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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. The site is secure. Because phlebitis may occur, the drug should be given through a central venous line when possible. The recommended starting dose of Cordarone I.V. 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 Dose Adjustments. Although amiodarone use during pregnancy is uncommon, there have been a small number of published reports of congenital goiter/hypothyroidism and hyperthyroidism associated with its oral administration. May repeat x 1 in 10 minutes if needed. (If given IVPush-admin over at least 5 min).PSVT: (For patients not on digoxin): 0.25 to 0.5 mg IV. Thyroid abnormalities have been described in up to 10 percent of patients receiving long-term amiodarone therapy.2 Hyperthyroidism may result from an excess of iodine or acute thyroiditis.20 Hypothyroidism is two to four times more common than hyperthyroidism.2, In hypothyroid patients with a strong clinical indication for amiodarone, the drug may be continued with appropriate thyroid hormone supplementation. Infusion*: <1 week 8600 Rockville Pike 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. (150 mg) to 100 ml D 5 W. Infuse 100 ml over 10 minutes. Initial dose: 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: No adjustment recommended Amiodarone (Cordarone) is a complex antiarrhythmic agent with multiple electrophysiologic effects, unusual pharmacokinetics, and numerous potentially harmful drug interactions and adverse effects. HOW SUPPLIED ---------------------- Prevention of ventricular fibrillation: Initial bolus: 0.5 mg/kg; repeat every 5-10 minutes to a total dose of 2 mg/kg. In most of the cases, the method of administration is via peripheral infusion. These intracellular metabolites of adenosine are not vasoactive. 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. May be administered once a day; twice a day dosing is recommended for total daily doses of 1000 mg or more or in patients who experience gastrointestinal tolerance. Amiodarone (Cordorone) IV to Oral conversion loading and 2.Weight of patient. WebWhen appropriate, monitor and adjust IV dose as necessary. 2010;11:5763. Renal Dosing: crcl 10-50 ml/minute: Administer every 6-12 hours. Add 3 mL of Cordarone I.V. CONTRAINDICATIONS HONcode standard for trust- worthy health, Skeletal Muscle Index And Ovarian Cancer Prognosis: A Meta-Analysis, 7 Natural Remedies for Rheumatoid Arthritis. 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. May follow with 0.125 to 0.25 mg IV q2-6h until 0.75 to 1.5 mg is given over 24hrs. The easiest way to lookup drug information, identify pills, check interactions and set up your own personal medication records. <> [900 mg / 500 ml ] [See comments] CONTRAINDICATIONS There are no known contraindications to the use of DIGIBIND. The primary treatment for pulmonary toxicity is withdrawal of amiodarone and provision of supportive care and, in some cases, corticosteroids. Add 18 mL of Cordarone I.V. Always consult your healthcare provider to ensure the information displayed on this page applies to your personal circumstances. ATRIUM CE Final Gale Watson 3 mL (150 mg) 10 Single-dose vials per carton (NDC 60505-0722-0). This material is provided for educational purposes only and is not intended for medical advice, diagnosis or treatment. 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. WebIV Drip Rate Calculator. and transmitted securely. Renal Dosing: CRCL <10 ml/minute: Decrease usual dose by 25% to 50% in severe renal impairment. 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 Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Click the topic below to receive emails when new articles are available. 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 difficulty of using this drug safely and effectively itself poses a significant risk to patients. In patients receiving oral amiodarone therapy, there may be a delay of two weeks or more before antiarrhythmic effects are noted. If you log out, you will be required to enter your username and password the next time you visit. Amiodarone Dosage Guide + Max Dose, Adjustments 4.Volume of fluid in bag. Grapefruit juice can inhibit amiodarone metabolism and lead to elevated drug levels,3 but the impact of this interaction on the long-term efficacy and toxicity of amiodarone is not known. Peak levels after 150 mg of supplemental infusions in patients with VT/VF range between 7 and 26 mg/L. 