Amiodarone Pediatric Dose — Antiarrhythmic Agent
Amiodarone is a class III antiarrhythmic agent that acts by prolonging cardiac action potential duration and refractory periods, with additional class I, II, and IV properties. It is used in pediatric patients for the management of serious ventricular and supraventricular arrhythmias refractory to other therapies. Due to its complex pharmacokinetics and potential for significant adverse effects, amiodarone is typically reserved for use in monitored settings.
Pediatric Dosing
Loading Dose: 5 mg/kg IV administered over 25 minutes; may repeat up to 2 additional times as clinically indicated.
Maintenance Infusion: 5–15 mcg/kg/min IV continuous infusion following the loading dose.
- Load: 5 mg/kg IV over 25 min — may repeat × 2
- Infusion: 5–15 mcg/kg/min IV
Worked example — 20 kg child: Loading dose: 20 × 5 mg/kg = 100 mg IV over 25 minutes. Maintenance infusion: 20 × 5 mcg/kg/min = 100 mcg/min (minimum rate) up to 20 × 15 mcg/kg/min = 300 mcg/min. Consult institutional protocol for maximum cumulative daily dose and concentration limits.
Indications and Clinical Context
Amiodarone is indicated for the acute management of hemodynamically significant or refractory arrhythmias in pediatric patients, including ventricular tachycardia (VT), ventricular fibrillation (VF), and certain supraventricular tachycardias (SVT). In the context of pediatric advanced life support (PALS), amiodarone is a recommended antiarrhythmic for shock-refractory VF/pulseless VT during cardiac arrest and for stable wide-complex tachycardias. Its broad mechanism of action makes it particularly useful when rhythm origin is uncertain or when other agents have failed.
Amiodarone is administered in monitored settings such as the PICU or emergency department, where continuous cardiac monitoring and hemodynamic assessment are available. Given its vasodilatory properties and risk of hypotension during IV loading, careful patient selection and preparation are essential.
Administration and Monitoring
Amiodarone must be administered intravenously; IV access is preferred, though intraosseous (IO) access is acceptable in emergent situations. The loading dose should be infused over 25 minutes to reduce the risk of hypotension and bradycardia; rapid bolus delivery increases hemodynamic risk. Compatibility with the infusion line should be confirmed, as amiodarone can adsorb to PVC tubing and should ideally be administered via non-PVC tubing when available.
- Monitor continuously for bradycardia, heart block, and hypotension during and after loading
- QTc prolongation is expected; monitor ECG throughout therapy
- Avoid concurrent use with other QT-prolonging agents where possible
- Phlebitis risk at peripheral IV sites — central venous access preferred for prolonged infusions
- For infusion rate and concentration, consult institutional pharmacy and 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.