AMIODARONE HYDROCHLORIDE

Cordarone X

Reviewed by Brenda Hughes, Dr Carl Kuschel, Dr Jon Skinner (Paediatric Cardiology) and Karen Anderson-Hawke (NS-ANP)
June 2005
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Management of Amiodarone Administration

Description

Prescription

Intravenous

Charted on fluid chart giving:

Also charted on drug chart under "continuous infusions" giving:

Oral

Administration

Intravenous

  1. Compatible with glucose 5% only.
  2. Incompatible with heparin saline, (use glucose 5% as flush solution), sodium bicarbonate, and sodium chloride.
  3. The maximum concentration that can be used is 6mg/ml.
  4. Concentrations of amiodarone less than 0.6mg/ml are unstable and should not be used.
  5. Use a Pall 0.2 micron in-line filter.
  6. Administration via a non-DEHB containing infusion set (use leur lock extension set BC563 and BC561) should be considered to reduce the possibility of plasticisers leaching from the infusion bags.
  7. Infusion solutions should be changed after 24 hours.

Oral

  1. Shake well before administration.
  2. Can be administered with milk.

Nursing Considerations

Intravenous

  1. Prior to intravenous administration document: blood pressure, respiratory rate and oxygen saturation level.
  2. Observe the cannula site closely, as sloughing of the skin and necrosis can occur with infiltration and extravasation of amiodarone.
  3. Monitor ECG and pulse oximetry continuously. Perform daily 12-lead ECG (for QTc interval).
  4. If the dose is changed, the patient recordings must be made every 10 minutes for the first ½ hour, then hourly for 2 hours, then 4 hourly.
  5. Diluted solution does not require protection from light.

Storage

References

1 Shann F. Drug Doses. Victoria:Royal Children’s Hospital, 2001.
2 Kemp CA, McDowell JM (eds.). Paediatric Pharmacopoeia (13th ed.). Melbourne: Pharmacy Dept., Royal Children’s Hospital, 2002.
3 Fenster PE et al. Pharmacokinetic evaluation of the digoxin–amiodarone interaction. J Am Coll Cardiol. 1985; 5:108.
4 Nadamanee K etal. Amiodarone-digoxin interaction: clinical significance, time course of development, potential pharmacokinetic mechanisms and therpeutic implications. J Am Coll Cardiol. 1984; 4:111.
5 Trissel LA. Handbook of Injectable Drugs (10th edition). American Society of Hospital Pharmacists;1998:Bethesda.
6 Sweetman S. (Ed.) Martindale: The Extra Pharmacopoeia. (33rd. ed). London : Royal Pharmaceutical Society; 2002.
7 Medicines for Children. Royal College of Paediatrics and Child Health. London: RCPCH Publications Limited,1999.
8 Micromedex Healthcare Series Vol. 118.
9 Amiodarone Data Sheet. Auckland: Baxter Healthcare Ltd, 2001.
10 Amiodarone Protocol. Starship Health Paediatric and Congenital Cardiac Service, 2005 (available via the intranet on ADHB Intranet/Medication Administration Guidelines/Intravenous/Paediatric).