# Amiodarone Preload Syringes Discontinued?



## north (May 19, 2008)

I was informed last week by our pharmacist that amiodarone 150 mg/3 ml leur jet syringes are discontinued.  Boundtree ALS confirmed this this morning.  Does anyone have more info on this or a suggested replacement other than vials or ampoules?

Thanks, 
Rob


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## Ridryder911 (May 19, 2008)

Don't know, don't use Cordarone, since it is twice the amount and no scientific data has demonstrated any difference between Lido and Cordarone. I believe you will see a shift back to Lido, alike the days of Bretylium. 

R/r 911


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## Flight-LP (May 19, 2008)

Whats so wrong with the ampules or vials?


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## Jon (May 20, 2008)

I know that when amiodarone was getting popular, one of the reasons _*AS I WAS TOLD*_, it was marketed in ampules was that it was more stable over time in glass than in plastic.

I'm not a chemist... does this sound correct? Is it possible that someone thought the plastic would work, except that now they know better?




Flight-LP said:


> Whats so wrong with the ampules or vials?


I don't think anything's wrong with them... but rember, Paramedics have been taught to prep drugs by inserting part A into part B, twisting, and injecting, for 30+ years (I've had instructors tell me their orders from Command used to be "give them a tan box" and a "purple box"... etc). Some paramedics aren't comfortable with having to draw up meds, and some probably feel that it takes more time.

My $0.02


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## triemal04 (May 20, 2008)

Jon said:


> I know that when amiodarone was getting popular, one of the reasons _*AS I WAS TOLD*_, it was marketed in ampules was that it was more stable over time in glass than in plastic.
> 
> I'm not a chemist... does this sound correct? Is it possible that someone thought the plastic would work, except that now they know better?
> 
> ...


So paramedics aren't comfortable having to draw up etomidate, cardizem, adenosine (maybe), sux, vecuronium, rocuronium, ativan, versed, fentanyl, zofran, inapsine, epi 1:1000, thiamine, benadryl, narcan (maybe), pitocin, and on and on and on?  

There are more drugs that are carried in vials or ampules than there are carried in pre-filled syringes.  Any school that teaches paramedics "to prep drugs by inserting Part A into part B, twisting, and injecting" should be burned to the ground right now.  And any paramedic who isn't comfortable drawing up a med should turn in their cert right now.


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## KEVD18 (May 20, 2008)

Jon said:


> I don't think anything's wrong with them... but rember, Paramedics have been taught to prep drugs by inserting part A into part B, twisting, and injecting, for 30+ years (I've had instructors tell me their orders from Command used to be "give them a tan box" and a "purple box"... etc). Some paramedics aren't comfortable with having to draw up meds, and some probably feel that it takes more time.
> 
> My $0.02



i agree that this is a completely bogus statement.


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## Jon (May 20, 2008)

:blush:Ok... after a little sleep, let me add to my comment. I really shouldn't post on here much after midnight 

I wasn't trying to imply that paramedics CAN'T draw up meds... but many common drugs are packaged in some form of pre-filled syringe for both convience and safety (less need to use any form of needle to draw it up).

Also... most of our narcs are in pre-filled carpojects.


Jon


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## Flight-LP (May 20, 2008)

"Doc, when we got on scene he was in Asystole. We gave him 3 gray boxes, 2 purples, and an amp of dark yellow.........."


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## firecoins (May 21, 2008)

I thought giving drugs was the cool part of being a medic.  B)


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## bonedog (May 22, 2008)

Ridryder911 said:


> Don't know, don't use Cordarone, since it is twice the amount and no scientific data has demonstrated any difference between Lido and Cordarone. I believe you will see a shift back to Lido, alike the days of Bretylium.
> 
> R/r 911




Rid, your dating yourself, just don't start quoting the proarrythmic results of the CAST study. 
Maybe we need a study titled ANTIARRYTHMIC'S and other theroies...

