amiodarone iv to po calculator
Interactions with warfarin and digoxin are the most clinically important. 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. 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. All of these events should be manageable in the proper clinical setting in most cases. Frendl G, Sodickson AC, Chung MK, et al. Unauthorized use of these marks is strictly prohibited. Renal Dosing: CRCL >60 ml/min: Administer 500 mcg twice daily. Bradycardia and heart block occur in 1 to 3 percent of patients receiving amiodarone.2 Amiodarone-induced proarrhythmia occurs at an annual rate of less than 1 percent.11 Although almost all patients treated with the drug have prolongation of the QT interval, polymorphic ventricular tachycardia (i.e., torsades de pointes) is rare. New-onset atrial fibrillation predicts long-term mortality after coronary artery bypass graft. If side effects become excessive, the dose should be reduced. Stop amiodarone; initiate corticosteroid therapy. Infusion*: <1 week Dose Adjustments. % Neither amiodarone nor DEA is dialyzable. If cardiac arrest is imminent, may give as a bolus. Peak serum concentrations after 15-minute infusions in healthy volunteers range from 5 to 41 mg/L. National Library of Medicine All Rights Reserved. If the starting dose is 500 mcg twice daily, then adjust to 250 mcg twice daily. Eur J Cardiothorac Surg. 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. 2004;4(1)2004Medscape. 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. 2017;52:665672. El-Chami MF, Kilgo P, Thourani V, et al. Its vasodilatory action can decrease cardiac workload and consequently myocardial oxygen consumption. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. Posology. Followed by Slow: 360 mg over the NEXT 6 hours (1 mg/min). The .gov means its official. Consensus follow-up recommendations from the NASPE are summarized in Table 4.4 A form to guide patient monitoring is provided in Figure 1. Amiodarone: I.V. Monitoring: Obtain blood samples at least 4 hrs after IV dose and 6-8hrs after oral dose. Cordarone I.V. Copyright 1993-2021 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. Amiodarone has been associated with toxicity involving the lungs, thyroid gland, liver, eyes, skin, and nerves (Table 2).2,5,11,19 The frequency of most adverse effects is related to the total amiodarone exposure (i.e., dosage and duration of treatment). 1 0 obj (900 mg) to 500 ml D 5 W (conc = 1.8 mg/ml). endobj Despite such measures, bradycardia was progressive and terminal in 1 patient during the controlled trials. If the potassium concentration exceeds 5 mEq/L in the setting of severe digitalis intoxication, therapy with DIGIBIND is indicated. 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. Use of evacuated glass containers for admixing Cordarone I.V. 2.Weight of patient. Postoperative atrial fibrillation following cardiac surgery: a persistent complication. Even in patients at high risk of arrhythmic death, in whom the toxicity of this drug is an acceptable risk, this drug poses major management problems that could be life-threatening in a population at risk of sudden death, so that every effort should be made to utilize alternative agents first. In most of the cases, the method of administration is via peripheral infusion. This site complies with the HONcode standard for trust- worthy health information: verify here. 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. Bradycardia, QT prolongation, GI upset, constipation; rarely, torsades de pointes, 600 to 800 mg per day in divided doses until a total of 10 g has been given (may use higher initial dosage or IV dosing in unstable inpatients); then 200 mg per day, Chest radiograph; pulmonary function tests, including Dlco. Amiodarone has a variable oral bioavailability. WebAdd 3 mL of Cordarone I.V. 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. INDICATIONS AND USAGE MULTAQ is indicated to reduce the risk of cardiovascular hospitalization in patients with paroxysmal or persistent atrial fibrillation (AF) or atrial flutter (AFL), with a recent episode of AF/AFL and associated cardiovascular risk factors (i.e., age >70, hypertension, diabetes, prior cerebrovascular accident, left atrial diameter 50 mm or left ventricular ejection fraction [LVEF] <40%), who are in sinus rhythm or who will be cardioverted. +*59mQau]pR+T7{vN2{pU[9jY0HR{Ui&IljC,7mh-`}pJ1l!:s(tG$IS|-L[UFrYfFqj9'FPaP9*?