The Navigation Model of Therapy: Why Awareness Changes Everything
November 16, 2025
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Brand Name :
Pacerone, Cordarone, Nexterone
Synonyms :
amiodarone
Class :
Antidysrhythmic
Brand Name :
Pacerone, Cordarone, Nexterone
Synonyms :
amiodarone
Class :
Antidysrhythmic
Dosage Forms & StrengthsÂ
TabletÂ
100 mgÂ
200 mgÂ
400 mgÂ
Injectable solutionÂ
50mg/mlÂ
150mg/100mlÂ
360mg/200mlÂ
Take loading dose of 800 to 1600 mg orally every day for 1 to 3 weeks until the response occurs
Take maintenance dose of 400 mg orally daily
Intravenous:
Administer 150 mg for 10 min, followed by 360 mg for next 6 hours, then 540 mg for remaining 18 hours and for a total of 1000 mg in a day
Administer maintenance dose of 0.5 mg/min for a total 720 mg in 24 hours at a concentration of 1 to 6 mg/ml
Duration of therapy continues to administer 0.5 mg/min for 2 to 3 weeks
Dosing considerations
Intravenous preparation contains polysorbate 80 and benzyl alcohol
Newer intravenous formulation does not contain polysorbate 80 or benzyl alcohol
For <1-week intravenous infusion: administer 800 to 1600 mg daily
For 1-to-3-week intravenous infusion: administer 600 to 800 mg daily
For >3-week intravenous infusion: administer 400 mg daily
Dosage Forms & StrengthsÂ
Injectable solutionÂ
50mg/mlÂ
150mg/100mlÂ
360mg/200mlÂ
TabletÂ
100 mgÂ
200 mgÂ
400 mgÂ
Supraventricular Tachycardia (SVT)Â
For Infants/children/adolescents:
Administer dose of 5 mg/kg intravenously for 1 hour initially and then follow with 5 mg/kg daily for 47 hours
Administer maintenance dose of 10 to 20 mg/kg daily for 7 to 10 days and then follow with 3 to 20 mg/kg daily
Dosing Considerations
Hypotension (36%), bradycardia (20%), and atrioventricular block (15%) were frequent dose-related adverse events in a pediatric trial of 61 patients, ranging in age from 30 days to 15 years. In some cases, these adverse events were severe or life-threatening
Newer intravenous formulation does not contain polysorbate 80 or benzyl alcohol
Refer to adult dosingÂ
may have an increased QTc-prolonging effect when combined with amiodarone
may have an increased QTc-prolonging effect when combined with amiodarone
may have an increased QTc-prolonging effect when combined with amiodarone
may have an increased QTc-prolonging effect when combined with amiodarone
may have an increased QTc-prolonging effect when combined with amiodarone
It may enhance the effect when combined with lonafarnib by affecting CYP3A4 metabolism
It may diminish the bioavailability when combined with bile acid sequestrants
amiodarone: they may increase the QTc-prolonging effect of clozapine
serum concentration of cardiac glycosides is increased by amiodarone
serum concentration of cardiac glycosides is increased by amiodarone
serum concentration of cardiac glycosides is increased by amiodarone
amiodarone: they may increase the QTc-prolonging effect of QTc-prolonging Agents
amiodarone: they may increase the QTc-prolonging effect of QTc-prolonging Agents
amiodarone: they may increase the QTc-prolonging effect of QTc-prolonging Agents
amiodarone: they may increase the QTc-prolonging effect of QTc-prolonging Agents
amiodarone: they may enhance the serum concentration of glycoprotein IIa Inhibitors
bladderwrack lowers the bioavailability of amidarone
when both drugs are combined, there may be an increase in qtc interval  
when both drugs are combined, there may be increased toxicity of amiodarone by QTC interval  
when both drugs are combined, there may be an increase in the serum concentration of talazoparib 
may increase the bradycardic effect
may decrease the therapeutic effect
may increase the QTc prolonging effect of QT-prolonging Class III Antiarrhythmics
It may enhance QTc interval when combined with pentamidine
may enhance the serum concentration when combined
may have an increased risk of rhabdomyolysis & myoglobinuria when combined with amiodarone
may increase the risk of adverse effects when combined
dihydroartemisinin/piperaquineÂ
combination of dihydroartemisinin/piperaquine with amiodarone will have QTc prolongation
It may enhance QTc interval when combined with perphenazine
It may enhance the effect when combined with pemigatinib by affecting CYP3A4 metabolism
it decreases the efficacy of sodium iodide I-131
It may enhance QTc interval when combined with lithium
It may diminish the level when combined with efavirenz by affecting CYP3A4 metabolism
amiodarone: they may decrease the therapeutic effect of agalsidase beta
amiodarone: they may increase the QTc-prolonging effect of voriconazole