I guess we are lucky up here in the north, we don't have to call for orders unless we are out of idea's, I did wonder why the boxes were different colours, I thought it was a "fire thing" ? (RAMPART)


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## firecoins (May 22, 2008)

I don't know enough about either meds to have a personal preference but it appears there are scientific studies showing amiodarone to be better.  There are probably problems with studies.  My system uses amiodarone. 

http://www.pulmonaryreviews.com/aug02/pr_aug02_lidocaine.html

http://www.sciencedirect.com/scienc...serid=10&md5=911afee100b911d2d0137a109c5edb24

Abstract of 2nd article


> The effectiveness of intravenous amiodarone for the treatment of incessant (shock resistant) ventricular tachycardia (VT) has not been established. This study evaluated the efficacy of a water-soluble amiodarone preparation or lidocaine for the treatment of shock-resistant VT. The trial was a double-blinded parallel design. Patients were randomized to receive up to 2 boluses of either 150 mg intravenous amiodarone or 2 boluses of 100 mg lidocaine followed by a 24-hour infusion. If the first assigned medication failed to terminate VT, the patient was crossed over to the alternative therapy. Twenty-nine patients were randomized to the study (18 received amiodarone and 11 received lidocaine). There were no significant differences between groups withregard to baseline characteristics. Immediate VT termination was achieved in 14 patients (78%) with amiodarone versus 3 patients (27%) on lidocaine (p <0.05). After 1 hour, 12 patients (67%) on amiodarone and 1 patient (9%) on lidocaine were alive and free of VT (p <0.01). Amiodarone had a 33% drug failure rate, whereas there was a 91% drug failure rate for lidocaine. The 24-hour survival was 39% on amiodarone and 9% on lidocaine (p <0.01). Drug-related hypotension with aqueous amiodarone was less frequent than with lidocaine. This study found that amiodarone is more effective than lidocaine in the treatment of shock-resistant VT.


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## mikeylikesit (Jun 7, 2008)

i still use Amiodarone for for VT on PEADS. i don't like prefilled stuff cause when it all in the same cabinet it is very easy in a time of stress to grab the wrong one for the wrong person e.g. the adult dose in lou of the Ped's dose.







.


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## AnthonyM83 (Jun 8, 2008)

Ridryder911 said:


> like the days of Bretylium.



I heard we exhausted our natural supply of this. Thus it's no longer readily available. Has anyone heard this, too?


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## Bongy (Jun 8, 2008)

*What so wrong in vials?*

Hello you all... For a long time I wasn't here but now I'm back... About a subj.. We(in Israel) we don't have prepared drugs at all... Nothing..Al in vials.. And it works fine.. 
About amiodarone - I have to disagree with RydRider... Followind ACLS,amiodaron is preffered than Lido.. Following my expirience - amiodarone better ether..But loading dose of 300 nessesary anyway... Otherwise it will take hours for it to start to work...


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## MedicPrincess (Jun 8, 2008)

In school we were drilled Amiodarone...Amiodarone....Amiodarone!  If we tried to use Lidocaine, the instructor would always say "Thats one choice, but whats a better choice?"  It became second nature to give the Amiodarone over Lidocaine.  Every now and then we would have an instructor that would switch it up and say we for whatever reason are out of Amiodarone and ask us what else we could use and the dose.

Fast forward to real life and being in the field....  I find myself reaching for the Lidocaine almost everytime now.  I have found it to work better, faster.


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## So. IL Medic (Jun 14, 2008)

AnthonyM83 said:


> I heard we exhausted our natural supply of this. Thus it's no longer readily available. Has anyone heard this, too?



I had an instructor that used to joke about how the bretylium bush ran out of berries...

As far as I know, the manufacturer ran out of one of the source ingredients about ten years ago. Bretylium manufacture resumed but the medical field moved on without it.


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## So. IL Medic (Jun 14, 2008)

There were many initial studies glorifying amiodarone. Since then, the follow up studies haven't been so kind. I have seen reports that amiodarone and lidocaine don't play well with each other which negatively affected earlier studies, that amiodarone only approaches the efficacy of lidocaine if vasopressin is administered first in codes, straight comparisons seem to show that lidocaine still outperfoms amidarone in many cases, in others, they are about equal.

For my part, I have to agree with Ridryder. If I want my patients to get better, I use lidocaine. We carry both and I have seen better results with lido. 

It may be old fashioned, but it works.


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## zacdav89 (Jun 30, 2008)

on school we were told how to use both just becuase different services have different drugs, i have only seen pre-filled used here for the code bags, everything else is in ampules. we learned how to deal with different forms of drug dillerey and it depends on the department


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