Amiodarone Vs. Lidocaine

[E in SD]

My county is in the process of making the switch from Lidocaine to Amiodarone per arrest protocol. Im currently in Medic school and the problem is the majority of our instructors are old school retired Medics/RN's who have NO field experiance with amiodarone and constantly bad mouth it because it has a ridiculosly long half life, (somewhere around 3 months) and can cause problems down the road with vision.

My question is for anyone out there how has used both and can fill me in on the pros and cons of each

 

[Ridryder911]

Do a lit. research.. currently there is little to no value between Lido and Amido...except the costs $$$. Cordorone is MUCH more expensive. Some, use it as an antiarrythmic with minimal + results.. but no change in V-Fib, V-tach...

Now, the half life is long as well people whom are on anticoagulants such as Coumadin, Cordorone can change their clotting time dangerously....so yes, it is a good med... better than Lido.. maybe yes, mmmm maybe no .. I have used for years in the ICU, before it was popular.

R/r 911

 

[VinBin]

From what I have heard, there is a statistically significant improvement in outcome with Amio as compared to Lido in Shock resistant rhythms...BUT the many trials do seem to present conflicting reports, but usually do show Amiodarone is "better"...but the definition of better is subjective...

Interesting read...http://www.emedicine.com/emerg/topic710.htm

"Some studies have suggested a trend toward increased survival with the use of amiodarone over lidocaine; however, the endpoint of these studies was survival to hospital admission. When survival to hospital discharge was considered, no significant differences between amiodarone and lidocaine were apparent."

 

[Ridryder911]

Part of the problem is many of those studies have been described as tainted with lack of some validity, since some was sponsored by the manufacture of Cordorone. Far as results there has not been many reports showing a major significant change. That is why AHA does not mandate the change. Many in the local circles are even suggesting that Cordorone may be placed as a suggested antiarrhythmic, but may be removed for decreasing fibrillation threshold such as in V-fib.

R/r 911

 

[jeepmedic]

Most of the studies I have seen and read refer to a witnessed arrest. We tried it for a while in a service I worked at then it was dropped due to Cost and we could not show any better save rates than with Lidocaine.

 

[FFEMT1764]

We use lidocaine exclusively, and the same goes for the local ER. Amiodarone is expensive, and in the studies preformed by the State EMS med director he determined that it could be used in place of lidocaine, but that it is not any better than the lido. I prefer the lidocaine because the administration is simple, unless the person is really small in size then they are going to get the whole prefilled syringe (100mg) anyways.

 

[VinBin]

Don't you think Amio is even easier to administer? Really only two doses needed for prehospital...

 

[Ridryder911]

Definitely not... Lidocaine is simple 1-1.5 mg/kg and upto 3mg/kg and hang a drip at 2-4mg (15,30,45 gtts/min usually premixed). Cordorone as well has to be mixed in glass bottles and D5W and does not come pre-mixed.

As well the side effects of Cordorone (patients on Coumadin, etc.) is very dangerous...

R/r 911

 

[VinBin]

I mean in terms of doses, no pt dependent calculations in most uses, no?

 

[Ridryder911]

I understand, but Lidocaine is also simple to calculate 1 - 1.5 mg /kg .. wt of patient in kg = dosage or weight and a half. i.e 150 lbs = approximately 75 kg so the dose would be 75mg to 112 mg. One can either perform loading doses of Lidocaine or hang and maintain a drip after initial bolus.

Again, as many has discussed the costs and no new validated proof any difference...

 

[volparamedic]

Think before change

Our medical director did away with lidocaine and carry only amiodarone. I think this a big mistake for any service to pick one or the other. Come on lido is CHEAP! Amiodarone is more expensive, you can hang it in IV bags but must be used within 2 hours due to it absorbes to phlyvinyl chloride bags and tubing. We mix it 150mg in 50ml D5% on a 10 gtt set over 10 minutes for a patient with a pulse...or a drop a second to be exact. If no pulse we give a bolus of 300mg IV no gtt is required. If you had it on a 60 gtt set you'd have to gtt 300 gtt's per second...doesn't add up. It does work...under the right conditions. There are a lot of problems with this drug due to high iodine content to it. If you are allergic to idodine or benzyl alcohol you can't have it. It cannot be used with cardiogenic shock, 2nd or 3rd degreee heart block in the absence of a pacemaker.

