Amiodarone Dosing and Administration Guidelines

Initial Treatment and Dosing

For adult patients in ventricular fibrillation unresponsive to CPR and defibrillation, the American Heart Association recommends administering 300 mg IV/IO as a rapid bolus, followed by a second dose of 150 mg IV/IO if VF persists 1
The initial bolus dose should only be given after multiple defibrillation attempts, epinephrine administration, and continued high-quality CPR 1

After successful resuscitation or for hemodynamically stable ventricular arrhythmias, the American Family Physician recommends transitioning to a continuous infusion following the standard loading protocol, which includes a loading infusion of 150 mg over 10 minutes 2
The standard 24-hour infusion regimen includes 1 mg/min (360 mg total) for the first 6 hours, followed by 0.5 mg/min (540 mg total) for the next 18 hours, resulting in a total of approximately 1000 mg in the first 24 hours 2, 3

The American Academy of Pediatrics states that absolute contraindications for amiodarone include second- or third-degree AV block or sick sinus syndrome without pacemaker 4
Relative contraindications include severe sinus node dysfunction and marked sinus bradycardia 4
The American Heart Association recommends continuous ECG monitoring for bradycardia, heart block, QT prolongation, and hypotension, which occurs in approximately 26% of patients 1

The American Heart Association classifies amiodarone as a Class IIb recommendation for shock-refractory VF/pulseless VT, with evidence showing it improves short-term survival to hospital admission compared to placebo or lidocaine 1
Studies demonstrate that amiodarone substantially improves survival and hospital admission rates in patients with shock-resistant, out-of-hospital ventricular fibrillation 2