Clinical effects of intravenous to oral amiodarone transition strategies in critically ill adult patients. (15th April 2019)

• Record Type: Journal Article
• Authors: Arnouk, Serena; Aberle, Caitlin; Altshuler, Diana; Merchan, Cristian; Piper, Greta L.; Papadopoulos, John
• Is Part Of: Journal of clinical pharmacy and therapeutics. Volume 44:Number 5(2019)
• Page Start: 693
• Page End: 700
• Publication Date: 2019-04-15
• Subjects: antiarrhythmic drug -- cardiovascular disease -- clinical pharmacokinetics -- atrial fibrillation; Clinical pharmacology -- Periodicals; Chemotherapy -- Periodicals; 615
• DOI: 10.1111/jcpt.12841
• Languages: English
• ISSNs: 0269-4727

Abstract

Summary: What is known and objective: There is limited guidance on how to transition critically ill patients from intravenous (IV) to oral (PO) amiodarone. The objective of this study was to assess the impact of IV and PO amiodarone overlap on short‐term tachyarrhythmia recurrence and adverse hemodynamic outcomes in the intensive care unit. Methods: This is a retrospective, single‐center analysis of critically ill adults who were treated with IV amiodarone for a supraventricular arrhythmia with rapid ventricular rate (RVR) and transitioned to PO amiodarone while inpatient. Patients were excluded if rate control was not achieved prior to the PO transition. Receipt of concomitant IV and PO therapy for ≤2 hours was considered no overlap (NOV) and >2 hours was considered overlap (OV). Tachyarrhythmia recurrence and adverse hemodynamic events were compared between groups. Results: A total of 90 patients (45 NOV, 45 OV) were included in the analysis. The median overlap duration was 0.1 (−1.3 to 1.2) hours in the NOV arm and 4 (2.6‐6.1) hours in the OV arm. Recurrence of RVR occurred in 9 (20%) patients in each arm ( P = 1.0). The median time from IV discontinuation to return of tachyarrhythmia was 10.5 hours. There were no significant differences in amiodarone dosing, electrolyte abnormalities, volume status or concomitant cardiac medications at the time of IV to PO transition. Hypotension occurred in 13% and 20% ( P = 0.369) and bradycardia in 9% and 13% ( P = 0.502) of patients in the NOV and OV arms, respectively. What is new and conclusion: Providing IV and PO overlap of amiodarone for a median of 4 hours did not decrease the rate of early tachyarrhythmia recurrence. Future studies are warranted to evaluate the impact of alternative amiodarone dosing strategies on breakthrough tachyarrhythmia. Abstract : The present study demonstrated that the strategy of IV and PO amiodarone overlap for a median of 4 hours at the time of conversion to PO therapy did not decrease the risk of short‐term tachyarrhythmia recurrence. Nevertheless, patients who received overlap did not experience significantly more hypotension or bradycardia than those who did not receive overlap. Future studies are warranted to evaluate the impact of alternative amiodarone dosing strategies on breakthrough tachyarrhythmia.