Amiodarone Therapy Guidelines

Indications and Administration

• The American Heart Association recommends amiodarone bolus for life-threatening ventricular arrhythmias (VF/pulseless VT) unresponsive to defibrillation and vasopressor therapy, as well as hemodynamically unstable ventricular tachycardia requiring immediate treatment 1, 2
• The American College of Cardiology suggests administering 300 mg IV bolus when rhythm remains refractory to CPR, defibrillation, and epinephrine in cardiac arrest with VF/pulseless VT 2
• The European Society of Cardiology indicates the use of amiodarone when immediate rhythm control is needed for hemodynamically unstable ventricular tachycardia 3

Dosage and Administration

• The American Heart Association recommends an initial bolus of 300 mg IV/IO over 10 minutes for life-threatening arrhythmias (VF/pulseless VT) 1, 2
• A second bolus of 150 mg IV/IO may be given if VF/pulseless VT persists 2
• The European Society of Cardiology suggests a loading dose of 150 mg IV bolus over 10 minutes for hemodynamically stable ventricular arrhythmias 1

Oral Loading Dose Administration

• The American Heart Association recommends an oral loading dose of 800-1,600 mg/day in divided doses for ventricular arrhythmias 1, 4
• The maintenance dose should be 200-400 mg/day after a total of 10 grams has been administered 1, 4

Transitioning from IV to Oral

• The American College of Cardiology suggests monitoring for breakthrough arrhythmias in the first 6 hours after IV discontinuation 4
• Close monitoring of ECG is necessary for QT prolongation, bradycardia, and heart block during the transition 4