Use of amiodarone in emergency

Amiodarone is one of the most common anti-arrhythmic drugs used in the Emergency Department. Recent guidelines on cardiac arrest with shockable rhythm (refractory ventricular fibrillation (VF)/pulseless ventricular tachycardia (VT)) recommend amiodarone as an- ti-arrhythmic of first choice. Amiodarone is also first choice drug in the treatment of various ven- tricular and supra-ventricular tachyarrhythmias. This paper deals with the main therapeutical in- dications of amiodarone in emergency medi- cine: dosage, side effects, contraindications and pharmacological interactions are reviewed. Amiodarone is effective for control of hemody- namically stable VT, polymorphic VT and wide- complex tachycardia of uncertain origin. It is al- so helpful for ventricular rate control of rapid atrial arrhythmias in patients with severely im- paired left ventricular (LV) function, when digital- is has been ineffective, and is an adjunct to elec- trical cardioversion. The major side effects of amiodarone are hypotension, bradycardia and peripheral phlebitis. Major contraindications to the intravenous (iv) injection of amiodarone are bradycardia, senoatrial block, severe disturbs of conduction, second or third degree atrio-ventric- ular blocks. Other contraindications are hy- potension, severe respiratory failure, hepatocel- lular failure and hyperthyroidism. Pharmacologi- cal interactions are reported with HMG-CoA re- ductase inhibitors, class I antiarrhythmic agents and other drugs which contribute to prolong QT interval, digoxin, oral anticoagulants and gener- al anaesthesia.