c6cL`bv!w? Safety outcomes include occurrence of bradycardia or hypotension while on amiodarone. FDA-approved for acute termination of A-flutter/A-fib (may be alternative to cardioversion): 1mg IV over 10min. This drug should be used at the lowest effective dose in order to prevent the occurrence of side effects. WebLowest effective dose, ideally 200 mg or less orally once per day or in divided doses. [720 mg / 500 ml ] [See comments] Dosing (adults): Ventricular arrhythmias: Oral: 1200-1800 mg/day in 3 divided doses, up to 2400 mg/day. Long-Term Use The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgment. If rounding is required, round to the nearest tenth.) The drug's high iodine content likely is a factor in its effects on the thyroid gland. Infusion: >3 weeks Initial Daily Dose of Oral Cordarone : 400 mg *Assuming a 720 mg/day infusion (0.5 mg/min). A meta-analysis11 of double-blind trials found the frequency of adult respiratory distress syndrome to be 1 percent annually. Supplied: 200 mg, 300 mg tab (sulfate). Medically reviewed by Drugs.com. Atrial fibrillation/flutter (Betapace AF): Crcl >60 ml/min: Administer every 12 hours. E.T. Although the U.S. Food and Drug Administration (FDA) has labeled amiodarone only for the treatment of life-threatening ventricular arrhythmias, the drug also is used to treat atrial fibrillation. Hypotension Infusion*: <1 week Initial Daily Dose of Oral Cordarone : 800-1600 mg, Duration of Cordarone I.V. Small doses (infants/small children) may be administered using tuberculin syringe. of vials = digitoxin (ng/mL) x body weight (kg) divided by 1000. 2014;148:e15393. Bradycardia: 0.5 mg I.V every 5 minutes, not to exceed a total of 3 mg or 0.04 mg/kg; may give intratracheal in 1 mg/10 ml dilution only, intratracheal dose should be 2-2.5 times the I.V. Crcl <40 ml/min: Use is contraindicated. 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. INDICATIONS AND USAGE: SOTYLIZE is an antiarrhythmic indicated for: The treatment of life-threatening ventricular arrhythmias. Amiodarone is more effective than sotalol or propafenone in preventing recurrent atrial fibrillation in patients for whom a rhythm-control strategy is chosen. Predicted Css= (Dose) (0.65 to 0.8)/ Digoxin clearance. (150 mg) to 100 ml D 5 W. Infuse 100 ml over 10 minutes. 3 0 obj RECOMMENDATIONS FOR ORAL DOSAGE AFTER I.V. Please enter a Recipient Address and/or check the Send me a copy checkbox. Clinically significant hypotension during infusions was seen most often in the first several hours of treatment and was not dose related, but appeared to be related to the rate of infusion. (an inline 0.22 micron filter should be used). Crcl 40-60 ml/min: Administer every 24 hours. Renal Dosing: CRCL 30-40 ml/minute: 100mg every 8 hours CRCL 15-30 ml/minute: 100mg every 12 hours CRCL <15 ml/minute: 100mg every 24 hours, Supplied: (Norpace): Capsule 100 mg, 150 mg (Norpace CR): Capsule (controlled release) 100 mg, 150 mg. A-fib/Flutter: Dosing (adults):: Usual initial dose: 500 mcg orally twice daily.
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