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. Cordarone IV WebConventional IV preparation contains polysorbate 80 and benzyl alcohol Newer IV formulation (Nexterone) does not contain polysorbate 80 or benzyl alcohol Conversion to oral 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. Heart Views. So I would first investigate the appropriateness of amiodarone use and its dose, and if indeed no loading approach is appropriate, I would just convert the patient to an equipotent IV dose while he/she is NPO. Malignant Arrhythmia and Cardiac Arrest in the Operating Room. Close monitoring is indicated during the loading phase and surrounding any dose adjustments. Ingestion of more than 10 mg of digoxin in previously healthy adults or 4 mg of digoxin in previously healthy children, or ingestion causing steady-state serum concentrations greater than 10 ng/mL, often results in cardiac arrest. Alqahtani A. Atrial fibrillation post cardiac surgery trends toward management. 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. Copyright 2022 Wolters Kluwer Health, Inc. All rights reserved. Webbetween PO and IV (64% vs. 68%, respectively; p=NS) 223 patients with symptomatic atrial fibrillation on digoxin PO amiodarone 600 mg in3 divided doses vs. IV amiodarone 5mg/kg PO to IV Amiodarone Switch MeSH Intravenously administered amiodarone is being used with increasing frequency in the acute treatment of atrial fibrillation. 2 Patients who received intravenous Mechanism of Action: Sotalol has both beta-adrenoreceptor blocking (Vaughan Williams Class II) and cardiac action potential duration prolongation (Vaughan Williams Class III) antiarrhythmic properties. If the potassium concentration exceeds 5 mEq/L in the setting of severe digitalis intoxication, therapy with DIGIBIND is indicated. Cordarone I.V. based on a 1:2.5 conversion from IV to PO: = Link to online calculator. 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). Amiodarone injection is used to treat life-threatening heart rhythm problems called ventricular arrhythmias. Dosage for toxicity during chronic therapy : for adults, 6 vials (228mg) usually is adequate to reverse most cases of toxicity. This retrospective, observational, single-center study included cardiothoracic surgery patients who were initiated on IV amiodarone for supraventricular arrhythmia and subsequently transitioned to oral amiodarone. is about 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: First Rapid: 150 mg (150 mg) to 100 mL D5W. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP. Applies to the following strengths: 50 mg/mL; 200 mg; 300 mg; 100 mg; 400 mg; 150 mg/150 mL-D0.5%; 900 mg/500 mL-D5%; 450 mg/250 mL-D5%; 150 mg/100 mL-D5%; 360 mg/200 mL-D5%. Intravenous amiodarone is a class III antiarrhythmic agent which has been reported to be safe and most effective in various clinical settings, without an associated increase in mortality rate. Small doses (infants/small children) may be administered using tuberculin syringe. If the starting dose is 500 mcg twice daily, then adjust to 250 mcg twice daily. (900 mg) to 500 ml D 5 W (conc = 1.8 mg/ml). Pacerone, Cordarone (amiodarone) dosing, indications, interactions An official website of the United States government. <>stream F~GMlILIvau88}]nv9W_%o"v2=Wo- hh Adjust infusion rate as needed to maintain desired heart rate and/or blood pressure, up to 300 mcg/kg/minute. The patient is now taking nothing by mouth (NPO), and the physician would like to The rate of the maintenance infusion may be increased to achieve effective arrhythmia suppression. The affinity of DIGIBIND for digitoxin is about 108 to 109 M-1. (loading dose only): 2 to 2.5 times the IV dose. (900 mg) to 500 mL D5W (conc = 1.8 mg/mL). WebAmiodarone 300 mg (6 mL from TWO ampoules) added to 100 mL glucose 5%, administer by IV infusion over 20 minutes. PO to IV Amiodarone Switch-Medscape-Apr22,2004. Factors that increase likelihood of digoxin toxicity: Hypokalemia, hypomagnesaemia, hypothyroidism, renal dysfunction, interacting drugs (eg quinidine, verapamil). 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). Photosensitivity is common in patients receiving amiodarone therapy. Eur J Cardiothorac Surg. You will receive email when new content is published. 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). 