It is good to use with Severe refractory arrhythmias...v-fib or v-tach, a-fib with rapid ventricular response and WPW syndrome.

It is very dangerous if you have thyroid problems...bradycardia...hypotension....beta blocker usage...calcium channel blocker usage...Hepatic problems...electrolyte imbalance. It can induse torsades de pointes....QT prolongation...Pulmonary Fibrosis (big time risk)....ARDS....increased anticoagulant effect....can elevate levels in plasma concentrations of digoxin, quimidine, procainamide, disopyramide, phenytion and cyclosporine and potentiate the myocardial depression with admin of volatile inhaled anesthetics. Grapefruit juice can inhibit amiodarone metabolism and lead to elevated drug levels but long-term efficacy and toxicity is not known at this time!

Note that they say you can use amiodarone for A-Fib...the FDA hasn't approved it for that at this time. Cardiologists are choosing it for high risk patients that could die. Amiodarone is highly lipid soluble. High concentrations in fat and muscle, liver, lungs and skin. Very dangerous to pregnant or lactating mother.

It's been shown good success rate for patients to have a heart beat at the hospital but nothing is said about discharge. I'm still waiting for my CA patient this week to improve from amiodarone usage....I've had 10 saves with using lidocaine that walk and talk today. My fav is lido...why change what works and is cheap??? MONEY!!!

I'm doing a big study on both due to loosing Lidocaine. Amiodarone does come prefilled syringe 150mg and you must premix 150mg in 50ml D5%.

Happy Choosing!!!

 

[Ridryder911]

Our medical director did away with lidocaine and carry only amiodarone. I think this a big mistake for any service to pick one or the other. Come on lido is CHEAP! Amiodarone is more expensive, you can hang it in IV bags but must be used within 2 hours due to it absorbes to phlyvinyl chloride bags and tubing. We mix it 150mg in 50ml D5% on a 10 gtt set over 10 minutes for a patient with a pulse...or a drop a second to be exact. If no pulse we give a bolus of 300mg IV no gtt is required. If you had it on a 60 gtt set you'd have to gtt 300 gtt's per second...doesn't add up. It does work...under the right conditions. There are a lot of problems with this drug due to high iodine content to it. If you are allergic to idodine or benzyl alcohol you can't have it. It cannot be used with cardiogenic shock, 2nd or 3rd degreee heart block in the absence of a pacemaker.

It is good to use with Severe refractory arrhythmias...v-fib or v-tach, a-fib with rapid ventricular response and WPW syndrome.

It is very dangerous if you have thyroid problems...bradycardia...hypotension....beta blocker usage...calcium channel blocker usage...Hepatic problems...electrolyte imbalance. It can induse torsades de pointes....QT prolongation...Pulmonary Fibrosis (big time risk)....ARDS....increased anticoagulant effect....can elevate levels in plasma concentrations of digoxin, quimidine, procainamide, disopyramide, phenytion and cyclosporine and potentiate the myocardial depression with admin of volatile inhaled anesthetics. Grapefruit juice can inhibit amiodarone metabolism and lead to elevated drug levels but long-term efficacy and toxicity is not known at this time!

Note that they say you can use amiodarone for A-Fib...the FDA hasn't approved it for that at this time. Cardiologists are choosing it for high risk patients that could die. Amiodarone is highly lipid soluble. High concentrations in fat and muscle, liver, lungs and skin. Very dangerous to pregnant or lactating mother.

It's been shown good success rate for patients to have a heart beat at the hospital but nothing is said about discharge. I'm still waiting for my CA patient this week to improve from amiodarone usage....I've had 10 saves with using lidocaine that walk and talk today. My fav is lido...why change what works and is cheap??? MONEY!!!

I'm doing a big study on both due to loosing Lidocaine. Amiodarone does come prefilled syringe 150mg and you must premix 150mg in 50ml D5%.

Happy Choosing!!!

Check your math. 50ml in 10 minutes = (50ml X 10 gtts / by 10 minutes = 500 / 10= 50 gtts/min. Thus a little slower than one drop per second as well, why would anyone want to use a mini (micro) drip on a bolus medication?

The treatment of WPW should be very cautiously treated. Most prefer Adenocard to really determine WPW, and then many prefer Pronestyl for better ability to control.

Lidocaine is effective, however more and more are finding out it has severe toxic effects, that many were not aware of. I agree it is a good medicine, when used appropriately, but is probably used way too much. I have not administered it in years..except for special occurences such as V-Fib, and post arrest situations.

