Amiodarone infusions

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emtech419

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Hey there.

I'm in paramedic school now. Today, in pharmacology, we got onto the discussion of amiodarone infusions, and our instructor mentioned that amiodarone infusions should only be given using D5W. Neither I, nor my classmates, were ever told this back in ACLS, and our instructor was unsure of whether mixing amiodarone in NSS is absolutely contraindicated.

Anybody here happen to know? Can amiodarone only be given in D5W, or is NSS acceptable for an infusion?
 
I don't know if it's an absolute contraindication, but every service I know uses D5W to dilute amiodarone.
 
Amiodarone will form precipitates when mixed with normal saline or ringers lactate. It doesn't like the sodium I think (or maybe the buffers? Can't remember and can't be bothered looking it up)
 
It can be mixed with either one.
 
our amio always comes premixed in d5. But make sure you always use a one of those micron filters with it.
 
We use NS. We have relatively short txp times, usually < 20 mins. Longer txp times may necessitate the use of D5.
 
If you wanna be real technical, it should be mixed with D5 in a glass bottle with an inline filter. Like Smash, I want to say it doesn't do well with sodium.

At least it doesn't eat the rubber stoppers out of vials anymore...
 
You can mix it with both for field settings. If I were to do a long interfacility i would use D5.

Canoeman
 
Glad ya'll cleared that up. I had a bit of a pucker factor going on for a minute thereB)
 
I seem to remember reading an article saying that said something about the whole Amiodarone/D5W not mattering too much for the time involved in emergency infusions. I think it was a more recent one than this but this is quoted in some other amiodarone lit I've read.

S Campbell, PE Nolan, M Bliss, R Wood and M Mayersohn, Stability of amiodarone hydrochloride in admixtures with other injectable drugs. Am J Hosp Pharm 43 (1996), pp. 917–921.
 
Phew.

Our pharm teacher is a flight nurse, so I suppose he has to think a little more long term.

I just know that my service does not carry bags of D5W, and probably the only D5 we have on the truck is pre-mixed with dopamine.

I guess my big concern was when I'm doing these Amiodarone infusions, I don't want to be killing my patients for lack of D5, but it sounds like the 10 minutes it takes to get that in is not going to make a difference.

Thank you all for your help.
 
I'm a medic student as well, in my internship phase. I had the same question a couple weeks ago, riding with a different agency under different protocols than my usual agency.. This new agency didn't have D5, I had been told the same: Never administer Amiodarone in NS. But my preceptor had infused 150mg in a 500ml NS bag a week prior, it worked just fine.

Think of it this way: with a typical 300mg bolus, Amiodarone is administered with NS, without any precipitate. Good question, mate! Goodluck!
 
Our pharm teacher is a flight nurse, so I suppose he has to think a little more long term.
Click to expand...

Depends on whether he works on helicopters or fixed wing. The rotorheads don't have to worry so much about long time because they are seldom with a medical patient any longer than you would be as a ground provider.

Now for fixed wing, where it's not uncommon for us to be with a patient for several hours, it might be more of a concern.
 
Are most EMS services administering amiodarone in non-cardiac arrest cases at 150mg in 100mL D5W?

Or do most not carry 100mL bags and instead dilute it in 250mL?
 
We carry amiodarone 150mg/3ml

For tachydysrhythmias at the discretion of the Intensive Care Paramedic they can hang an infusion of 150mg in 150ml of D5 over 15 minutes.
 
Filters....

They just get all clogged up!
:ph34r:
 
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