Amiodarone

Question 1

Drug Class of Amiodarone

Answer 1

Anti-arrhythmic

Question 2

Presentation of Amiodarone

Answer 2

Ampoule, 150 mg/3 mL amiodarone

Question 3

Schedule of Amiodarone

Answer 3

S4 (Restricted drugs).

Question 4

Pharmacology of Amiodarone

Answer 4

Amiodarone prolongs the duration of the action potential and therefore the refractory period of atrial, nodal and ventricular tissues. It also reduces conduction across all cardiac tissue – including myocardial and conducting system cells. Amiodarone demonstrates electrophysiological properties across all Vaughan-Williams Class groups, which enables a broad spectrum of activity.

Question 5

Metabolism of Amiodarone

Answer 5

The majority of amiodarone is excreted via the liver and GI tract 
 by biliary excretion; there may be some hepatic recirculation.

Question 6

Indications of Amiodarone

Answer 6

• Cardiac arrest (refractory VF OR pulseless VT)

* Sustained conscious VT (haemodynamically stable)

Question 7

Contraindications of Amiodarone

Answer 7

• Cardiac arrest ( refractory VF or pulseless VT ): - Nil
• Sustained conscious VT (haemodynamically stable):
- KSAR or hypersensitivity to amiodarone
- severe conduction disorders (unless pacemaker 
 or AICD in situ)
- current amiodarone therapy
- concurrent anti-arrhythmic therapy that 

prolongs the QT interval
- pregnancy and/or lactation

Question 8

Precautions of Amiodarone

Answer 8

• Cardiac arrest (refractory VF or pulseless VT):
- concurrent anti-arrhythmic therapy that prolongs the QT interval
- thyroid disease
• Sustained conscious VT (haemodynamically stable):
- hypotension
- thyroid disease

Question 9

Side Effects of Amiodarone

Answer 9

• Hypotension
• Bradycardia
• Nausea and/or vomiting
• Peripheral paraesthesia

Question 10

Routes of Administration Amiodarone

Answer 10

Intravenous injection (IV)
Intraosseous injection (IO)
Intravenous infusion (IV INF)

Question 11

Onset time of Amiodarone IV

Answer 11

5 minutes

Question 12

Duration time of Amiodarone IV

Answer 12

30 minutes

Question 13

Half life of Amiodarone

Answer 13

14–110 days
 (with chronic dosing)

Question 14

Special Notes of Amiodarone

Answer 14

• If the patient is on oral amiodarone, the following cardiac arrest administration protocols continue to be authorised.
• If lignocaine 2% has been administered to a patient with conscious VT that progresses into cardiac arrest, the following administration protocols continue to be authorised.
• If the patient is in Torsade de Pointes due to suspected prolonged QT interval from excess amiodarone administration, magnesium sulphate administration is to be considered.
• After completion of a risk/benefit analysis, the QAS authorises the administration of sodium chloride 0.9% (flush or running 
 IV line) following amiodarone administration in cardiac arrest, despite manufacturer’s recommendations.

Question 15

Adult Dose of Amiodarone IV
Cardiac arrest (refractory VF or pulseless VT )

Answer 15

300 mg
Slow push over 2 minutes.

Repeated once at 150 mg after 5 minutes.
Total maximum dose – 450 mg.

Question 16

Adult Dose of Amiodarone IO
Cardiac arrest (refractory VF or pulseless VT )

Answer 16

300 mg
Slow push over 2 minutes.

Repeated once at 150 mg after 5 minutes.
Total maximum dose – 450 mg.

Question 17

Adult Dose of Amiodarone IV INF

Sustained conscious VT (haemodynamically stable)

Answer 17

300 mg
infusion over 30 minutes.
Administer via SPRINGFUSOR® 30 mL.
Single dose only.
Syringe preparation: Mix 300 mg Amiodarone 
 6 mL) with 24 mL of glucose 5% in a 30 mL SPRINGFUSOR® syringe to achieve a final concentration of 300 mg /30 mL. 

Ensure syringes are appropriately labelled. Administer via SPRINGFUSOR® 30 mL at a rate 
 of 60 mL/hour (over 30 minutes).

Question 18

Paediatric Dose of Amiodarone IV
Cardiac arrest (refractory VF or pulseless VT )

Answer 18

5 mg/kg
Slow push over 2 minutes.
Single dose only.
Syringe preparation: Mix 150 mg (3 mL) 
 of amiodarone with 12 mL of glucose 5% 

(totalling 15 mL) in a 20 mL syringe to achieve 
 a final concentration of 10 mg/mL.

Question 19

Paediatric Dose of Amiodarone IO
Cardiac arrest (refractory VF or pulseless VT )

Answer 19

5 mg/kg
Slow push over 2 minutes.
Single dose only.
Syringe preparation: Mix 150 mg (3 mL) 
 of amiodarone with 12 mL of glucose 5% 

(totalling 15 mL) in a 20 mL syringe to achieve 
 a final concentration of 10 mg/mL.