Amiodarone Pediatric Dose — Resuscitation
Amiodarone is a class III antiarrhythmic agent that prolongs the cardiac action potential and refractory period through multichannel blockade (sodium, potassium, calcium channels, and beta-adrenergic inhibition). It is a first-line antiarrhythmic used in pediatric resuscitation for shock-refractory ventricular fibrillation (VF) and pulseless ventricular tachycardia (pulseless VT), as well as for hemodynamically significant perfusing tachycardias.
Pediatric Dosing
- VF / Pulseless VT (cardiac arrest): 5 mg/kg IV/IO rapid bolus
- Perfusing tachycardias: 5 mg/kg IV/IO infused over 20–60 minutes
Worked example: For a 20 kg child: 20 × 5 mg/kg = 100 mg total dose. Administer as a rapid IV/IO bolus for pulseless arrest, or dilute and infuse over 20–60 minutes for a perfusing rhythm. Consult institutional protocol for maximum single-dose limits and concentration guidelines.
Indications and Clinical Context
Amiodarone is indicated in pediatric cardiac arrest for VF or pulseless VT that persists after two or more defibrillation attempts and initial epinephrine administration, consistent with PALS resuscitation algorithms. It is the preferred antiarrhythmic in this setting due to its broad-spectrum activity and favorable evidence compared with older agents.
For perfusing (hemodynamically stable or unstable) tachycardias — including supraventricular tachycardia unresponsive to first-line measures and wide-complex tachycardias — amiodarone is infused slowly over 20–60 minutes to reduce the risk of hemodynamic compromise associated with rapid administration.
Administration and Monitoring
In cardiac arrest, the 5 mg/kg dose is delivered as a rapid IV/IO bolus followed by a normal saline flush. For perfusing tachycardias, the same dose must be diluted and administered over 20–60 minutes via IV/IO to mitigate hypotension and bradycardia. Intraosseous access is acceptable when IV access is unavailable.
- Route: IV or IO (preferred); avoid peripheral extravasation — amiodarone is highly vesicant
- Monitoring: Continuous cardiac monitoring for bradycardia, QT prolongation, and hypotension during and after infusion
- Key adverse effects: Hypotension, bradycardia, heart block, phlebitis at infusion site
- Contraindications: Known hypersensitivity to amiodarone or iodine; second- or third-degree AV block without a pacemaker
- Max dose / repeat dosing: Consult institutional protocol
Disclaimer: This article is an educational reference summarizing standard pediatric dosing values. It is not a substitute for clinical judgment. Always verify doses against institutional protocols, the current edition of authoritative references (e.g., Lexicomp, Harriet Lane Handbook, PALS guidelines), the patient’s accurate weight, and any patient-specific factors (renal/hepatic function, allergies, comedications) before administration.