Amiodarone Injection: Uses, Dosage, Side Effects & Nursing Considerations

 

💉 Introduction:

Amiodarone is a powerful antiarrhythmic medication used to treat and prevent life-threatening ventricular and supraventricular arrhythmias, including ventricular tachycardia (VT) and ventricular fibrillation (VF). Due to its broad-spectrum action on cardiac conduction, it's often part of Advanced Cardiac Life Support (ACLS) protocols.

Amiodarone is especially important in emergencies and for long-term rhythm control. However, its potent nature demands close nursing monitoring and patient education due to serious potential side effects.

💊 Generic Name:

Amiodarone Hydrochloride

💼 Trade Names:

• Cordarone

• Pacerone

• Nexterone

• Aratac (International)

🧪 Class / Action:

• Pharmacologic Class: Class III Antiarrhythmic

• Therapeutic Class: Antidysrhythmic

• Action: Prolongs repolarization by blocking potassium channels, slows conduction through the AV node, and has beta-blocking and calcium channel-blocking activity.

💉 Route / Dosage:

Routes of Administration:

• Intravenous (IV)

• Oral (PO)

IV Dosage (Adults):

• Loading Dose: 150 mg IV over 10 minutes

• Followed by: 1 mg/min for 6 hours, then 0.5 mg/min for 18 hours

• Total max dose: Up to 2.2 g in 24 hours

Oral Dosage (Maintenance):

• 200–400 mg/day in divided doses (based on clinical response)

Always titrate based on patient response, ECG, and toxicity risk.

⚠️ High Alert Medication:

YES ✅
Amiodarone is considered a high-alert medication due to its narrow therapeutic range, risk of organ toxicity, and potential to cause life-threatening arrhythmias if improperly administered.

💡 Indications:

• Ventricular fibrillation (VF)

• Ventricular tachycardia (VT)

• Atrial fibrillation (AF) with rapid ventricular response

• Supraventricular tachycardia (SVT)

• Prevention of recurrent arrhythmias

• Used in ACLS for shock-refractory VF/VT

🔬 Mechanism of Action:

Amiodarone primarily acts as a Class III antiarrhythmic, blocking potassium channels to prolong repolarization and refractory period in myocardial tissue.
Additionally, it:

• Blocks sodium channels (Class I effect)

• Beta-blocker-like activity (Class II)

• Calcium channel-blocking activity (Class IV)
  This multichannel blockade slows the heart rate, stabilizes electrical conduction, and prevents abnormal impulses.

🚫 Contraindications:

• Known hypersensitivity to amiodarone or iodine

• Severe sinus node dysfunction

• 2nd- or 3rd-degree AV block (without pacemaker)

• Bradycardia causing syncope

• Cardiogenic shock

• Thyroid dysfunction (use with caution)

⚠️ Adverse Reactions / Side Effects:

Common Side Effects:

• Bradycardia

• Hypotension

• Nausea

• Photosensitivity

• Blue-gray skin discoloration

• Corneal deposits (visual halos)

Serious Side Effects:

• Pulmonary toxicity (interstitial pneumonitis, fibrosis)

• Liver toxicity (elevated LFTs, hepatitis)

• Thyroid dysfunction (hyper/hypothyroidism)

• QT prolongation → Torsades de Pointes

• Optic neuropathy

• Severe skin reactions (SJS/TEN)

🩺 Nursing Implications:

• Monitor continuous ECG, especially QT interval and bradycardia.

• Check electrolyte levels (K⁺, Mg²⁺) before and during therapy.

• Monitor liver function (LFTs), thyroid levels (TSH, T3, T4), and pulmonary function regularly.

• Administer IV doses via central line to prevent phlebitis or tissue necrosis.

• Use an in-line filter when infusing IV amiodarone.

• Be alert for vision changes, respiratory distress, or worsening arrhythmias.

• Monitor for hypotension during IV loading dose.

• Use sunscreen and advise patient to avoid sun due to photosensitivity risk.

🧑‍⚕️ Patient Education:

• Take oral amiodarone exactly as prescribed—do not stop abruptly.

• Report shortness of breath, persistent cough, vision changes, or weight changes.

• Avoid grapefruit juice (increases drug levels and risk of toxicity).

• Inform patients about routine blood work and lung/eye checks during therapy.

• Educate about photosensitivity: use sunblock and protective clothing.

• Report any yellowing of skin/eyes, dark urine, or fatigue (may signal liver issues).

• Avoid other QT-prolonging drugs without physician approval.

📋 Notes for Nurses:

• Always use a central line for IV infusion lasting longer than 1 hour.

• Use dedicated IV tubing—amiodarone can adhere to plastics.

• In emergency settings (ACLS), push 300 mg IV bolus for pulseless VT/VF.

• Long half-life: up to 58 days—effects and side effects can last weeks.

• Pre-medicate with lidocaine or antiemetics to reduce GI upset with oral forms.

• Cumulative toxicity risk increases with duration of therapy—routine monitoring is essential.

• Document infusion rate, cardiac rhythm, vital signs, and adverse events.

📌 Summary Table:

Feature	Description
Generic Name	Amiodarone Hydrochloride
Trade Names	Cordarone, Pacerone, Nexterone
Class	Class III Antiarrhythmic
Routes	IV, Oral
High Alert	Yes
Indications	VT, VF, AFib, SVT
Mechanism	Potassium channel blocker with multi-class effects
Side Effects	Bradycardia, pulmonary/liver toxicity, thyroid imbalance
Contraindications	AV block, iodine allergy, bradycardia
Nursing Implications	Monitor ECG, electrolytes, LFTs, PFTs, thyroid function
Patient Education	No grapefruit, photosensitivity precautions, routine tests