1 0 obj Obtain first level within 24 hours of digitalization. %PDF-1.7 Hypersensitivity reaction: 0.2-0.5 mg IM, SQ every 20 minutes to 4 hours (maximum single dose: 1 mg). Renal Dosing: CRCL >60 ml/min: Administer 500 mcg twice daily. Reconstitution: Dissolve each vial with 4 ml sterile water (do not shake). N-desethylamiodarone (DEA) is the major active metabolite of amiodarone in humans. The recommended starting dose 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). If the starting dose was 125 mcg twice daily, then adjust to 125 mcg every day. Atrial fibrillation/flutter (Betapace AF): Crcl >60 ml/min: Administer every 12 hours. The relationship between plasma amiodarone concentrations and effect, as well as the contribution of the metabolite DEA, is not well established.2 Routine monitoring of the amiodarone plasma level is not recommended.4 [Evidence level C, consensus/expert guidelines], Amiodarone is approved for use in the secondary prevention of life-threatening ventricular arrhythmias. IV: One meta-analysis of 13 studies of patients with congestive heart failure or recent myocardial infarction showed a small reduction in total annual mortality, from 12.3 percent to 10.9 percent (absolute risk reduction [ARR], 2.4 percent; number needed to treat [NNT], 42).5 [Evidence level A, meta-analysis] The benefit of amiodarone therapy was more pronounced in the patients who had congestive heart failure, with treatment reducing the annual mortality rate from 24.3 percent to 19.9 percent (ARR, 4.4 percent; NNT, 23). Infusion: 1 to 3 weeks A much less common presentation is adult respiratory distress syndrome. 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. The net effect is to shift the equilibrium away from binding of digoxin to its receptors in the body, thereby reversing its effects. Amiodarone Loading Dose Regimen 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%. Last updated on Sep 13, 2022. [Loading: 10 to 15 mcg/kg IBW in divided doses (q4-8h) over 12-24hrs.] 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. 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. Emergency Followed by Slow: 360 mg over the NEXT 6 hours (1 mg/min). Postoperative atrial fibrillation following cardiac surgery: a persistent complication. When the maintenance dose is given IV, the onset and peak will occur earlier, however the duration of action is the same. This dose can be used in patients in acute distress or when a serum concentration is not available. (150 mg) to 100 mL D5W (concentration = 1.5 mg/mL). Obtain a baseline chest X-ray and pulmonary-function tests, including diffusion capacity, when treatment with this drug is initiated. (Glass bottle or polyolefin container) ( 267 mg of quinidine gluconate = 275 mg of quinidine polygalacturonate = 200 mg of quinidine sulfate. The elimination half-life of amiodarone is highly variable and unusually long, averaging about 58 days. Use of evacuated glass containers for admixing Cordarone I.V. 2017;52:665672. 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. 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. Assuming that the plan was not to load the patient, you could simply convert to an equivalent IV dose. Reconstitution/preparation techniques: The manufacturer product information should be consulted. DOSAGE AND ADMINISTRATION The only recommended dosage of MULTAQ is 400 mg twice daily in adults. Adverse reactions: dose related hypotension; ventricular arrhythmias; heart failure. 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. Followed by Slow: 360 mg over the NEXT 6 hours (1 mg/min). Any report from the patient of worsening dyspnea or cough should elicit a prompt assessment for pulmonary toxicity. Monitoring: Obtain blood samples at least 4 hrs after IV dose and 6-8hrs after oral dose. Mechanism of Action Adenosine is a potent vasodilator in most vascular beds, except in renal afferent arterioles and hepatic veins where it produces vasoconstriction. Cordarone I.V is not intended for maint therapy. Cordarone IV (Amiodarone Intravenous): Uses, Dosage, Side WebLowest effective dose, ideally 200 mg or less orally once per day or in divided doses. RECOMMENDATIONS FOR ORAL DOSAGE AFTER I.V. Amiodarone and DEA cross the placenta and both appear in breast milk. Studies on the use of amiodarone for the primary prevention of sudden death in high-risk patients have had mixed results. HEPATOTOXICITY: Liver injury is common with this drug, but is usually mild and evidenced only by abnormal liver enzymes. Consider stopping amiodarone; causal relationship is uncertain. endobj 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; Approved for acute termination. WebUse oral administration wherever possible. Amiodarone: I.V. Add 18 ml of Cordarone I.V. The initial infusion rate should not exceed 30 mg/min. concentrations should not exceed 2 mg/mL unless a central venous catheter is used. PMC Oral: 250-500 mg/dose every 3-6 hours or 500 mg to 1 g every 6 hours extended release; usual dose: 50 mg/kg/24 hours; maximum: 4 g/24 hours. A patient started on oral (PO) amiodarone approximately 1 week ago (400 mg/day). Renal Dosing Ventricular arrhythmias (Betapace): Crcl >60 ml/min: Administer every 12 hours. 