Intravenous amiodarone for recurrent sustained hypotensive ventricular tachyarrhythmias

Levine, Joseph; Massumi, Ali; Scheinman, Melvin M.; Winkle, Roger A.; Platia, Edward V.; Chilson, Donald A.; Gomes, J. Anthony; Woosley, Raymond L.

doi:10.1016/0735-1097(95)00427-0

Cited by 196 publications

(77 citation statements)

References 11 publications

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“…58 Because of the use of investigator-initiated, intermittent, open-label amiodarone boluses for recurrent VT, the actual mean amiodarone doses received by the 3 groups were 742, 1175, and 1921 mg/d. There was no statistically significant difference in the number of patients without VT/VF recurrence during the 1-day study period: 32 of 86 (41%), 36 of 92 (45%), and 42 of 92 (53%) for the low-, medium-, and high-dose groups, respectively.…”

Section: Short-term Control Of Vt/vfmentioning

confidence: 99%

Evidence-Based Analysis of Amiodarone Efficacy and Safety

1999

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Section: Short-term Control Of Vt/vfmentioning

confidence: 99%

Evidence-Based Analysis of Amiodarone Efficacy and Safety

1999

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“…In another study by Levine et al no clear dose-response relation was found in the treatment of recurrent sustained hypotensive ventricular tachyarrhythmias, with respect to success rates, time to first recurrence of tachyarrhytmia or mortality over 24 h. However, there was reported a significant dose-response relation between the 500-mg dose group and the combined 1000-and 2000-mg dose groups in the time to first event when the first 12 h were considered. This discrepancy could be explained by the small sample size of the study or the relative insensitivity of these end points 52 . Kinetic analysis of plasma levels of i.v.…”

Section: Intravenous Administrationmentioning

confidence: 97%

Therapeutic monitoring of amiodarone: pharmacokinetics and evaluation of the relationship between effect and dose/concentration

Vyskocilova¹,

Grundmann²,

Kacířová³

2017

Biomed Pap Med Fac Univ Palacky Olomouc Czech Repub

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Amiodarone is the most effective agent in the therapy of arrhythmias. However, the clinical effect of acute and chronic treatment is unclear and there are differences irrespective of comparable plasma/myocardial amiodarone and its metabolite desethylamiodarone concentations as well. Its unusual pharmacokinetics results in interindividual variation in plasma levels. The association between amiodarone and desethylamiodarone plasma levels and clinical efficacy is difficult to evaluate. This review was carried out to assess whether there is any objective correlation between amiodarone and desethylamiodarone plasma levels and the clinical effect. We summarized the results of relevant studies and clarified the relationship between plasma levels and effect vis á vis the pharmacokinetics and pharmacogenetics of this drug. Certain correlation was seen with oral amiodarone therapy, in others, plasma amiodarone levels were unrelated to therapeutic response and showed no correlation with changes in electrocardiogram or electrophysiological parametres. Several studies show that plasma concentration ranging between 0.5 and 2.5 mg/L appears to be the most effective, others demonstrate no difference between responders and non-responders. One way of interpreting plasma levels is to establish an individual patient´s effective concentration. Therapeutic drug monitoring can contribute to determining optimal concentration.

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“…In this popula-tion of severely ill patients, the rate of TdP was about 1%. 57,58 The rate of TdP was 1-3% in trials involving patients with a variety of dysrhythmias treated with various doses of IV ibutilide. 32,[59][60][61] Torsades de pointes has not been associated with infusion of bretylium [62][63][64] or lidocaine, 2,65,66 a class IB antidysrhythmic.…”

Section: Discussionmentioning

confidence: 99%

Meta‐analysis of the Risk of Torsades de Pointes in Patients Treated with Intravenous Racemic Sotalol

Marill

Runge

2001

Academic Emergency Medicine

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Abstract. Objective: Intravenous (IV) racemic sotalol is useful for the treatment of multiple tachydysrhythmias. The authors hypothesized that the risk of torsades de pointes (TdP) in patients treated with a single IV infusion of sotalol is lower than the 2-4% risk associated with chronic oral sotalol therapy. Methods: A MEDLINE search under the subject heading ''sotalol'' was made of all publications involving humans written in English or German from 1966 to October 1, 2000. A meta-analysis of all original reports including patients who were given a single infusion of at least 1.5 mg/kg or 100 mg of IV sotalol over 30 minutes or less was performed. Potential variables predictive of TdP were assessed. The primary outcome was the observation of TdP associated with IV sotalol infusion. Secondary measurements included hypotension, bradycardia, and worsening of congestive heart failure. All excluded studies and case reports were also examined for evidence of TdP associated with IV sotalol treatment. Results: The search included 1,005 publications. There were 37 reports in which 962 patients received IV sotalol and met the inclusion criteria. There was one report of self-terminating TdP lasting 10 seconds among the 962 patients included in the study. There was no report of TdP associated with only IV racemic sotalol administration in any of the excluded studies. If it is assumed that the risk of TdP is homogeneous in the population of patients treated with IV sotalol, then based on the 962 included patients, the rate of TdP is 0.1% (95% CI = 0.003% to 0.6%). Conclusions: The overall risk of TdP in patients treated with a single infusion of IV sotalol is low compared with that in patients given chronic oral sotalol therapy.

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Intravenous amiodarone for recurrent sustained hypotensive ventricular tachyarrhythmias

Abstract: Intravenous amiodarone is a relatively safe therapy for ventricular tachyarrhythmias refractory to other medications.

Cited by 196 publications

References 11 publications

Evidence-Based Analysis of Amiodarone Efficacy and Safety

Evidence-Based Analysis of Amiodarone Efficacy and Safety

Therapeutic monitoring of amiodarone: pharmacokinetics and evaluation of the relationship between effect and dose/concentration

Meta‐analysis of the Risk of Torsades de Pointes in Patients Treated with Intravenous Racemic Sotalol

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