Amiodarone dosing in adults by indication

Indications	Route of administration	Loading dose^*	Maintenance dose^*
Atrial arrhythmias
Prevention of recurrent PAF Pharmacologic cardioversion of PAF^¶	Oral	Total loading dose: 6 to 10 grams. Outpatient: Given as 400 to 600 mg orally per day in 2 to 3 divided doses with meals. Inpatient: Given as 400 to 1200 mg orally per day in 2 to 3 divided doses with meals.	100 to 200 mg orally once per day. Use the lower dose for older patients and those with low body mass.
Pretreatment before elective cardioversion or catheter ablation of AF	Oral	Total loading dose: 6 to 10 grams orally over 2 to 6 weeks. Given as 400 to 1200 mg orally per day in 2 to 3 divided doses.	100 to 200 mg orally once per day. Use the lower dose for older patients and those with low body mass.
Restoration and maintenance of NSR in critically ill patients with AF Ventricular rate control in critically ill patients with AF and rapid ventricular response	Intravenous	Total loading dose: 10 grams (1050 mg IV, followed by oral). Given as 150 mg IV bolus over 10 to 30 minutes, followed by continuous IV infusion at 1 mg per minute for 6 hours, then 0.5 mg per minute for 18 hours^Δ. IV infusion (0.5 mg per minute) may be extended past 24 hours if unable to transition to oral therapy.	If amiodarone will be used chronically: 100 to 200 mg orally once per day. Use the lower dose for older patients and those with low body mass.
	Transitioning to oral^◊	Following IV infusion, give 400 to 1200 mg orally per day in 2 to 3 divided doses to complete a total (IV plus oral) loading dose of 10 grams; consider overlapping IV and oral amiodarone for 24 to 48 hours.
Prevention of AF after cardiac surgery	Intravenous or oral	A variety of regimens have been used in clinical trials. Refer to amiodarone drug information.
Ventricular arrhythmias
Prevention of recurrent sustained VT, nonsustained VT, or frequent PVCs Primary and secondary prevention of SCD for those who cannot have or refuse an ICD Prevention of VT in patients with continuous flow LVADs	Oral	Total oral loading dose: 6 to 10 grams. Outpatient: 400 to 600 mg orally per day in 2 to 3 divided doses with meal. Inpatient: 400 to 1200 mg orally per day in 2 to 3 divided doses with meals.	Lowest effective dose (typically 200 mg orally once per day).
Cardiac arrest associated with VF or pulseless VT	Intravenous	300 mg IV or IO rapid bolus with a repeat dose of 150 mg as indicated. Upon return of spontaneous circulation, follow with an infusion of 1 mg per minute for 6 hours and then 0.5 mg per minute for 18 hours^§.
Recurrent or incessant VT in hemodynamically stable patients in a hospital setting	Intravenous	Total loading dose: 10 grams (1050 mg IV, followed by oral). 150 mg IV bolus over 10 minutes, followed by continuous IV infusion at 1 mg per minute for 6 hours, then 0.5 mg per minute for 18 hours^§. IV infusion (0.5 mg per minute) may be extended past 24 hours if unable to transition to oral therapy^*.	If amiodarone is used chronically: Lowest effective dose.
	Transitioning to oral^◊	Following IV infusion 400 to 1200 mg orally per day in 2 to 3 divided doses to complete a total (IV plus oral) loading dose of 10 grams. Consider overlapping IV and oral amiodarone for 24 to 48 hours.	If amiodarone is used chronically: Lowest effective dose.

AF: atrial fibrillation; ICD: implantable cardioverter-defibrillator; IO: intraosseous; IV: intravenous; LV: left ventricular; NSR: normal sinus rhythm; PAF: paroxysmal atrial fibrillation; PVC: premature ventricular complex; SCD: sudden cardiac death; VF: ventricular fibrillation; VT: ventricular tachycardia.

* In patients with chronic liver disease, use the lowest effective oral dose. Adjustment is not required for IV loading doses.

¶ Oral amiodarone is less effective for pharmacologic cardioversion of PAF than for prevention of recurrent PAF.

Δ When administered to critically ill patients with atrial fibrillation and rapid ventricular response, repeated 150 mg boluses can be given over 10 to 30 minutes if needed, but no more than six to eight additional boluses should be administered in any 24-hour period.

◊ For patients who have received an IV amiodarone infusion for >2 weeks, transition to maintenance oral amiodarone dosing.

§ Repeated 150 mg boluses can be given if needed, up to 2.2 grams in the first 24 hours.

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Amiodarone dosing in adults by indication