This site is intended for UK healthcare professionals
Medscape UK Univadis Logo
Medscape UK Univadis Logo

Amiodarone parenteral


Injections of amiodarone

Drugs List

  • amiodarone 150mg/3ml concentrate for solution for injection
  • amiodarone 300mg/10ml injection
  • CORDARONE X 150mg/3ml injection
  • Therapeutic Indications


    Atrial fibrillation
    Atrial flutter
    Nodal tachycardias
    Supra-ventricular tachycardia
    Ventricular fibrillation - recurrent
    Ventricular tachycardia
    Wolff-Parkinson-White syndrome



    Initial dose: 5mg/kg by intravenous infusion over 20 minutes to 2 hours.
    Administer as a dilute solution in 250ml 5% dextrose injection for a 150mg ampoule of amiodarone hydrochloride or 500ml 5% dextrose injection for a 300mg ampoule of amiodarone hydrochloride.
    This may be followed by repeat infusion up to 1.2g (15mg/kg bodyweight) in up to 500ml 5% dextrose injection per 24 hours.
    To prevent local reactions (phlebitis), do not use concentrations exceeding 3mg/ml.

    Direct intravenous injection
    150mg to 300mg in 10 to 20ml 5% dextrose injection over a minimum of 3 minutes, given as a slow intravenous injection in extreme emergency situations (e.g. sustained ventricular tachycardia and supraventricular tachycardia). This should not be repeated for at least 15 minutes.
    Maximum dose: 5mg/kg bodyweight given as a direct injection.

    Cardiopulmonary resuscitation of shock-resistant ventricular fibrillation/pulseless ventricular tachycardia
    300mg (or 5mg/kg body weight) diluted in 20ml 5% dextrose and rapidly injected over at least 3 minutes.
    An additional 150mg (or 2.5mg/kg body weight) IV dose may be given if ventricular fibrillation persists.


    Not licensed for use in children under 3 years

    Loading dose: 5mg/kg bodyweight intravenously over 20 minutes to 2 hours.
    Maintenance dose: 10 to 15mg/kg/day intravenously. If needed, oral therapy may be initiated concurrently.

    The following alternative dosing schedule may be suitable:
    Ventricular fibrillation or pulseless ventricular tachycardia refractory to defibrillation (unlicensed)
    Children aged 1 month to 18 years
    5mg/kg (maximum 300mg) intravenously over at least 3 minutes. The dose may be repeated once if required.

    Supraventricular and ventricular arrhythmias (unlicensed)
    Children aged 1 month to 18 years
    Initial dose: 5mg/kg to 10mg/kg intravenously over 20 minutes to 2 hours.
    Maintenance dose: By continuous infusion, 300micrograms/kg/hour to 1.5mg/kg/hour. Do not exceed 1.2g in 24 hours.


    Formulations containing benzyl alcohol are not recommended in neonates and premature babies under 3 years as they may cause toxic and allergic reactions.

    Ventricular fibrillation or pulseless ventricular tachycardia refractory to defibrillation (unlicensed)
    5mg/kg intravenously over at least 3 minutes. The dose may be repeated once if required.

    Supraventricular and ventricular arrhythmias (unlicensed)
    Initial dose: 5mg/kg intravenously over 30 minutes.
    Maintenance dose: 5mg/kg intravenously over 30 minutes every 12 to 24 hours.

    Additional Dosage Information

    Amiodarone injection is primarily intended for emergency treatment and where a rapid response is required or where oral administration is not possible.

    Changeover from intravenous to oral therapy
    As soon as an adequate response has been obtained, oral therapy should be initiated concurrently at the usual loading dose. Intravenous therapy should then be phased out gradually.


    For intravenous infusion or slow intravenous injection.

    Intravenous infusion is preferred to bolus injection due to the haemodynamic effects sometimes associated with rapid injection. Amiodarone may be used prior to DC conversion.

    Thrombophlebitis can occur if amiodarone is injected regularly or infused for prolonged periods into a peripheral vein. When repeated or continuous infusion is anticipated, administration by a central venous catheter is recommended.

    If a peripheral line is used, it is important to ensure the line is patent to avoid extravasation, either by virtue of successful administration of other drugs by the same line, or, if this administration is the first by the line, prior flushing to ensure the patency of the line.

    Intravenous injections should be given slowly since rapid intravenous administration has been associated with circulatory collapse, anaphylactic shock, hot flushes, sweating and nausea. A moderate and transient reduction in blood pressure may occur.

    When given by infusion, amiodarone reduces the drop size, so counting drops per minute to calculate the rate of infusion will under-dose the patient. If appropriate, adjustments should be made to the rate of infusion. Use of a volumetric infusion pump is recommended to administer amiodarone infusion.


