Amiodarone Almus - Pharmacology: Prolongs action potential, duration, and refractory period in myocardial cells; acts as noncompetitive inhibitor of alpha- and beta-adrenergic receptors.
Treatment of life-threatening, recurrent ventricular arrhythmias (ie, ventricular fibrillation and hemodynamically unstable ventricular tachycardia) that do not respond to other antiarrhythmic agents.
Initiation of treatment and prophylaxis of frequently recurring ventricular fibrillation and hemodynamically unstable ventricular tachycardia in patients refractory to other therapy; treatment of ventricular tachycardia and fibrillation when oral Amiodarone Almus is indicated but patient is unable to take oral medication.
Conversion of atrial fibrillation and maintenance of sinus rhythm; supraventricular tachycardia; AV nodal reentry tachycardia.
Used for: Treating life-threatening recurrent heart rhythm disturbances in patients who cannot tolerate or do not respond well to other medicines. It may also be used for other conditions as determined by your doctor.
Amiodarone Almus is an antiarrhythmic. It works by stabilizing the heart rhythm in conditions in which the heart is beating too fast or in an irregular rhythm. It is usually used in situations in which the abnormal heart rhythms, if not treated, could cause death.
Amiodarone Almus belongs to a class of drugs called Vaughan-Williams Class III antiarrhythmic agents. It is used in the treatment of a wide range of cardiac tachyarhthmias, including both ventricular and supraventricular (atrial) arrhythmias. After intravenous administration in man, Amiodarone Almus relaxes vascular smooth muscle, reduces peripheral vascular resistance (afterload), and slightly increases cardiac index. Amiodarone Almus prolongs phase 3 of the cardiac action potential. It has numerous other effects however, including actions that are similar to those of antiarrhythmic classes Ia, II, and IV. Amiodarone Almus shows beta blocker-like and calcium channel blocker-like actions on the SA and AV nodes, increases the refractory period via sodium- and potassium-channel effects, and slows intra-cardiac conduction of the cardiac action potential, via sodium-channel effects.
Amiodarone Almus is used to treat arrhythmia -- a heart disease where the heartbeat is not regular or is too fast. When the heart is not pumping regularly or is pumping too fast, blood cannot be efficiently pumped out of the heart to other parts of the body. Amiodarone Almus slows down the heart rate and helps to make the heartbeat more regular.
Oral Ventricular arrhythmias
Adult: 800-1,600 mg/day in 1-2 divided doses for 1-3 wk until initial therapeutic response is achieved, then reduce dose to 600-800 mg/day in 1-2 divided doses for 1 mth.
Maintenance: 400 mg/day; lower doses may be used for supraventricular arrhythmias. Daily doses may be divided. Close monitoring of the patient is recommended. Use the minimum effective dose. Hepatic impairment: Dosage reduction may be necessary. Intravenous Life-threatening ventricular arrhythmias
Adult: Recommended starting dose: About 1 g over 1st 24 hr. Dose is given in a 3-phase sequence. Initial rapid loading dose: Infuse 150 mg at a rate of 15 mg/minute (initial infusion rate should not exceed 30 mg/minute); followed by the slow loading phase: Infuse 360 mg at a rate of 1 mg/minute; followed by the first maintenance phase: Infuse 540 mg at a rate of 0.5 mg/minute. After the 1st 24 hr, maintain infusion rate at 0.5 mg/minute (i.e. 720 mg over 24 hr); rate may be increased to achieve effective suppression of arrhythmia. For breakthrough episodes, supplemental doses of 150 mg may be given at 15 mg/minute; may repeat supplemental doses up to a max IV dose of 2.2 g/24 hr. Maintenance infusion at up to 0.5 mg/minute may be continued for up to 2-3 wk with caution. Concentrate for inj should be diluted prior to admin. Conversion to oral therapy will depend on the administered dose of the IV therapy and the bioavailability of the oral drug. Hepatic impairment: Dosage reduction may be necessary. Intravenous Pulseless ventricular fibrillation or ventricular tachycardia
Adult: Initial: 300 mg (diluted in 20-30 ml dextrose 5% or normal saline) if VF or VT recurs, to be given as a single dose by rapid IV inj. Supplemental dose: 150 mg followed by an infusion of 1 mg/minute for 6 hr, then 0.5 mg/minute. Max: 2.1 g daily. Hepatic impairment: Dosage reduction may be necessary. Reconstitution: To make solution for 1st rapid loading infusion or supplemental infusion: Add 3 ml of Amiodarone Almus HCl concentrate (50 mg/ml) to 100 ml of dextrose 5% to give a final conc of 1.5 g/ml; for slow infusion: Add 18 ml of Amiodarone Almus HCl concentrate (50 mg/ml) to 500 ml of dextrose 5% to give a final conc of 1.8 mg/ml; for subsequent maintenance infusions, diluted solutions with conc ranging from 1-6 mg/ml may be used. Solutions with conc ≥2 mg/ml should be administered via a central venous catheter. Incompatibility: Y-site incompatibility: Cefamandole, sodium bicarbonate, heparin, aminophylline. Syringe incompatibility: Heparin. Admixture incompatibility (amiodarone conc: 4 mg/ml): Cefazolin sodium, cefamandole, mezlocillin sodium, sodium bicarbonate, heparin sodium, aminophylline.
Indications: Listed in dosage.
Oral Ventricular and supraventricular arrhythmias including those associated with Wolff-Parkinson-White syndrome
Adult: Initially, 200 mg tid for 1 wk decreased to 200 mg bid for a further wk.
Maintenance: Usually 200 mg daily or lowest effective dose.
Elderly: Hepatic impairment: Dosage reduction may be necessary in patients who develop signs of hepatotoxicity during treatment. Intravenous Ventricular and supraventricular arrhythmias including those associated with Wolff-Parkinson-White syndrome
Adult: Initially, 5 mg/kg in 250 ml of 5% glucose, infused over 20-120 minutes with ECG monitoring. To be given via central venous catheter. Max dose: 1.2 g in 24 hr. Hepatic impairment: Dosage reduction may be necessary in patients who develop signs of hepatotoxicity during treatment. Incompatibility: Amiodarone Almus injection is incompatible with aminophylline, flucloxacillin, heparin, sodium bicarbonate and sodium chloride solutions.
Ventricular and supraventricular disorders. Wolf- Parkinson-White syndrome. Angina pectoris.