when both drugs are combined, both increase the QTC interval  
both lapatinib and amiodarone increase the QTc interval
may increase the QT-prolonging effect and enhance the risk of ventricular arrhythmias
when both drugs are combined, there may be an increased risk or severity of QTC prolongation
when both drugs are combined, there may be an increased risk or severity of QTC prolongation  
CYP3A strong enhancers of the small intestine may reduce the the bioavailability of amiodarone
when both drugs are combined, there may be an increased QTc interval 
amiodarone and gilteritinib, when used in combination, increase the QTc interval
when both drugs are combined, there may be an increase in the QTC interval
when both drugs are combined, there may be increase in ceritinib and arsenic trioxide both increase QTc interval
when both drugs are combined, there may be increase in ceritinib and arsenic trioxide both increase QTc interval
when both drugs are combined, there may be an increased risk of adverse effects 
may increase the QTc interval when combined
may increase the level of effectiveness through P-glycoprotein MDR1 efflux transporter
may enhance the serum concentration
may increase the QTc prolonging effect
may have an increased QTc-prolonging effect when combined with amiodarone
atazanavir: they may enhance the serum concentration of amiodarone
cimetidine: they may enhance the serum concentration of amiodarone
daclatasvir: they may increase the bradycardic effect of amiodarone
indinavir: they may enhance the serum concentration of amiodarone
nelfinavir: they may enhance the serum concentration of amiodarone
ritonavir: they may enhance the serum concentration of amiodarone
tipranavir: they may enhance the serum concentration of amiodarone
tizanidine: they may enhance the serum concentration of amiodarone
lofexidine: they may increase the arrhythmogenic effect of amiodarone
the toxicity of either of the drugs is increased due to pharmacokinetic synergism
amiodarone may enhance the bradycardic effect of beta-blockers
amiodarone may enhance the bradycardic effect of beta-blockers
amiodarone may enhance the bradycardic effect of beta-blockers
amiodarone may enhance the bradycardic effect of beta-blockers
amiodarone may enhance the bradycardic effect of beta-blockers
may have an increased bradycardic effect when combined with beta-blockers
may have an increased bradycardic effect when combined with beta-blockers
may have an increased bradycardic effect when combined with beta-blockers
may have an increased bradycardic effect when combined with beta-blockers
may have an increased bradycardic effect when combined with beta-blockers
Strong CYP3A4 inducers may decrease serum concentrations of the active metabolite(s) of amiodarone
Strong CYP3A4 inducers may decrease serum concentrations of the active metabolite(s) of amiodarone
Strong CYP3A4 inducers may decrease serum concentrations of the active metabolite(s) of amiodarone
Strong CYP3A4 inducers may decrease serum concentrations of the active metabolite(s) of amiodarone
Strong CYP3A4 inducers may decrease serum concentrations of the active metabolite(s) of amiodarone
It has the potential to amplify the hypoglycemic impact of sulfonylureas
It has the potential to amplify the hypoglycemic impact of sulfonylureas
It has the potential to amplify the hypoglycemic impact of sulfonylureas
It has the potential to amplify the hypoglycemic impact of sulfonylureas
It has the potential to amplify the hypoglycemic impact of sulfonylureas
It may diminish the effect when combined with griseofulvin by CYP3A4 metabolism
it may diminish the therapeutic efficacy when combined with castor oil
may enhance the concentration of serum when combined with amiodarone
may enhance the concentration of serum when combined with amiodarone
may enhance the concentration of serum when combined with amiodarone
may enhance the concentration of serum when combined with amiodarone
may enhance the concentration of serum when combined with amiodarone
it may enhance the qtc interval when combined with lofexidine
It may enhance the levels when combined with tamsulosin by affecting CYP3A4 metabolism
it may diminish the metabolism when combined with ciclesonide
amiodarone: they may increase the bradycardic effect of Beta-Blockers
When used with amiodarone, levobetaxolol's therapeutic effectiveness can be enhanced
when amiodarone is used in conjunction with mibefradil, The risk or seriousness of adverse events may be enhanced
Combining tegafur with amiodarone can reduce tegafur’s metabolism
amiodarone: they may enhance the serum concentration of CYP3A Inhibitors