    Hypersensitivity to benzyl alcohol
    Acute porphyria
    Circulatory failure
    Long QT syndrome
    Non-paced severe cardiac conduction defect
    Non-paced sinus node dysfunction
    Severe hypotension
    Severe respiratory impairment
    Sinoatrial exit block
    Sinus bradycardia
    Thyroid dysfunction
    Torsade de pointes

    Precautions and Warnings

    Children under 3 years
    Family history of long QT syndrome
    Family history of thyroid dysfunction
    Cardiac failure
    Electrolyte imbalance
    History of thyroid disorder
    History of torsade de pointes
    Respiratory impairment

    Anaesthetist should be made aware patient is taking this medication
    Correct electrolyte disorders before treatment
    Advise ability to drive/operate machinery may be affected by side effects
    No absolute contraindications for emergency use
    Treatment to be initiated by specialist
    Contains benzyl alcohol
    Consider central venous admin if inflammation of peripheral vein occurs
    Consider chest x-ray prior to initiating therapy
    Monitor hepatic function before and at 6 monthly intervals during treatment
    Monitor serum potassium levels before treatment
    Perform ECG before and during treatment
    Annual ophthalmological examination recommended
    If pulmonary toxicity suspected do chest x-ray, and lung function tests
    Monitor blood pressure and ECG continuously throughout treatment
    Monitor patient for some months after discontinuing treatment
    Monitor respiratory function
    Monitor serum electrolytes
    Monitor thyroid function regularly
    Only use when facilities exist for cardiac monitoring or defibrillation
    Long half life.Drug interactions possible weeks after treatment has stopped
    Predisposition QT prolongation: Counsel patient on symptoms of arrhythmias
    Withdraw if severe bradycardia or idioventricular rhythm occur
    May cause changes to ECG
    Discontinue if 2nd or 3rd degree AV, sinoatrial or bifascicular block occur
    Discontinue if hyperthyroidism occurs
    Discontinue if jaundice or other evidence of hepatic impairment occurs
    Discontinue if pulmonary toxicity occurs
    Maintain treatment at the lowest effective dose
    Advise patient to moderate alcohol intake during treatment
    Advise patient grapefruit products may increase plasma level
    Female: Contraception required during and for 6 months after treatment
    Avoid direct exposure to sunlight

    Intravenous injections should be given slowly since rapid intravenous administration has been associated with circulatory collapse, anaphylactic shock, hot flushes, sweating and nausea. A moderate and transient reduction in blood pressure may occur. Atropine may be required in such patients with bradycardia. Patients with respiratory failure (notably asthmatics) may experience bronchospasm and /or apnoea. Isolated cases of anaphylactic shock have been reported.

    If subsequent oral therapy is considered necessary patients should be carefully supervised as amiodarone may cause delayed serious adverse reactions including damage to the eyes, heart, lungs, liver, thyroid gland, skin and peripheral nervous system.

    Monitoring of thyroid function (ultrasensitive TSH) is recommended before start of treatment in all patients, then six monthly thereafter. Monitoring should be continued for some months after discontinuation of treatment particularly in the elderly.

    Anti-thyroid treatment has been undertaken for the use of severe thyroid hyperactivity, large doses may be required initially. Anti-thyroid therapy may not always be effective and concomitant high dose corticosteroid therapy may be required for several weeks.

    Severe hepatocellular insufficiency may occur within the first 24 hours of IV amiodarone administration and may sometimes be fatal.

    Pulmonary toxicity should be suspected if new or progressive shortness of breath or cough develops in a patient on amiodarone. The onset may be slow but may be rapidly progressive. It has been mostly reported with long term use but a few cases have presented shortly after beginning treatment.

    Pregnancy and Lactation


    Amiodarone is contraindicated during pregnancy, except in exceptional circumstances.

    Amiodarone and its metabolite desethylamiodarone both cross the placenta. Most frequent complications include impaired growth, preterm birth and impaired function of the thyroid gland in newborn babies. Hypothyroidism, bradycardia and prolonged QT intervals were observed in approximately 10% of newborns. Isolated cases of an increased thyroid gland or cardiac murmurs were found.

    Due to the half-life of amiodarone, treatment should be discontinued several months before conception to prevent foetal exposure. Schaefer (2007) suggests that if exposure occurs before 12 weeks gestation (when the foetal thyroid gland begins to function), adverse effects on the foetal thyroid function should be ruled out with an ultrasound scan. Newborns who were exposed in utero should have their thyroid function monitored.

    Hale (2010) concludes it has a high rate of toxicity and should not be given to pregnant mothers unless critically required.

    The use of all medication in pregnancy should be avoided whenever possible; particularly in the first trimester. Non-drug treatments should also be considered. When essential, a medication with the best safety record over time should be chosen, employing the lowest effective dose for the shortest possible time. Polypharmacy should be avoided. Teratogens taken in the pre-embryonic period, often quoted as lasting until 14 to 17 days post-conception, are believed to have an all-or-nothing effect. Where drugs have a short half-life, and when the date of conception is certain, this may allow women to be reassured where drug exposure has occurred within this time frame. Further advice may be available from the UK National Teratology Information Service (NTIS) and through ToxBase, available via password on the internet ( ) or if this is unavailable at the backup site ( ).


    Amiodarone is contraindicated during breastfeeding.

    Amiodarone is excreted into the breast milk in significant quantities.