&L,?uH`Xp2YdCq1X,Q>Rxw:se2Uk;XuHepn dGB$rRE*17wAp_gCw88lg# wBEaz-EBpzxjcTE)a- WIT Provides access to the latest drug monographs submitted to the Food and Drug Administration (FDA). Oral Loading - Half-life elimination: 40-55 days (range: 26-107 days); Pre- and post-treatment with amiodarone may promote successful and sustained cardioversion. Drip preparation: Add 2.5 grams/ 250 ml D5W or NS [Drip rate (ml/hr)= wt(kg) x mcg/min x 0.006 ]. The Society of thoracic Surgeons practice guideline on the prophylaxis and management of atrial fibrillation associated with general thoracic surgery. lxEG@Ff j|h^^xklM&A{r:hY3ES$O~"s\B@CK*c#wOgrPhRML,rAWy\ijC 5t4cJh)#pY stNbS7Y< The use of amiodarone for postoperative atrial fibrillation (AF) is widespread; however, there is a paucity of data on the optimal duration of overlap when transitioning from intravenous (IV) to oral amiodarone. Sotalol does not have partial agonist or membrane stabilizing activity. 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. Add 3 mL of Cordarone I.V. Adjust infusion rate as needed to maintain desired heart rate and/or blood pressure, up to 300 mcg/kg/minute. When the maintenance dose is given IV, the onset and peak will occur earlier, however the duration of action is the same. One of its main effects, with prolonged administration, is to lengthen the cardiac action potential, a class III effect. 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. 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. 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. 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. Supplied: 200 mg, 300 mg tab (sulfate). Duration of Cordarone I.V. Assuming that the plan was not to load the patient, you could simply convert to an equivalent IV dose. Disclaimer. Amiodarone Hydrochloride Injection, 50 mg/mL is supplied in: [Oral bioavailability (tablets): 70 to 80%]. Number of vials needed =[(steady state serum digoxin level (ng/ml) x weight (kg)] / 100. 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. In some patients, inserting a pacemaker is required. 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). Renal Dosing: crcl 10-50 ml/minute: Administer every 6-12 hours. dose. Copyright 2022 Wolters Kluwer Health, Inc. All rights reserved. AF recurrence occurred in 24.5% of patients (n = 45). If patient is < 60kg give 0.01 mg/kg over 10 minutes. > 3 weeks. = Link to Medscape monograph about a drug. Duration of Cordarone I.V. Bradycardia should be treated by slowing the infusion rate or discontinuing amiodarone. Monitoring: Pacerone, Cordarone, Nexterone, Cordarone IV. [900 mg / 500 ml ] [See comments] endobj 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 endobj government site. Please see our, 2010synthroid-levoxyl-levothyroxine-342732. All Rights Reserved. 1.Desired Dose. Decrease dose by 30-50% in hepatic insufficiency. Cordarone IV is a prescription medicine used to treat the symptoms of irregular heart rhythm (Ventricular Arrhythmias). Like class I drugs, amiodarone blocks sodium channels at rapid pacing frequencies, and like class II drugs, it exerts a noncompetitive antisympathetic action. The bioavailability of amiodarone is variable but generally poor, ranging from 22 to 95 percent.1 Absorption is enhanced when the drug is taken with food.2 Amiodarone is highly lipid soluble and is stored in high concentrations in fat and muscle, as well as in the liver, lungs, and skin. 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. Use carton to protect contents from light until used. Time to steady state: 5-7 days (average) ESRD: 15-20 days. 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. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. Maintenance infusion: 540 mg over the REMAINING 18 hours (0.5 mg/min). There has been limited experience in patients receiving intravenous amiodarone for longer than 3 weeks. infusion over >/= 30 minutes is preferred. Hypotension Greenberg JW, Lancaster TS, Schuessler RB, et al. 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. In light of these variabilities, it is very difficult to come up with an exact equivalent dose, but generally most practitioners cut the dose by approximately 50% when converting from PO to IV. DOSE RECOMMENDATIONS -- FIRST 24 HOURS -- Loading infusions. DOSE RECOMMENDATIONS -- FIRST 24 HOURS -- Loading infusions. 