amiodarone: they may enhance the serum concentration of CYP3A Inhibitors
amiodarone: they may enhance the serum concentration of CYP3A Inhibitors
amiodarone: they may enhance the serum concentration of CYP3A Inhibitors
amiodarone: they may enhance the serum concentration of CYP3A Inhibitors
When alprazolam and amiodarone is used together, this leads to reduction in the alprazolam’s metabolism
When dexrabeprazole and amiodarone is used together, this leads to reduction in the dexrabeprazole’s metabolism
When domeperidone and amiodarone is used together, this leads to reduction in the domeperidone’s metabolism
When amiodarone is used together with fluconazole, this leads to reduction in the amiodarone metabolism
When acetohexamide is used together with amiodarone, this lead to reduction in acetohexamide’s metabolism
When amiodarone is used together with ouabain, this leads to a rise in the concentration serum of ouabain
When ponesimod is used together with amiodarone, this leads to enhanced risk or seriousness of bradycardia
amiodarone: they may decrease the therapeutic effect of thyroid products
amiodarone: they may decrease the therapeutic effect of thyroid products
amiodarone: they may decrease the therapeutic effect of thyroid products
amiodarone: they may decrease the therapeutic effect of thyroid products
amiodarone: they may enhance the serum concentration of tizanidine
amiodarone: they may enhance the serum concentration of verteporfin
amiodarone: they may enhance the serum concentration of silodosin
amiodarone: they may enhance the serum concentration of carbamazepine
amiodarone: they may enhance the serum concentration of brimonidine
amiodarone: they may enhance the serum concentration of atorvastatin
amiodarone: they may enhance the serum concentration of aliskiren
When amiodarone is used together with givinostat, this leads to enhanced risk or severity of Qtc prolongation
When amiodarone is used together with oleandomycin, this leads to enhanced concentration serum of amiodarone
When amiodarone is used together with patupilone, this leads to enhanced concentration serum of amiodarone
When amiodarone is used together with ridaforolimus, this leads to enhanced concentration serum of amiodarone
amiodarone: it may decrease the metabolism of gestodene
hepatic enzyme metabolism i.e., CYP3A4 metabolism is affected when amiodarone used combinely with lidocaine and raising its levels
amiodarone: it may enhance serum concentrations of simvastatin
when both drugs combine amiodarone will increase effect of ifosfamide by affecting the enzyme CYP3A4 metabolism.
when both drugs are combined, there may be a decreased metabolism of etoposide   
when both drugs are combined, there may be an increased risk of nerve damage   
when both drugs are combined, there may be a reduced metabolism of erlotinib  
increase the therapeutic effect of daunorubicin by P-glycoprotein efflux transporter
QTc interval are increased both by lenvatinib and amiodarone.
the effect of amiodarone is decreased by lorlatinib, by altering intestinal or hepatic CYP3A4 enzyme metabolism
increases serum level of cabazitaxel by affecting the enzyme CYP3A4
May increase serum level and toxic effects of docetaxel by affecting MDR1/PG-P efflux transporter
when both drugs are combined, there may be an increased effect of ivosidenib by affecting hepatic or intestinal enzyme cyp3a4 metabolism  
when both drugs are combined, there may be an increased level or effect of amiodarone 
when both drugs are combined, there may be an increased QTC interval 
increase the therapeutic effect of idarubicin by P-glycoprotein efflux transporter
it enhances by affecting the hepatic enzyme CYP2C9 metabolism
relugolix/​estradiol/​norethindroneÂ
may increase the level of effectiveness through P-glycoprotein MDR1 efflux transporter
may enhance the serum concentration of CYP2C8 inhibitors
may increase the bradycardic effect of beta blockers
may increase the serum concentration of lidocaine
metabolism of amiodarone can be reduced when combined with telaprevir
an increased risk of hyperkalemia can be seen when amiodarone is administered with bumadizone
the risk of QTc prolongation may be increased
the toxicity of either of the drugs is increased due to pharmacokinetic synergism
the therapeutic activity of amiodarone may be reduced
the serum levels of amiodarone may be increased
the serum levels of amiodarone may increased
the rate of metabolism of dydrogesterone may be reduced
the risk or extent of hypoglycemia can be raised when amiodarone is combined with insulin pork