    The iodine released by amiodarone could have cardiac or thyroid effects. There is one report of neonatal hypothyroidism. Due to the long half life of amiodarone, if amiodarone was discontinued at birth, amiodarone would continue to be excreted for days to weeks. If neonatal hypothyroidism develops, treatment should be promptly initiated. Only use amiodarone in nursing mothers under exceptional circumstances and the infant should be monitored for cardiovascular and thyroid function.

    If the mother develops hypothyroidism her milk supply may be diminished.

    Neonates, infants born prematurely, those with low birth weight, those with an unstable gastrointestinal function or who have serious illnesses may require special consideration. For any infant, if a drug is prescribed to the nursing mother, it should be at the lowest practical dose and for the shortest time. When drug administration is unavoidable and breastfeeding is to continue, minimisation of exposure of the infant to the drug may sometimes be achieved by timing the maternal doses to just after a feeding episode. Infants exposed to drugs via breast milk should be monitored for unusual signs or symptoms. Interactions between the drug received by the infant from the mother's milk and medication prescribed for the infant should also be considered, for example, when the drug given to the infant may prevent metabolism of the drug received via breast milk.
    Specialist advice is available from the UK Drugs in Lactation Advisory Service at

    Side Effects

    Acute hepatic disorders
    Adult respiratory distress syndrome
    Anaphylactic shock
    Aplastic anaemia
    Atrioventricular block
    Back pain
    Benign intracranial hypertension
    Blurred vision
    Bone marrow granuloma
    Bronchiolitis obliterans
    Burning sensation
    Cardiac arrest
    Chronic hepatic disease
    Circulatory collapse
    Conduction disturbances
    Corneal microdeposits (reversible)
    ECG changes
    Exfoliative dermatitis
    Haemolytic anaemia
    Hepatic failure
    Hot flushes
    Hypersensitivity reactions
    Increases in serum transaminases (transient)
    Injection site reactions
    Interstitial pneumonitis
    Local pain (injection site)
    Maculopapular rash
    Optic neuritis
    Optic neuropathy
    Peripheral neuropathy
    Possible alteration of thyroid function tests
    Pro-arrhythmic effects
    Prolongation of QT interval
    Pulmonary alveolitis
    Pulmonary fibrosis
    Pulmonary haemorrhage
    Pulmonary toxicity
    Respiratory failure
    Serum creatinine increased
    Sino-atrial block
    Sinus arrest
    Skin tingling
    Slate-grey skin discolouration
    Sleep disturbances
    Taste disturbances
    Torsades de pointes
    Visual haloes
    Weight changes
    Weight loss


    It is strongly recommended that the UK National Poisons Information Service be consulted on cases of suspected or actual overdose where there is doubt over the degree of risk or about appropriate management.

    The following number will direct the caller to the relevant local centre (0844) 892 0111

    Information may be obtained if you have access to ToxBase the primary clinical toxicology database of the National Poisons Information Service. This is available via password on the internet ( ) or if this is unavailable at the backup site ( ).

    Further Information

    Last Full Review Date: October 2013

    Reference Sources

    Drugs During Pregnancy and Lactation: Treatment Options and Risk Assessment, 2nd edition (2007) ed. Schaefer, C., Peters, P. and Miller, R. Elsevier, London.

    Drugs in Pregnancy and Lactation: A Reference Guide to Fetal and Neonatal Risk, 9th edition (2011) ed. Briggs, G., Freeman, R. and Yaffe, S. Lippincott Williams & Wilkins, Philadelphia.

    Injectable Medicines Administration Guide, 3rd edition (2010) UCL NHS Foundation Trust. Wiley-Blackwell, Oxford.

    Medications and Mothers' Milk, 14th Edition (2010) Hale, T. Hale Publishing, Amarillo, Texas.

    Summary of Product Characteristics: Cordarone X Intravenous. Sanofi. Revised January 2013.

    Summary of Product Characteristics: Amiodarone Injection Minijet 30mg/ml. International Medication Systems (UK) Ltd. Revised October 2012.

    Summary of Product Characteristics: Amiodarone Hydrochloride 50mg/ml. Hameln pharmaceuticals ltd. Revised September 2012.

    NAPOS; The Drug Database for Acute Porphyria.
    Available at:
    Amiodarone Last revised: September 25, 2009.
    Last accessed: October 17, 2013.

    NICE Evidence Services Available at: Last accessed: 06 October 2022

    US National Library of Medicine. Toxicology Data Network. Drugs and Lactation Database (LactMed).
    Available at:
    Amiodarone Last revised: September 7, 2013
    Last accessed: October 17, 2013.

    Access the full UK drug database with a FREE Medscape UK Account
    It takes just a few minutes, and you’ll get unlimited access to information on over 11,000 UK drugs.
    Register for Free

    Already a member? Log in

    Medscape UK | Univadis prescription drug monographs & interactions are based on FDB Multilex Content

    FDB Logo

    FDB Disclaimer : FDB Multilex is intended for the use of healthcare professionals and is provided on the basis that the healthcare professionals will retain FULL and SOLE responsibility for deciding what treatment to prescribe or dispense for any particular patient or circumstance.