Amiodarone

Aliases: Pacerone, Nextorone, Codarone 

Indications: V-Fib or Pulseless V-Tach(pVT) Cardiac Arrest, Post Resuscitation Care, Wide Complex Tachycardia with a Pulse, & Symptomatic A-fib. 

Contraindications:  Without a pulse: None; With a pulse: bradycardia, second/third degree AV block

Concentrations: 

Nebulization: 50mg/mL

Dosing

Adult:

Indication	Dose	Route	Note
Pulseless VT or VF	300mg (1st dose) 150mg (2nd dose)	IV Push	4 minutes between doses
Wide Complex Tachycardia with a Pulse (VT)	150 mg	IV infusion over 10 minutes	Use a pump when available

Pediatric:

Indication	Dose	Route	Note
Pulseless VT or VF	5 mg/kg (max adult dose)	IV Push	4 minutes between doses

Precautions: Use with caution in patients with known thyroid disease. Consider OLMC discussion. 

Adverse/Side Effects: Vasodilation (usually not associated with decreased cardiac output secondary to the negative inotropic effects), hypotension, bradycardia, AV block, increased QT interval, V-Tach.    

Class: Antiarrhythmic, Primarily Class III but has properties of all the Vaughan Williams classifications  

Mechanism of Action: Prolongs the duration of the action potential and refractory period of all Cardiac fibers. Depresses the Phase 0 slope by causing a sodium blockade. Causes a Beta block as well as a weak calcium channel blockade. Primarily a Potassium-channel blocker (Class III antiarrhythmic) blocks the potassium channels that are responsible for phase 3 repolarization. Blocking these channels slows (delays) repolarization, which leads to an increase in action potential duration and an increase in the effective refractory period (ERP). Relaxes vascular smooth muscle, decreases peripheral vascular resistance, and increases coronary contractility. 

Onset of Action	Peak Effect	Duration of Action
Variable	30 to 45 minutes	Variable