28 (24%)

5 (4%)

4 (3%)

4 (3%)

4 (3%)

0 (0%)

32 (27%)

7 (6%)

2 (2%)

2 (2%)

3 (3%)

2 (2%)

28 (26%)

5 (5%)

6 (6%)

4 (4%)

2 (2%)

1 (1%)

-

-

-

-

-

-

There was a significant dose-related increase in the time to first event (p= 0.025). A difference was observed between the 125 mg and 1,000 mg dose groups (p<0.030), but not between the 125 mg and 500 mg (p= 0.100) or 500 mg and 1,000 mg (p= 0.500) groups.

Adverse Events

See results; hypotension was the most common (26%) treatment-emergent adverse event during IV amiodarone therapy; there was no dose-response relationship.

Study Author Conclusions

Intravenous amiodarone is effective for the treatment of recurrent, life-threatening ventricular tachyarrhythmias.

InpharmD Researcher Critique

One major limitation of this study is the inclusion of patients with hemodynamically destabilizing VT, as the associated hypotension complicates outcome interpretations. Additonally, the study's dated publication may limit the applicability of its findings, as treatment practices have evolved. Furthermore, the allowance of 150 mg supplemental IV amiodarone infusions to manage recurrent ventricular tachyarrhythmias may have confounded the interpretation of the dose-response relationship for event rates.

References: Scheinman MM, Levine JH, Cannom DS, et al. Dose-ranging study of intravenous amiodarone in patients with life-threatening ventricular tachyarrhythmias. The Intravenous Amiodarone Multicenter Investigators Group. Circulation. 1995;92(11):3264-3272. [doi:10.1161/01.cir.92.11.3264](https://doi.org/10.1161/01.cir.92.11.3264) Background Background Multisociety guidelines published in 2018 on antiarrhythmic drugs provide an overview of clinical pharmacology and recommended monitoring parameters. Co-administration of amiodarone with digoxin, beta-blockers, verapamil, or diltiazem should be closely monitored due to increased risk of bradycardia, atrioventricular (AV) block, and hypotension; however, data supporting a dose-dependent relationship between amiodarone and hypotension or shock were not described in the guidelines. [\[1\]](https://inpharmd.com/inquiries/a8f809f8678dfad2a2bc7ece3a9fdf897191a5933a8329b6b66639cb3cace7b9#citation-1) Due to administration of amiodarone in critically ill patients who were already hemodynamically unstable, an exact correlation between incidence of hypotension and amiodarone administration was difficult to discern. Thus, one 2003 randomized, double-blind, placebo-controlled trial investigated the acute cardiovascular effects of an intravenous (IV) loading dose of amiodarone in 30 adult patients undergoing non-emergent coronary artery bypass grafting. Participants were stratified based on their preoperative left ventricular ejection fraction (LVEF) into those with LVEF ≤30% or \>30% and were randomly assigned to receive either 150 mg of intravenous amiodarone diluted in 100 mL of normal saline or an equivalent placebo over 10 minutes following sternal closure. Notably, hypotension requiring intervention occurred in 3 patients (20%) of the amiodarone cohort versus 0 of placebo (p= 0.22); hypotension episodes in the amiodarone arm were transient and resolved without significant hemodynamic comprom

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