Recommended concentration: 1-6
mg/ml. Central line is req'd for concentrations > 2 mg/ml.
[Supplied:
3 ml amp (50 mg/ml)].
Infusion: whenever possible administer through a central venous
catheter. Also, an in-line filter should be used during administration.
Cordarone I.V. concentrations greater than 3 mg/mL in D 5 W 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.
Therefore, for infusions longer than 1 hour, Cordarone I.V.
concentrations should not exceed 2 mg/mL unless a central venous
catheter is used. Cordarone I.V. infusions exceeding 2 hours must be
administered in glass or polyolefin bottles containing D5W. Use of
evacuated glass containers for admixing Cordarone I.V. is not
recommended as incompatibility with a buffer in the container may cause
precipitation.
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 D 5 W. Infuse 100 mL over 10 minutes.
Followed by Slow: 360 mg over the
NEXT 6 hours (1 mg/min). Add 18 mL of Cordarone I.V. (900
mg) to 500 mL D 5 W (conc = 1.8 mg/mL).
Maintenance infusion: 540 mg over the
REMAINING 18 hours (0.5 mg/min).
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. concentrations
greater than 2 mg/mL should be administered via a central venous
catheter). 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. The rate of the maintenance
infusion may be increased to achieve effective arrhythmia
suppression. The initial infusion rate should not exceed 30
mg/min. 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. There is limited experience in
patients receiving Cordarone I.V. > 3 weeks.
RECOMMENDATIONS FOR ORAL DOSAGE AFTER
I.V. INFUSION
Duration of Cordarone I.V. Infusion*: <1 week
Initial Daily Dose of Oral Cordarone : 800-1600 mg
Duration of Cordarone I.V. Infusion: 1 to
3 weeks
Initial Daily Dose of Oral Cordarone : 600-800 mg
Duration of Cordarone I.V. Infusion: >3 weeks
Initial Daily Dose of Oral Cordarone : 400 mg
*Assuming a 720 mg/day infusion (0.5 mg/min). Cordarone I.V
is not intended for maint therapy.
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.
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.) If side effects become excessive, the dose should
be reduced.
Loading Dose (Daily): (Ventricular
Arrhythmias) 800 to 1,600 mg x 1-3 weeks, then 600 to 800 mg x ~1
month, then start maintenance of 400mg/day.
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. 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.
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