Amiodarone Administration Guidelines

Contraindications and Precautions

The American Heart Association guidelines support amiodarone for refractory VF/pulseless VT after failed defibrillation, CPR, and vasopressor therapy, with a recommended dose of 300 mg IV/IO bolus 3, 4
In patients with baseline heart rates below 60 bpm without life-threatening arrhythmia, IV amiodarone should be used with extreme caution and is relatively contraindicated unless a pacemaker is available or the situation is immediately life-threatening with no safer alternatives 1
Patients already receiving beta-blockers, calcium channel blockers, or digoxin have additive bradycardic effects and require heightened vigilance, with a substantial increase in the risk of severe bradycardia or heart block 1

For life-threatening ventricular arrhythmias in a perfusing patient, the recommended dose is 150 mg over 10 minutes 2
For cardiac arrest VF/pulseless VT, the recommended dose is 300 mg IV/IO bolus, with a possible second 150 mg bolus if the rhythm persists 3, 4

Hypotension occurs in 16% of patients receiving IV amiodarone, so the bolus should be given cautiously in patients with borderline blood pressure, and administering a vasoconstrictor before amiodarone may prevent hypotension 1, 4