ClinCalc Pro
Menu
Calculators Drugs Pathways AI Dx Donate Get the App
Antiarrhythmic (Class III) Pregnancy: Avoid — associated with fetal thyroid dysfunction, neonatal hypothyroidism, and neurodevelopmental effects; use only if life-threatening arrhythmia

Amiodarone (IV — ICU/Peri-Arrest)

Brand names: Cordarone

Adult dose

Dose: VF/pVT: 300 mg IV bolus; Haemodynamically stable VT/AF: 150–300 mg over 1 hour then 900 mg over 23 hours
Route: IV
Frequency: Loading then maintenance infusion
Max: 1.2 g/day IV
Drug of choice for shock-resistant VF/pVT (given after 3rd defibrillation per ALS). For stable arrhythmias: 300 mg in 5% glucose over 1 hour via central line (causes phlebitis peripherally). Must use 5% glucose as diluent (not saline — precipitates).

Paediatric dose

Dose: 5 mg/kg
Route: IV
Frequency: Single bolus (VF/pVT)
Max: 300 mg
Paediatric VF/pVT: 5 mg/kg IV bolus (max 300 mg) after 3rd shock per PALS algorithm.

Dose adjustments

Renal

No dose adjustment required.

Hepatic

Caution in hepatic impairment — hepatotoxic potential. Use with caution.

Paediatric weight-based calculator

Paediatric VF/pVT: 5 mg/kg IV bolus (max 300 mg) after 3rd shock per PALS algorithm.

Clinical pearls

  • IV amiodarone MUST be diluted in 5% glucose — precipitates in saline and causes crystallisation in giving set
  • Hypotension with IV loading is mainly due to polysorbate 80 (the solvent) — not the amiodarone itself; aqueous formulation (Nexterone) has less hypotension but not available in all countries
  • ALS 2021: amiodarone 300 mg after 3rd shock in VF/pVT; second dose 150 mg after 5th shock

Contraindications

  • Sinus bradycardia without pacemaker
  • Sino-atrial block
  • Thyroid dysfunction (relative)
  • Iodine allergy (relative — amiodarone contains iodine)

Side effects

  • Hypotension (IV — vasodilation from solvent polysorbate 80)
  • Phlebitis (peripheral IV)
  • QT prolongation
  • Photosensitivity (long-term)
  • Thyroid dysfunction (both hypo- and hyperthyroidism)
  • Pulmonary toxicity (long-term)
  • Corneal microdeposits
  • Hepatotoxicity

Interactions

  • Warfarin (significantly increases INR — check INR within 5 days)
  • Digoxin (increases digoxin levels — halve digoxin dose)
  • Simvastatin (increase myopathy risk — max 20 mg simvastatin)
  • QT-prolonging drugs (additive)
  • Phenytoin (bidirectional interaction)

Monitoring

  • ECG (QT, QRS, rhythm)
  • BP during IV infusion
  • TFTs, LFTs, CXR (long-term use)
  • INR if on warfarin

Reference: BNFc; BNF 90; Resuscitation Council UK ALS 2021; BNFc PALS; MHRA Amiodarone Safety Update. Verify against your local formulary and the latest BNF before prescribing.

Related

Curated clinical cross-links plus same-class fallbacks.

Calculators
Pathways