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Pacerone
amiodarone
Black Box Warnings .
Appropriate Use
restrict use to indicated life-threatening arrhythmias due to drug-assoc. toxicity; initiate tx in a clinical setting with available continuous ECG and cardiac resuscitation
Pulmonary Toxicity
hypersensitivity pneumonitis or interstitial/alveolar pneumonitis in 10-17% of pts; abnormal diffusion capacity w/o sx more common; fatal in 10% of pts; obtain baseline chest x-ray and PFTs, incl. diffusion capacity; repeat hx, physical exam, and chest x-ray q3-6mo
Hepatotoxicity
common but usually mild w/ only elev. LFTs; overt hepatic failure can occur w/ few fatal cases; obtain baseline and periodic LFTs; D/C or decr. dose if LFTs >3x normal or is 2x elev. baseline; D/C if liver injury s/sx
Proarrhythmic Effects
arrhythmias worsened, significant heart block, or sinus bradycardia in 2-5% of pts; effects prolonged vs. other antiarrhythmics
Adult Dosing .
Dosage forms: TAB: 100 mg, 200 mg, 400 mg
ventricular arrhythmias, malignant
- [400 mg PO qd]
- Start: load 800-1600 mg PO qd x1-3wk until response, then 400-600 mg PO qd x4wk; Info: divide loading doses >1000 mg/day bid-tid w/ meals; divide maint. doses bid w/ meals if GI intolerance
atrial fibrillation/flutter (off-label)
- [maintenance rate control]
- Dose: 100-200 mg PO qd; Info: give w/ meals if GI intolerance
- [maintenance rhythm control]
- Dose: 200 mg PO qd; Start: 400-800 mg/day PO divided bid-qid x1-4wk; Info: give w/ meals if GI intolerance
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [see below]
- hepatic impairment: consider decr. usual dose
Peds Dosing .
- Dosage forms: TAB: 100 mg, 200 mg, 400 mg
supraventricular arrhythmia (off-label)
- [5-10 mg/kg/dose PO qd]
- Start: load 10-20 mg/kg/dose PO qd x7-10 days
renal dosing
- [no adjustment]
- renal impairment: no adjustment
- HD/PD: no adjustment; no supplement
hepatic dosing
- [not defined]
- hepatic impairment: consider adult hepatic dosing for guidance