Amiodarone (Amiodarone Hydrochloride)
Also sold as: Cordarone, Tachyra, Amiodar
Pregnancy
Cat D
Lactation
Avoid
Schedule
H
Forms
Tablet 100mg +3
Indications
- Life-threatening ventricular fibrillation (VF) — first-line in ACLS
- Hemodynamically unstable ventricular tachycardia (VT)
- Atrial fibrillation — rate and rhythm control
- Atrial flutter
- Supraventricular tachycardias — refractory cases
- Prevention of recurrent VF/VT after resuscitation
Adult Dosing
Cardiac arrest (VF/pulseless VT — ACLS)
300 mg IV bolus
Additional 150mg IV if VF/VT recurs; follow with IV infusion 1mg/min for 6 hours then 0.5mg/min for 18 hours
Give undiluted or in D5W. Subsequent oral loading as below.
Atrial fibrillation (rhythm control/loading)
200 mg three times daily x 4 weeks, then 200 mg twice daily x 4 weeks, then 200 mg once daily (maintenance)
Loading over 8 weeks; maintenance 100–200mg OD (minimum effective dose)
Oral loading required due to long half-life (40–55 days). Effect may not be seen for weeks.
IV (stable VT/AF rate control in ICU)
150 mg IV over 10 minutes, then 1 mg/min infusion for 6 hours, then 0.5 mg/min
Transition to oral as soon as feasible
Max cumulative IV dose: 2.2g/24 hours. Monitor BP closely during IV infusion (causes vasodilation).
Renal Dose Adjustment
| CrCl / eGFR | Dose Adjustment |
|---|---|
| Any degree of renal impairment | No dose adjustment required — primarily hepatic metabolism; dialysis does not remove amiodarone |
Hepatic Adjustment
Use with extreme caution in hepatic impairment — amiodarone itself causes hepatotoxicity. Avoid in severe hepatic disease. Monitor LFTs closely.
Pregnancy & Lactation
Pregnancy: Category D
Crosses placenta; associated with neonatal hypothyroidism, hyperthyroidism, bradycardia, and IUGR. Contains large amount of iodine (37% by weight). Use only for life-threatening arrhythmias when no alternative exists. Monitor neonatal thyroid function.
Lactation: Avoid
Excreted in breast milk in significant amounts. Infant may receive large iodine load — risk of neonatal thyroid dysfunction. Breastfeeding should be discontinued if amiodarone is required.
Top Drug Interactions
| Interacting Drug | Effect | Severity |
|---|---|---|
| Warfarin | Inhibits CYP2C9 — increases warfarin levels dramatically, nearly doubling INR. Reduce warfarin dose by 30–50% when starting amiodarone; monitor INR weekly initially. Effect persists weeks after amiodarone stopped (due to long half-life). | Major |
| Digoxin | Inhibits P-glycoprotein — increases digoxin levels 70–100%. Halve digoxin dose when adding amiodarone; monitor serum digoxin levels. | Major |
| QT-prolonging drugs (sotalol, dofetilide, haloperidol, erythromycin, fluoroquinolones) | Additive QT prolongation — risk of torsades de pointes and fatal ventricular arrhythmia. Avoid combinations; if unavoidable, continuous ECG monitoring required. | Major |
| Simvastatin / lovastatin | Amiodarone inhibits CYP3A4 — markedly increases statin levels; serious risk of myopathy and rhabdomyolysis. Do not exceed simvastatin 20mg/day with amiodarone. Consider pravastatin (not CYP3A4 metabolized). | Major |
| Cyclosporine / tacrolimus | Inhibits CYP3A4 — increased calcineurin inhibitor levels; nephrotoxicity risk | Major |
| Beta-blockers / calcium channel blockers | Additive depression of sinus node and AV node — bradycardia and AV block. Avoid diltiazem/verapamil combination; use with caution with beta-blockers. | Major |
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Side Effects
Common
- Photosensitivity (blue-grey skin discoloration with prolonged use)
- Corneal microdeposits (in virtually all patients >6 months — usually asymptomatic, reversible)
