Amiodarone
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Trade Name
Classification
Class III antiarrhythmic; also has Class I, II, and IV properties
Dosage/Route
- * Dosage:
- – Tablets: 100 mg, 200 mg, 400 mg
- – IV: 50 mg/mL vials
- * Route: Oral (PO), intravenous (IV)
Usual Dosage
- * Ventricular Arrhythmias (PO): Loading: 800-1600 mg/day (divided) for 1-3 weeks; maintenance: 200-400 mg/day
- * IV (Acute): 150 mg IV bolus over 10 min, then 1 mg/min for 6 hours, then 0.5 mg/min for 18 hours; max 2.2 g/day
- * Adjust based on response; taper IV to PO when stable
Mechanism of Action
Prolongs action potential duration and refractory period by blocking potassium channels (Class III). Also inhibits sodium (Class I), beta-adrenergic (Class II), and calcium channels (Class IV), slowing conduction and stabilizing arrhythmias (esp. ventricular tachycardia/fibrillation)
Side Effects & Adverse Effects
- * Side Effects: Nausea, fatigue, tremor, photosensitivity
- * Adverse Effects:
- – Pulmonary toxicity (boxed warning; fibrosis, dyspnea)
- – Hepatotoxicity (elevated LFTs)
- – Thyroid dysfunction (hypo- or hyperthyroidism)
- – Bradycardia, QT prolongation (torsades risk)
- – Corneal deposits, blue-gray skin (long-term)
Nursing Management (Implications & Teachings)
- * Implications:
- – Monitor ECG (QT interval), HR, BP (esp. IV; bradycardia risk)
- – Assess lung sounds (crackles = toxicity), LFTs, thyroid function baseline/periodically
- – IV: Use glass bottle/PVC-free tubing, 0.22-micron filter; central line preferred
- – Check for drug interactions (e.g., warfarin, digoxin—potentiates)
- * Teachings:
- – Take PO with food to reduce GI upset
- – Use sunscreen, protective clothing (photosensitivity)
- – Report shortness of breath, yellow skin, or slow pulse
- – Long-term use needs regular eye/lung/thyroid checks
Indication for This Patient
- * Life-threatening ventricular arrhythmias (e.g., VT, VF) unresponsive to other agents
- * Atrial fibrillation (off-label, rhythm control)
Time
- * Timing: PO: Once or twice daily; IV: Bolus then continuous infusion
- * Onset: PO: Days-weeks; IV: Hours
- * Peak: PO: 3-7 hours; IV: During infusion
- * Duration: Weeks (long half-life ~58 days)