When amiodarone is used together with oliceridine, this leads to enhanced concentration serum of oliceridine
the cardio depressant activity of methoxyflurane may be increased
QT-prolonging other agents (highest Risk) may intensify amiodarone's QTc-prolonging action
QT-prolonging other agents (highest Risk) may intensify amiodarone's QTc-prolonging action
QT-prolonging other agents (highest Risk) may intensify amiodarone's QTc-prolonging action
QT-prolonging other agents (highest Risk) may intensify amiodarone's QTc-prolonging action
the rate of metabolism of tocofersolan may be reduced with amiodarone
Actions and SpectrumÂ
Amiodarone has a moderate sodium channel blocking effect, which helps to slow down the conduction of electrical impulses in the heart. They inhibit sodium channels; it prolongs the action potential duration and refractory period in cardiac cells.Â
Amiodarone possesses alpha-adrenergic blocking properties, although this effect is less pronounced compared to its beta-blocking action.Â
Frequency definedÂ
1-10%Â
CHFÂ Â
Hyperthyroidism Â
Visual disturbances Â
Optic neuritis Â
Hepatitis and cirrhosis Â
SA node dysfunction Â
>10%Â
Hypotension Â
Constipation Â
Anorexia Â
Malaise Â
Photosensitivity Â
Abnormal gait/ataxia Â
Frequency not definedÂ
Demyelinating polyneuropathyÂ
Corneal microdepositsÂ
Post marketing ReportsÂ
Hypersensitivity: angioedema, urticariaÂ
Gastrointestinal: cirrhosis, pancreatitis, dry mouth, Hepatitis, cholestatic hepatitisÂ
Psychiatric: Hallucination, confusional state, disorientation, deliriumÂ
Neurology: Pseudotumor cerebri, parkinsonian symptomsÂ
Black Box WarningÂ
It has the potential to cause severe and potentially fatal lung damage, including pulmonary fibrosis.Â
Amiodarone is used to treat arrhythmias; it can also cause new or worsened arrhythmias. This risk is particularly relevant during the initiation and dose-adjustment phases of treatment.Â
Amiodarone can cause liver damage, ranging from asymptomatic increases in liver enzymes to severe liver injury, including liver failure.Â
Contraindication/Caution:Â
ContraindicationÂ
HypersensitivityÂ
Pregnancy/LactationÂ
Pregnancy consideration:Â
Pregnancy category: Insufficient data availableÂ
Lactation: Excretion of the drug in human breast milk is knownÂ
Pregnancy Categories:Â
Category A: well-controlled and Satisfactory studies show no risk to the fetus in the first or later trimester.Â
Category B: there was no evidence of risk to the fetus in animal studies, and there were not enough studies on pregnant women.Â
Category C: there was evidence of risk of adverse effects in animal reproduction studies, and no adequate evidence in human studies must take care of potential risks in pregnant women.Â
Category D: adequate data with sufficient evidence of human fetal risk from various platforms, but despite the potential risk, and used only in emergency cases for potential benefits.Â
Category X: Drugs listed in this category outweigh the risks over benefits. Hence these categories of drugs need to be avoided by pregnant women.Â
Category N: There is no data available for the drug under this category.Â
PharmacologyÂ
Amiodarone slows down the depolarization phase and lengthens the action potential duration by inhibiting sodium channels, especially in their inactivated state. Numerous potassium channels are blocked by amiodarone. The refractory period and repolarization phase of cardiac cells are both extended as a result of this action.Â
PharmacodynamicsÂ
It prolongs the duration of the cardiac action potential, primarily by blocking potassium channels responsible for repolarization. This prolongation leads to an increase in the effective refractory period, which reduces the re-entry circuits and can help terminate arrhythmias.Â
PharmacokineticsÂ
AbsorptionÂ
Food like high-fat meals can significantly increase the bioavailability of amiodarone.Â
DistributionÂ
Amiodarone has a large volume of distribution approximately 66 L/kg.Â
MetabolismÂ
Amiodarone undergoes hepatic metabolism primarily through the cytochrome P450 (CYP) enzyme.Â
Elimination and excretionÂ
The elimination of amiodarone and its metabolites primarily occurs through biliary excretion into feces.Â
AdministrationÂ
It can be administered via different routes, including oral, intravenous, and intraosseous.Â
Patient information leafletÂ
Generic Name: amiodaroneÂ
Why do we use amiodarone?Â
Amiodarone is used for the treatment of ventricular arrhythmias.It can be used as a preventive measure to reduce the risk of further life-threatening arrhythmias.Â
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