4i$h>B/>tJ1g'nS-84]h9L\\: In a meta-analysis of 18 RCTs, amiodarone was similar to other antiarrhythmic drugs in its ability to convert patients to normal sinus rhythm (72.1 percent for amiodarone compared with 71.9 percent for other antiarrhythmic drugs).18 [Evidence level A, meta-analysis] The meta-analysis did not address the effect of antiarrhythmic drugs on mortality and other clinical outcomes. DOSAGE AND ADMINISTRATION The only recommended dosage of MULTAQ is 400 mg twice daily in adults. This has occurred in 2% to 5% of patients in various series, and significant heart block or sinus bradycardia has been seen in 2% to 5%. Would you like email updates of new search results? There is no established relationship between drug concentration and therapeutic response for short-term intravenous use. Repeat history, physical exam, and chest X-ray every 3 to 6 months. 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. Amiodarone is generally considered a class III antiarrhythmic drug, but it possesses electrophysiologic characteristics of all four Vaughan Williams classes. Renal Dosing: CRCL <10 ml/minute: Decrease usual dose by 25% to 50% in severe renal impairment. INFUSION Duration of Cordarone I.V. Once inside the cell, adenosine is rapidly phosphorylated by adenosine kinase to adenosine monophosphate, or deaminated by adenosine deaminase to inosine. Amiodarone therapy is contraindicated in patients with second- or third-degree heart block who do not have a pacemaker. Studies on the use of amiodarone for the primary prevention of sudden death in high-risk patients have had mixed results. The most serious potential adverse effect of amiodarone therapy is pulmonary toxicity, which may result from direct drug-induced phospholipidosis or immune-mediated hypersensitivity.19 The most common clinical presentation is subacute cough and progressive dyspnea, with associated patchy interstitial infiltrates on chest radiographs and reduced diffusing capacity on pulmonary function tests. Do Not Copy, Distribute or otherwise Disseminate without express permission. Mechanisms of Action 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. Stopping the infusion and restarting at a slower rate may help if infusion-related reactions occur. 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: This adverse effect occurs at a rate of 0.6 percent annually.11, Patients with liver toxicity are rarely symptomatic. Alternatively, maint dose= Loading dose x [0.14 x crcl / 500 ] Avoid IM injections-can lead to severe pain (If it must be given by this route, give deep IM followed by massage). concentrations greater than 3 mg/mL in D5W have been associated with a high incidence of peripheral vein phlebitis; however, concentrations of 2.5 mg/mL or less appear to be less irritating. This website also contains material copyrighted by 3rd parties. Available for Android and iOS devices. 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. is about 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: First Rapid: 150 mg Neonatal Hypo- or Hyperthyroidism Amiodarone crosses the placenta and reaches measurable levels in breast milk. Thyroid function test should be performed where appropriate prior to therapy in all patients. Medically reviewed by Drugs.com. Druga PO to IV Considerations Comments Amiodarone (Cordarone) Use an IV dose thats 50% of the PO maintenance Use Alaris LVP with Guardrails and select amIODAROne LOAD - = 60 kg in Critical Care Adult or Coronary Care Unit profile. N-desethylamiodarone (DEA) is the major active metabolite of amiodarone in humans. Before based on a 1:2.5 conversion from IV to PO: = Link to online calculator. The https:// ensures that you are connecting to the %PDF-1.7 INDICATIONS AND USAGE: SOTYLIZE is an antiarrhythmic indicated for: The treatment of life-threatening ventricular arrhythmias. HOW SUPPLIED ---------------------- Infuse over 30 minutes-- must use 0.22 micron filter. Peak serum concentrations after single 5 mg/kg 15-minute intravenous infusions in healthy subjects range between 5 and 41 mg/L. HHS Vulnerability Disclosure, Help The negative chronotropic effect of amiodarone in nodal tissues is similar to the effect of class IV drugs. Because absorption and elimination are variable, maintenance-dose selection is difficult, and it is not unusual to require dosage decrease or discontinuation of treatment. Prevention of ventricular fibrillation: Initial bolus: 0.5 mg/kg; repeat every 5-10 minutes to a total dose of 2 mg/kg. It is used in patients who have already been treated with other medicines that did not work well. Amiodarone: I.V. ---------------------------------------Supplied: Injection, powder for reconstitution: Digibind: 38 mg. ========================= Dilution: Prescribed dose/ 50 ml NS. 