Class III antiarrhythmic
Preparation: 50 mg/ml (3 ml = 150 mg)
Resuscitation – adults (VF/pVT)
- 300 mg i.v./i.o.[1]after the 3rd shock · 50 mg/ml (3 ml = 150 mg) · = 6 ml
- 150 mg i.v./i.o.[1]after the 5th shock · 50 mg/ml (3 ml = 150 mg) · = 3 ml
What counts is the total number of shocks (persistent or recurrent VF). Three stacked shocks in a witnessed arrest monitored on a cardiac monitor count as one shock.
Resuscitation – children (VF/pVT)
- 5 mg/kg i.v./i.o.[2]max. 300 mg · after the 3rd shock (2nd dose 5 mg/kg, max. 150 mg, after the 5th shock) · 50 mg/ml (3 ml = 150 mg)
AT: the i.v. amiodarone product 50 mg/ml (SmPC as of 12/2021) contains benzyl alcohol (60.6 mg per ampoule) – i.v. contraindicated in preterm and term neonates, infants and children up to 3 y; under 18 y no official dosing recommendation (section 5.1 only gives study doses); another Austrian amiodarone product is available in AT only as tablets. DE: benzyl alcohol contraindication up to 3 y according to the SmPC (e.g. the German SmPC of an amiodarone product; a generic amiodarone product also contains benzyl alcohol); one German SmPC explicitly excludes resuscitation in defibrillation-resistant ventricular fibrillation from this. Check the product. Safety and efficacy in children not established according to the German SmPCs – ERC dose off-label.
| BW | 5 mg/kg i.v./i.o. · 50 mg/ml |
|---|---|
| 3 kg | 15 mg 0.3 ml |
| 5 kg | 25 mg 0.5 ml |
| 10 kg | 50 mg 1 ml |
| 15 kg | 75 mg 1.5 ml |
| 20 kg | 100 mg 2 ml |
| 25 kg | 125 mg 2.5 ml |
| 30 kg | 150 mg 3 ml |
| 40 kg | 200 mg 4 ml |
Contraindications
- None in cardiac arrest.
- Otherwise, among others, sinus bradycardia, higher-degree AV block without pacemaker, thyroid dysfunction, QT prolongation (SmPC).
Notes
- For infusion, dilute only with glucose 5 %.
- Alternative in cardiac arrest if amiodarone is unavailable or locally specified – lidocaine 100 mg, then 50 mg (see Lidocaine).
- Hypotension and bradycardia with rapid administration outside resuscitation.