Amiodarone
Cordarone
Multi-channel blocker for oral and intravenous use with properties from classes I–IV. Extensive tissue distribution and a half-life measured in weeks — initiation and discontinuation have consequences for months.
Pulmonary toxicity, hepatotoxicity, and proarrhythmia. Reserve for life-threatening arrhythmias; initiate under monitoring.
Dosing in adults
| Indication | Regimen | Comment |
|---|---|---|
| Ventricular fibrillation / pulseless VT | 300 mg iv as bolus, may be repeated with 150 mg | after 3rd defibrillation |
| Stable ventricular tachycardia | 150 mg iv over 10 min, then 1 mg/min for 6 h | then 0.5 mg/min |
| Pharmacological cardioversion (iv) | 5–7 mg/kg iv over 1–2 h, then 50 mg/h | maximum 1200 mg/24 h |
| Intravenous loading | 300 mg in 250 ml glucose 50 mg/ml over 30–60 min, then 900–1200 mg over 24 h | preferably via a central line |
| Oral loading (per SmPC) | 200 mg × 3 for 1 week, then 200 mg × 2 for 1 week | take with food |
| Oral loading, rapid | 200 mg × 3 for 4 weeks, then 200 mg × 1 | practice regimen beyond the SmPC |
| Maintenance | 200 mg × 1 or lower | review the dose regularly, particularly above 200 mg daily |
No adjustment at any eGFR. Not removed by haemodialysis.
Reduce dose; discontinue if ALT exceeds 3 × baseline.
Orally: loading 10–20 mg/kg/day for 7–10 days, maintenance 5–10 mg/kg/day. Intravenously: loading 5 mg/kg over 20 min to 2 h, maintenance 10–15 mg/kg/day. In cardiac arrest 5 mg/kg as a bolus, maximum 300 mg.
Avoid as first-line treatment for newly diagnosed atrial fibrillation in a young patient without structural heart disease — toxicity is cumulative and lifelong exposure is rarely justified by the rhythm benefit.
Pharmacokinetics
- BIOAVAIL.
- 35–65 % orally
- Vd
- 66 l/kg
- t½
- 40–55 days
- PROTEIN BINDING
- 96 %
- METABOLISM
- CYP3A4, CYP2C8
- EXCRETION
- Biliary / faecal
- INHIBITS
- CYP3A4, 2C9, 2D6, P-gp
- ONSET
- days orally · minutes iv