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. David McAuley, Pharm.D. Initial Daily Dose of Oral Cordarone : 600-800 mg. 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. Abstract The use of amiodarone for postoperative atrial fibrillation (AF) is widespread; however, there is a paucity of data on the optimal duration of overlap when transitioning from intravenous (IV) to oral amiodarone. The initial infusion rate should not exceed 30 mg/min. Drugs.com provides accurate and independent information on more than 24,000 prescription drugs, over-the-counter medicines and natural products. endobj PMC Dosage modification: c interval should be measured 2-3 hours after the initial dose. 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. Major adverse reactions: proarrhythmic events: VT, PVC's, BC, AV block, torsades de pointes, etc. concentrations greater than 2 mg/ml should be administered via a central venous catheter). Last updated on Sep 13, 2022. MULTAQ should be taken as one tablet with the morning meal and one tablet with the evening meal. The patient is now taking nothing by mouth (NPO), and the physician would like to 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. You've successfully added to your alerts. If intravenous amiodarone is administered during pregnancy, the patient should be apprised of the potential hazard to the fetus. <> May give by bolus injection if cardiac arrest is imminent. Ocular: Ophthalmic examination, including fundoscopy and slit-lamp examination, Respiratory: History, physical exam, chest X-ray, and pulmonary function tests, including diffusion capacity. 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. 10-15g of amiodarone is required to load a patient. If liver enzyme levels are three times higher than normal, amiodarone should be discontinued unless a patient is at high risk for recurrence of life-threatening arrhythmia.2. DIGIBIND binds molecules of digoxin, making them unavailable for binding at their site of action on cells in the body. 2 0 obj Amiodarone is considered to be a class III drug (Vaughan Williams classification), which indicates that it prolongs the QT interval. Hypotension is the most common adverse effect seen with intravenous amiodarone. -----------------------------------Dosage Each vial of Digibind 38 mg or DigiFab 40 mg will bind ~0.5 mg of digoxin or digitoxin. The recommended starting dose of Cordarone I.V. A much less common presentation is adult respiratory distress syndrome. May consider giving 10 vials, observing the patient's response, and following with an additional 10 vials. Any patient who notes changes in visual acuity or peripheral vision should be referred for ophthalmologic evaluation. Alqahtani A. Atrial fibrillation post cardiac surgery trends toward management. The relative efficacy of amiodarone and ICDs in preventing sudden death in patients without coronary disease is under investigation. In patients who also are taking digoxin and warfarin, physicians must pay close attention to digoxin levels and prothrombin time, keeping in mind that the effects of interaction with amiodarone do not peak until seven weeks after the initiation of concomitant therapy. Crcl <10 ml/min: Individualize dose. If the starting dose was 250 mcg twice daily, then adjust to 125 mcg twice daily. 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. (loading dose only): 2 to 2.5 times the IV 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; Supplied: 150 mg, 200 mg, 250 mg capsule. US BOXED WARNINGS (TABLET): These effects may also be seen with IV administration. 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. 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. <> In clinical trials, after 48 hours of continued infusions (125, 500, or 1000 mg/day) plus supplemental (150 mg) infusions (for recurrent arrhythmias), amiodarone mean serum concentrations between 0.7 to 1.4 mg/L were observed (n=260). May be further diluted with normal saline. <> Infusion: 1 to 3 weeks Thyroid toxicity is the most common complication that requires intervention. Hypersensitivity reaction: 0.2-0.5 mg IM, SQ every 20 minutes to 4 hours (maximum single dose: 1 mg). Accessibility Infusion: 1 to 3 weeks Initial Daily Dose of Oral Cordarone : 600-800 mg. The highly variable systemic availability of oral amiodarone may be attributed potentially to large interindividual variability in CYP3A4 activity.
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