Table 2.
Synoptic precautions for prevention of pulmonary toxicity by safe dosage of amiodarone
| Daily dose | Phase of therapy | Application form | Duration | |
|---|---|---|---|---|
| 1.8 g/d | Not used in any current dosing scheme as the maintenance dose. Experiences in this dosage level as initial loading dose are rare and date back to the l980s, when the incidence of pulmonary toxicity was observed more frequently (28). | not used | NA | NA |
| Initiation of treatment, initial loading phase: | ||||
| 1.2 g/d or 1.0 g/d | Loading dose in many centres and trials, usually limited to days (5–15 days). Should be monitored continuously. Higher doses do not bear electrophysiological benefits (26) while lower doses delay the control over the arrhythmia. Amiodarone should be administered orally as soon as control over the arrhythmia is achieved. | Initial saturation phase | p.o., i.v. in malabsorption or until life-threatening arrhythmia controlled | 5–15 days |
| 800 mg/d | Reduced loading dose in special indications, elderly patients or reduced organ functions (as in our case). | |||
| Intermittent loading phase, re-saturation doses: | ||||
| 600 mg/d | Usual maximum daily dose used outside a specialized arrhythmia monitoring ward or an intensive care unit. Intravenous application is unnecessary except for special indications (e.g. malabsorption). Transiently used, limited to several (4–8) weeks. This daily dose sometimes is employed for a re-saturation after relapse of an arrhythmia under a low maintenance dose. | Intermittent re-saturation, consecutive loading | p.o., i.v. in malabsorption | 4–8 weeks |
| 400 mg/d | Integrated in an initiation scheme for some weeks (see also loading scheme in our arrhythmia centre). A relapse of the arrhythmia might necessitate temporary re-elevation of dosing. In rare cases this might be the elevated maintenance dose under special indications. A dose of 400 mg/d that is obviously not limited to several weeks should be reason for further individual clarification with a rhythmologist. | Consecutive loading phase | p.o. | 4 weeks |
| Maintenance dose | ||||
| 200 mg/d | Normal maintenance dose. Higher maintenance doses need special indications (e.g. futile trials of dose reduction in the patient’s history). In these cases, it should be discussed whether an intermittent loading phase with subsequent lower maintenance dose might be more effective and less toxic. | Maintenance therapy | p.o. exclusively | maintenance |
| 100 mg/d | Reduced maintenance doses in elderly patients with reduced organ function. | Reduced dose | p.o. exclusively | |