- Nausea and vomiting (loading phase)
- Fatigue
- Tremor and ataxia
- Constipation
- Hypothyroidism (more common) or hyperthyroidism
- Sleep disturbance
Serious / Discontinue If
- PULMONARY TOXICITY — interstitial pneumonitis, ARDS, organizing pneumonia (1–5% incidence; potentially fatal); check CXR and DLCO annually
- THYROID DYSFUNCTION — hypothyroidism (most common) or hyperthyroidism (more dangerous); check TFTs every 6 months
- HEPATOTOXICITY — transaminase elevation common; fulminant hepatic failure rare but fatal; monitor LFTs every 6 months
- Peripheral neuropathy — dose-related, partially reversible
- Optic neuropathy / optic neuritis — rare but can cause permanent visual loss; urgent ophthalmology referral
- Proarrhythmia — torsades de pointes (despite being used to treat arrhythmias)
- QT prolongation — ECG monitoring mandatory
- Bradycardia and AV block — especially with concomitant nodal agents
Contraindications
- Sinus bradycardia or sinus node disease (without pacemaker)
- Second or third degree AV block (without functioning pacemaker)
- Known iodine hypersensitivity
- Thyroid dysfunction (relative — use with extreme caution)
- Severe respiratory failure
- Circulatory collapse or severe hypotension (oral formulation)
- Concurrent use with QT-prolonging agents that have high torsades risk
Available Indian Brands
| Brand | Manufacturer | Price (approx) |
|---|---|---|
| Cordarone 100mg | Sanofi India | ₹48/10 tablets |
| Tachyra 100mg | Sun Pharma | ₹38/10 tablets |
| Amiodar 200mg | Cipla | ₹75/10 tablets |
Monitoring Required
- TFTs (TSH, free T4) — at baseline and every 6 months (thyroid disease is common — hypo and hyper)
- LFTs (ALT, AST) — at baseline and every 6 months (hepatotoxicity)
- CXR — at baseline and annually (pulmonary toxicity screening)
- Pulmonary function tests (DLCO) — annually, or if new respiratory symptoms
- ECG — PR interval, QRS duration, QTc — at baseline, after loading, and every 6 months
- Serum amiodarone and desethylamiodarone levels (optional; therapeutic range 1–2.5 mg/L)
- Ophthalmology review — annual slit lamp exam (corneal deposits; urgent if visual symptoms)
- Electrolytes (potassium, magnesium) — maintain normal levels to prevent arrhythmia
- INR if on warfarin — weekly initially, then monthly once stable
- Digoxin levels if co-prescribed
Patient Counseling Points
- Use high-factor sunscreen (SPF 50+) and protective clothing outdoors — severe photosensitivity; avoid prolonged sun exposure
- Report any new breathlessness, cough, or chest pain — may indicate serious lung toxicity
- Report any weight gain, fatigue, cold intolerance (hypothyroidism) OR weight loss, palpitations, heat intolerance (hyperthyroidism)
- Report any visual changes or eye pain immediately
- Regular blood tests (thyroid, liver, lung function) are mandatory every 6 months — this drug affects multiple organs
- Do not stop amiodarone suddenly without consulting your cardiologist — effects last weeks after stopping
- Inform all doctors of this medication — it interacts with many commonly used drugs
- Take with food to reduce nausea during loading phase
- Skin discoloration (blue-grey tinge) may occur with long-term use — partially reversible on stopping
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Clinically reviewed by: Dr. Priya Menon, DM (Cardiology), PGIMER Chandigarh
Last reviewed: 2026-04-01
References
- Drugs.com — Amiodarone Monograph
- CIMS India — Amiodarone
- ACC/AHA/HRS Guideline for Management of Atrial Fibrillation 2023
- AHA ACLS Guidelines 2020 — Cardiac Arrest Algorithms
- Indian National Formulary 2023
- Micromedex — Amiodarone Drug Interactions
- Epocrates — Amiodarone Clinical Pharmacology