Personally, unless they are having left sided PVC's or re-current R on T phenomen, or being symptomatic, I will leave them alone. Making sure they are not ischemic in nature, and treat the cause, not so much the effect.
I had to get an order NOT to tx PVC's last shift.. the patient was in bigeminal, but was electrolyte induced (post dialysis). The physician thought it was humorous of giving an order not to give a med...

R/r 911
R/r 911

 

[triemal04]

Pretty sure she was talking about giving the 150mg/10min in a 50cc bag with a microdrip. 50cc over 10 minutes with a 60 set. Which does come out to be 300 drops per minute. Just wasn't stated that clearly.

 

[volparamedic]

Well, if you drip it too fast you can cause bradycardia and/or hypotension. Besides, the med bag has up to 2 hours.

We don't have protocols to use it for WPW...just a finding that cardiologist are using it for in my investigation.

I'd rather have lido...short half life thus the reason for a continous gtt even after a bolus.
Amiodarone stays for an average of 47 days in a body...can't get out of your system.

Thus the saying....treat your patient not your monitors. To fix a true problem you must find the cause.

 

[spidermedic]

In cardiac arrest lidocaine, amiodarone and urine all have about the same efficacy.

In wide tachy rhythms amiodarone certainly beats out lidocaine, but in narrow-complex rhythms it doesn't seem to do any better than diltiazem.

 

[RichmondMedik]

Has anyone seen the studies where Amio was administered with EPI together or with Vaso ?? there is some interesting results. I will see if I can put the last one I read on line

stay Safe

Paul

 

[MSDeltaFlt]

My county is in the process of making the switch from Lidocaine to Amiodarone per arrest protocol. Im currently in Medic school and the problem is the majority of our instructors are old school retired Medics/RN's who have NO field experiance with amiodarone and constantly bad mouth it because it has a ridiculosly long half life, (somewhere around 3 months) and can cause problems down the road with vision.

My question is for anyone out there how has used both and can fill me in on the pros and cons of each

Amiodarone:

CON: I have seen first hand what can... WILL happen when Cardarone is given post arrest IVP, and not through a pump: CPR will resume. This drug is very expensive. You have to mix it in a special way.

PRO: Not weight specific, and, when given correctly, can and will treat a multitude of dysrrhythmias. It's an old drug that they brought back into circulation for a reason.

Lidocaine:

CON: Lido can make a pt Lido toxic and cause Sz's. Lido is weight specific: mg/kg. Is limited to only ventricular rhythms.

PRO: What medic doesn't know how to figure the actual mg dose of 1.5 mg/kg on ANY size pt? That's kinda like an athelete not knowing how to ride a bike. Lido comes prefilled. It's not that expensive.

You look at one school of thought and they will say Lidocaine does not work. You look at another school of thought and they will say Amiodarone does not work.

It's 6 to 1, and a half dozen to the other, dude.

 

[fma08]

plain and simple, for field codes, Amiodarone is way easier to work with. 300mg then 150mg then done. lido you actually have to do some math, 1-1.5mg/kg upto 3mg/kg and unless you know the pt's weight in kg... Amiodarone is simpler, i wish my service would carry it, but we have lido.

 

[Ridryder911]

plain and simple, for field codes, Amiodarone is way easier to work with. 300mg then 150mg then done. lido you actually have to do some math, 1-1.5mg/kg upto 3mg/kg and unless you know the pt's weight in kg... Amiodarone is simpler, i wish my service would carry it, but we have lido.

Awww... now we would not have to use our noggin would we? C'mon Initial bolus 1 mg/kg really how hard is that? 150 pounds approx 75kg =75 mg; now was that hard? Oh, the drips are much more simpler than Cordarone.

Really, who cares how hard it is to calculate? What is best for the patient, right? Since neither one shows much difference in the long run, either one is just as good as another. Now, Amiodarone is showing some promising changes in arrhythmias, (what it has been used for, for decades.. yes it is really an old cardiac drug).

R/r 911

 

[fma08]

why would i want to use my noggin? well yes i may still be new, thats just the way i see it, i figure there's enough going on in a code situation that i a possible slip up in drug calculations with lido is one less thing i'd have to worry about and i'm not the greatest at estimating a pt's weight. but since we carry lido, i've learned to work with it. you are right, neither one is absolutely 100% better, so whatever is used with you're service, better make sure you know it.