324 mg extended release tab (gluconate). Copyright 2023 American Academy of Family Physicians. 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. dose. WebA client is receiving an IV solution of sodium chloride 0.9% (Normal Saline) 250 ml with amiodarone (Cordarone) 1 gram at 17 ml/hour. Druga PO to IV Considerations Comments Amiodarone (Cordarone) Use an IV dose thats 50% of the PO maintenance WARNINGS WebThere were no significant differences in amiodarone dosing, electrolyte abnormalities, volume status or concomitant cardiac medications at the time of IV to PO transition. WebLidocaine is rarely indicated in cats, because clinically significant or life-threatening ventricular arrhythmias are rare in this species. Accessibility 2014;148:e15393. The recommended starting dose of Cordarone I.V. DOSE RECOMMENDATIONS -- FIRST 24 HOURS -- Loading infusions. Instruct patients to avoid sun exposure and use sun-barrier creams or protective clothing. Before This website also contains material copyrighted by 3rd parties. 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. Organophosphate or carbamate poisoning: 2 mg IV, followed by 2 mg every 15 minutes until adequate response (initial doses of up to 6 mg may be used in life-threatening cases). Amiodarone Hydrochloride 50 mg/ml Concentrate INFUSION Duration of Cordarone I.V. Its vasodilatory action can decrease cardiac workload and consequently myocardial oxygen consumption. One of its main effects, with prolonged administration, is to lengthen the cardiac action potential, a class III effect. Thyroid function test should be performed where appropriate prior to therapy in all patients. Neonatal Hypo- or Hyperthyroidism Various practice guidelines recommend amiodarone as a second-line drug in the long-term treatment of atrial fibrillation in patients with structural heart disease and in highly symptomatic patients without heart disease.10 Several smaller studies have shown that amiodarone is similar to quinidine and sotalol in the treatment of atrial fibrillation in these patients.11,12 In one randomized controlled trial (RCT),12 sinus rhythm was maintained successfully for 16 months in 65 percent of patients treated with amiodarone, compared with 37 percent of patients treated with sotalol or propafenone (ARR, 28 percent; NNT, 3.6). In patients with extended and recurrent sun exposure, bluish skin discoloration may develop in exposed areas. CLINICAL PHARMACOLOGY After intravenous injection of Digoxin Immune Fab (Ovine) in the baboon, digoxin-specific Fab fragments are excreted in the urine with a biological half-life of about 9 to 13 hours.1 In humans with normal renal function, the half-life appears to be 15 to 20 hours.2 Experimental studies in animals indicate that these antibody fragments have a large volume of distribution in the extracellular space, unlike whole antibody which distributes in a space only about twice the plasma volume.1 Ordinarily, following administration of DIGIBIND, improvement in signs and symptoms of digitalis intoxication begins within one-half hour or less.2,3,4,5. 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. Number of vials needed =[(steady state serum digoxin level (ng/ml) x weight (kg)] / 100. Administer thyroid hormone supplementation. Supplied: 50 mg, 100 mg, 150 mg tablet. <>stream Pharmacokinetics and Metabolism infusion: 140 mcg/kg/minute for 6 minutes using syringe or columetric infusion pump; total dose: 0.84 mg/kg. Once inside the cell, adenosine is rapidly phosphorylated by adenosine kinase to adenosine monophosphate, or deaminated by adenosine deaminase to inosine. A loading regimen (i.e., use of a relatively high dosage at the beginning of therapy) can shorten the delay. 