Implementation

• High Alert: IV vasoactive medications are inherently dangerous; fatalities have occurred from medication errors involving amiodarone. Before administering, have second practitioner check original order, dose calculations and infusion pump settings. Patients should be hospitalized and monitored closely during IV therapy and initiation of oral therapy. IV therapy should be administered only by physicians experienced in treating life-threatening arrhythmias. Do not confuse amiodarone with inamrinone, formerly called amrinone

• Hypokalemia and hypomagnesemia may decrease effectiveness or cause additional arrhythmias; correct before therapy

» Monitor closely when converting from IV to oral therapy, especially in geriatric patients

• PO: May be administered with meals and in divided doses if GI intolerance occurs or if daily dose exceeds 1000 mg

• IV:
Administer via volumetric pump; drop size may be reduced, causing altered dosing with drop counter infusion sets
Administer through an in-line filter
Infusions exceeding 2 hr must be administered in glass or polyolefin bottles to prevent adsorption. However, polyvinyl chloride (PVC) tubing must be used during administration because concentrations and infusion rate recommendations have been based on PVC tubing

• Direct IV:
Diluent: Administer undiluted. May also be diluted in 20–30 ml of D5W or 0.9% NaCl.
Concentration: 50 mg/ml

• Rate:
Administer IV push

• Intermittent Infusion:
Diluent: Dilute 150 mg of amiodarone in 100 ml of D5W. Infusion stable for 2 hr in PVC bag.
Concentration: 1.5 mg/ml

• Rate:
Infuse over 10 min. Do not administer IV push

• Continuous Infusion:
Diluent: Dilute 900 mg (18 ml) of amiodarone in 500 ml of D5W. Infusion stable for 24 hr in glass or polyolefin bottle.
Concentration: Solution above: 1.8 mg/ml. Concentration may range from 1–6 mg/ml (concentrations > 2 mg/ml must be administered via central venous catheter)

• Rate:
Infuse at a rate of 1 mg/min for the first 6 hr, then decrease infusion rate to 0.5 mg/min and continue until oral therapy initiated

• Y-Site Compatibility:

» amikacin

» amphotericin B

» atracurium

» atropine

» bumetanide

» calcium chloride

» calcium gluconate

» caspofungin

» ceftizoxime

» ceftriaxone

» cefuroxime

» ciprofloxacin

» clindamycin

» daptomycin

» dexmedetomidine

» diltiazem

» dobutamine

» dopamine

» doxycycline

» epinephrine

» eptifibatide

» erythromycin lactobionate

» esmolol

» famotidine

» fenoldopam

» fentanyl

» fluconazole

» gentamicin

» granisetron

» insulin

» isoproterenol

» labetalol

» lepirudin

» lidocaine

» linezolid

» lorazepam

» methylprednisolone

» metronidazole

» midazolam

» milrinone

» morphine

» nesiritide

» nitroglycerin

» norepinephrine

» palonosetron

» penicillin G potassium

» phenylephrine

» potassium chloride

» procainamide

» quinupristin/dalfopristin

» rifampin

» tacrolimus

» tirofiban

» tobramycin

» vancomycin

» vasopressin

» vecuronium

» voriconazole

• Y-Site Incompatibility:

» aminophylline

» bivalirudin

» ceftazidime

» digoxin

» ertapenem

» heparin

» imipenem-cilastatin

» levofloxacin

» micafungin

» piperacillin/tazobactam

» potassium phosphates

» sodium bicarbonate

• Additive Incompatibility:

» aminophylline

» heparin

» sodium bicarbonate

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