Amiodarone

Details About Generic Salt ::  Amiodarone 

Main Medicine Class:: Cardiovascular System   Sub Medicine Class ::  Anti Arrhythmics

4B. ANTI-ARRHYTHMICS in 4. CARDIOVASCULAR SYSTEM
AMIODARONE
BENZOFURAN DERIVATIVE | ANTI-ARRHYTHMIC (CLASS III)
PK: A: Slow & variable D: 66 L/kg (range: 18-148 L/kg), Vd M: Hepatic E: Feces, urine (<1% as unchanged drug)

Indications & Dose: ATRIAL FIBRILLATION Acute IV Adult 125mg/h 24h | CARDIAC ARREST IV/IO Adult Loading dose: Initially 300mg as single dose, If required another 150mg may be consideredSecondary to pulseless ventricular tachycardia/ventricular fibrillation | LIFE-THREATENING VENTRICULAR ARRHYTHMIAS PO Adult Loading dose: 0.8-1.6g/day 1-3 weeks, once adequate response MD 600-800mg/day 1 month, further reduced to 400mg/day | IV Adult Inf: Loading dose: Initially 150mg (15mg/min) followed by 360mg (1mg/min), MD 540 mg (0.5mg/min). After the first 24h, 0.5 mg/min 2-3 wks | PULSELESS VT/VF IV Adult Initially 300mg (IV push), if inadequate add supplemental dose of 150mg Child 5mg/kg (max 300mg/dose) repeat up to a max dose 15 mg/kg/day (for adolescent max dose 2.2g/day) | RECURRENT ATRIAL FIBRILLATION Long-term therapy PO Adult Initially loading dose 10mg/kg/day 2 wks, followed by 300mg daily 4 wks, MD 200mg/day | SUPRAVENTRICULAR ARRHYTHMIAS PO Adult Loading dose: 600-800mg/day 1-4 wks and/or until adequate control is achieved/ adverse effects become prominent, MD 100-400mg/day Child Loading dose: 10-15mg/kg/day 4-14 days, reduced to 5mg/kg/day for several wk | SUPRAVENTRICULAR/VENTRICULAR ARRHYTHMIAS IV/IO Child Loading dose: 5mg/kg (over 20-60 min), administration rate adjusted according to urgency. If no response, additional doses may be infused as needed in 5-mg/kg increments up to a total dosage of 15mg/kg/day | VENTRICULAR ARRHYTHMIAS PO Child Loading dose: 10-15mg/kg/day 4-14 days, reduced to 5mg/kg/day for several wk

Contra: Bradycardia, sino-atrial heart block, severe conduction disturbances/sinus node disease, thyroid dysfunction, iodine sensitivity, severe respiratory failure, circulatory collapse, severe arterial hypotension, CHF/cardiomyopathy, post-cardiac surgery, neonates

Precautions: HF, electrolyte disorders, severe pulmonary/hepatic disease, history of HF, elderly

ADR: Serious: severe bradycardia, sinus arrest, conduction disturbances, severe hypotension, ventricular tachyarrhythmias, torsade de pointes, HF, hypo-or hyperthyroidism, severe pulmonary toxicity, pulmonary fibrosis, interstitial pneumonitis, liver cirrhosis, hepatitis, benign yellowish-brown corneal microdeposits, photosensitivity, anaphylactic shock, hot flushes, benign intracranial HTN, hemolytic/aplastic anemia, peripheral neuropathy, paresthesias, ataxia, tremor, nightmares, Others: headache, sleeplessness, epididymitis, thrombophlebitis, abdominal pain, abnormal salivation, abnormal taste, diarrhea, nausea, sweating, myopathy, vomiting, metallic taste

DDI: Serious Verapamil/Diltiazem increases cardiac depressant effects, Oxygen increases risk of drug-induced postoperative respiratory distress syndrome, Clarithromycin/Azithromycin/Disopyramide/Erythromycin increases risk of QT interval prolongation & torsade de pointes, Quinolones increases risk of torsade de pointes, β-blockers leads to hypotension, bradycardia, ventricular fibrillation & asystole, Lithium leads to hypothyroidism, Haloperidol leads to QT prolongation, Phenytoin/Colestyramine reduces drug level, GA results in bradycardia, myocardial depression, hypotension, decreased cardiac output

Diet:

Monitor: TFT & LFT (before treatment & q6months), PFT, serum K+ levels & chest x-ray before treatment, BP, HR, rhythm throughout therapy, lethargy, edema of hands/feet, weight loss

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