From the Guidelines
The dosage of amiodarone is 200-400 mg daily for maintenance therapy.
Dosage Information
- The loading dose for amiodarone can range from 800 mg daily for 1 week to 1.2-1.8 g per day in divided doses until 10 g total in the acute setting, followed by a maintenance dose of 200 mg daily 1, 2, 3, 4.
- In the non-acute setting and for chronic maintenance therapy, the dosage of amiodarone can be 200-400 mg daily orally 2, 3, 4.
- For intravenous administration, the loading dose is 150 mg over 10 min, followed by a maintenance dose of 0.5 to 1 mg/min IV 1, 3.
Important Considerations
- Amiodarone can be useful to control the heart rate in patients with atrial fibrillation when other measures are unsuccessful or contraindicated 1, 3, 4.
- The use of low-dose amiodarone (200 mg daily or less) may be effective and associated with fewer side effects than higher-dose regimens 5.
- Amiodarone is associated with a relatively high incidence of potentially severe extracardiac toxic effects, making it a second-line or last-resort agent in many cases 5.
From the FDA Drug Label
DOSAGE & ADMINISTRATION Amiodarone shows considerable interindividual variation in response. Thus, although a starting dose adequate to suppress life-threatening arrhythmias is needed, close monitoring with adjustment of dose as needed is essential The recommended starting dose of amiodarone HCl injection is about 1000 mg over the first 24 hours of therapy, delivered by the following infusion regimen: The maintenance infusion rate of 0. 5 mg/min (720 mg/24 hours) should be continued utilizing a concentration of 1 to 6 mg/mL The rate of the maintenance infusion may be increased to achieve effective arrhythmia suppression. The first 24-hour dose may be individualized for each patient; however, in controlled clinical trials, mean daily doses above 2100 mg were associated with an increased risk of hypotension
The dosage of amiodarone is as follows:
- Starting dose: 1000 mg over the first 24 hours of therapy
- Maintenance infusion rate: 0.5 mg/min (720 mg/24 hours)
- Maximum daily dose: individualized, but mean daily doses above 2100 mg were associated with an increased risk of hypotension 6
From the Research
Dosage of Amiodarone
The dosage of amiodarone varies depending on the condition being treated and the patient's response to the medication.
- For arrhythmias such as supraventricular tachycardia or atrial fibrillation, maintenance doses of amiodarone range from 100 to 400 mg/day 7.
- For suppressing "warning" ventricular arrhythmias in patients with chronic ischemic heart disease, moderate doses of 400 mg/day are effective 7.
- For treatment and prevention of sustained recurrent ventricular tachycardia and malignant arrhythmias, higher doses of about 800 mg/day may be required 7.
- Low-dose amiodarone, defined as a maintenance dose of 200-400 mg/day, has been used for suppression of atrial fibrillation, with success rates of 53-79% in nonrandomized trials 8, 9.
- In older patients with atrial fibrillation, a lower dose of 100 mg daily has been shown to be effective and well-tolerated in 94% of patients 10.
- For pharmacological cardioversion of recent-onset atrial fibrillation, intravenous amiodarone has been used as a bolus or as a bolus followed by a continuous infusion, with doses ranging from 3 to 7 mg/kg body weight and 900 to 3000 mg/day, respectively 11.
- Oral amiodarone has also been used for pharmacological cardioversion, with a single loading-dose of 25-30 mg/kg body weight 11.