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. The antisympathetic action and the block of calcium and potassium channels are responsible for the negative dromotropic effects on the sinus node and for the slowing of conduction and prolongation of refractoriness in the atrioventricular (AV) node. UpToDate Medically reviewed by Drugs.com. 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. Amiodarone exhibits complex disposition characteristics after intravenous administration. Note: Decrease dose in patients with CHF, elderly, hepatic disease. Monitor BUN and serum creatinine q2days (qd if unstable). Intravenous to Oral Transition of Amiodarone (IOTA): Effect of All Rights Reserved. The authors report no conflicts of interest. 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. Digoxin is considered to be a 3rd line drug in stable patients who fail to respond to adenosine/verapamil/esmolol. 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. endstream See table. A meta-analysis11 of double-blind trials found the frequency of adult respiratory distress syndrome to be 1 percent annually. When long-term amiodarone therapy is used, potential drug toxicity and interactions must be considered. Amiodarone may subsequently be continued until the patient has recovered from their critical illness (e.g., for 1-2 weeks). Infusion: whenever possible administer through a central venous catheter. A local search option of this data can be found here. 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. The time at which a previously controlled life-threatening arrhythmia will recur after discontinuation or dose adjustment is unpredictable, ranging from weeks to months. Hypotension (refractory to dopamine/dobutamine): Initial (continuous infusion): 1 mcg/minute (range: 1-10 mcg/minute); titrate to desired effect; severe cardiac dysfunction may require doses >10 mcg/minute (up to 0.1 mcg/kg/minute). 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. Infuse 100 mL over 10 minutes. Amiodarone Onset of the antiarrhythmic effect of intravenous amiodarone occurs in less than 30 minutes.15, In the Advanced Cardiac Life Support (ACLS) guidelines published in 2000, amiodarone and procainamide are recommended for the initial treatment of hemodynamically stable wide-complex tachycardia.16 However, these guidelines list amiodarone as being only possibly effective for the treatment of refractory pulseless ventricular tachycardia or ventricular fibrillation. Supplied: Adenocard: 3 mg/ml (2 ml, 4 ml) Adenoscan: 3 mg/ml (20 ml, 30 ml). If side effects become excessive, the dose should be reduced. Time to steady state: 5-7 days (average) ESRD: 15-20 days. metoprolol, propranolol, atenolol, diltiazem, amiodarone, lidocaine, bisoprolol, verapamil, flecainide, Tenormin. Thyroid toxicity is the most common complication that requires intervention. 2010;55:13701376. > 3 weeks. 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. 5 0 obj Hepatic impairment: Reduce dose by 50%. Anti-Arrhythmics - GlobalRPH IV to oral transition (infusion duration Despite such measures, bradycardia was progressive and terminal in 1 patient during the controlled trials. May repeat x 1. 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.) Sotalol does not have partial agonist or membrane stabilizing activity. 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). Conversion from oral to IV: Decrease IV dose by 20 to 25%. 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. Cordarone IV may be used alone or with other Federal government websites often end in .gov or .mil. amiodarone: Dosing, contraindications, side effects, and pill (anephric: 4-6 days). of vials = level (ng/mL) x body weight (kg) divided by 100, Digitoxin: No. Any patient who notes changes in visual acuity or peripheral vision should be referred for ophthalmologic evaluation. For chronic toxicity: 6 vials; for infants and small children 3 weeks: 400mg po qd initially. Crcl 10-30 ml/min: Administer every 36-48 hours. endobj All Rights Reserved. The rate of the maintenance infusion may be increased to achieve effective arrhythmia suppression. FATAL TOXICITY: This drug is intended for use only in patients with the indicated life-threatening arrhythmias because its use is accompanied by substantial toxicity. Cordarone I.V. May give by bolus injection if cardiac arrest is imminent. A causal relationship is not well established. The dosage in cats is 0.10.4 mg/kg, IV bolus over ~1 min, then increase to a total dose of 0.251 mg/kg, IV slowly, if no response.