Amiodarona
Amiodarone
Amiodarone hydrochloride
También conocido como: Cordarone · Pacerone · Nexterone · amiodaroni hydrochloridum · L3428 · 51087N · SKF-33134-A · Amiodaronum
Revisado por el equipo veterinario de VetSheetActualizado 5 abr 2026Referencia veterinaria basada en la evidencia
Las dosis son una referencia clínica para profesionales veterinarios autorizados. Confirme siempre con el prospecto actual y cada paciente individual.
Dosis por especie
🌎 NA — North America🌍 EU — Europe
Perros
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| For atrial fibrillation or ventricular arrhythmias primarily in ambulatory patients | 8-10 mg/kg PO every 12 hours | PO | q12h | — | 🌎 NA |
| For ventricular arrhythmias secondary to occult cardiomyopathy in Doberman pinschers | 10 mg/kg PO twice daily for one week and then 8 mg/kg PO once daily. After 6 months reduce to 5 mg/kg PO once daily. | PO | q12h then q24h | Long-term | 🌎 NA |
| For ventricular tachycardia when other first line drugs (Class I antiarrhythmics ± beta-blockers) are ineffective | 10 mg/kg PO q12h for one week and then 5 mg/kg PO q12h for maintenance. | PO | q12h | Long-term | 🌎 NA |
| For SVTs or Vtach | 10-20 mg/kg PO once daily (q24h) loading for 5-7 days; 5-10 mg/kg PO once daily thereafter. | PO | q24h | Long-term | 🌎 NA |
| Ventricular and supraventricular arrhythmias, atrial fibrillation, ventricular pre-excitation syndromes | Dose not specified in monograph | PO/IV | Not specified | Not specified | 🌍 EU |
- For atrial fibrillation or ventricular arrhythmias primarily in ambulatory patients: Use caution if patient has bradycardia, AV blocks, or thyroid disorders.
- For ventricular arrhythmias secondary to occult cardiomyopathy in Doberman pinschers: For severe V-Tach, mexiletine is added at 5-8 mg/kg three times daily for one week. Once efficacy confirmed, patient weaned off mexiletine.
- Ventricular and supraventricular arrhythmias, atrial fibrillation, ventricular pre-excitation syndromes: Use as an IV infusion for recent onset atrial fibrillation has variable efficacy for restoring sinus rhythm but a high frequency of severe adverse effects.
Caballos
| Indicación | Dosis | Vía | Frecuencia | Duración | Región |
|---|---|---|---|---|---|
| For conversion of atrial fibrillation or ventricular tachycardia | 5 mg/kg/hr for one hour, followed by 0.83 mg/kg/hr for 23 hours and then 1.9 mg/kg/hour for the following 30 hours. | IV | CRI | Up to 54 hours | 🌎 NA |
- For conversion of atrial fibrillation or ventricular tachycardia: Infusion was discontinued when conversion occurred or when any side effects were noted. Regimen should be further adapted based upon PK/PD studies.
Las dosis son una referencia clínica para profesionales veterinarios autorizados. Confirme siempre con el prospecto actual y cada paciente individual.
Resumen
La amiodarona es un agente antiarrítmico de Clase III potente y de amplio espectro, utilizado principalmente para arritmias ventriculares y supraventriculares graves y refractarias.
Debido a su perfil farmacocinético complejo y su potencial significativo de toxicidad, generalmente se reserva para casos en los que las terapias convencionales y menos tóxicas han fallado.
Perlas clínicas:
- Estructuralmente, la amiodarona es un derivado de benzofurano yodado. Un comprimido de 200 mg contiene aproximadamente 75 mg de yodo, lo cual puede afectar la función tiroidea.
- Es altamente lipofílica, lo que conduce a una extensa distribución tisular y acumulación en el tejido adiposo, contribuyendo a su vida media excepcionalmente larga y variable.
- En medicina veterinaria, se utiliza notablemente en Doberman Pinschers con miocardiopatía dilatada (DCM) oculta que presentan taquicardia ventricular rápida de complejo ancho o síncope.
- Debido al alto riesgo de efectos adversos (incluyendo hepatotoxicidad y disfunción tiroidea), es esencial un monitoreo riguroso.
Mecanismo de acción
Amiodarone is uniquely versatile, possessing properties of all four Vaughan-Williams antiarrhythmic classes, though it is primarily classified as a Class III agent.
- Class III (Primary): Blocks potassium (K+) channels → prolongs phase 3 repolarization, action-potential duration (APD), and the effective refractory period (ERP) in myocardial cells.
- Class I: Blocks fast sodium (Na+) channels → slows conduction velocity.
- Class II: Non-competitively blocks beta-adrenergic receptors → provides sympatholytic effects, reducing heart rate.
- Class IV: Weakly blocks calcium (Ca2+) channels → slows AV node conduction and suppresses automaticity.
It is metabolized in the liver to its active metabolite, desethylamiodarone, which also contributes significantly to its antiarrhythmic effects.
Seguridad y advertencias
Contraindicaciones
- Hypersensitivity to amiodarone or iodine
- Severe sinus-node dysfunction
- Severe sinus bradycardia
- 2nd or 3rd degree AV block
- Bradycardial syncope
Efectos adversos
- Vomiting
- Anorexia
- Hepatopathy (elevated liver enzymes, bilirubinemia)
- Bradycardia
- Neutropenia
- Thrombocytopenia
- Positive Coombs' test
- Corneal deposits
- Injection site pain (IV)
- Facial pruritus and hyperemia (IV)
- Hind limb weakness (horses)
- Diarrhea (horses)
Precauciones
High Toxicity Potential: Clinical experience in veterinary patients is limited. Use only when other less toxic and more commonly used drugs are ineffective.
- Hepatic Effects: Hepatopathy can occur before clinical signs are noted; routine serial evaluation of liver enzymes and bilirubin is strongly recommended.
- Thyroid Function: May alter thyroid hormone levels (increases T4 and reverse T3, decreases T3) due to high iodine content.
- Pregnancy: FDA Category D. Embryotoxic in laboratory animals; congenital thyroid abnormalities detected in offspring. Use only if benefits outweigh risks.
Interacciones farmacológicas
Significantly increases serum levels and/or pharmacologic/toxic effects of the anticoagulant.
Significantly increases serum levels and/or toxic effects of digoxin.
Increases cyclosporine levels; may increase creatinine.
Significantly increases serum levels and/or toxic effects of lidocaine.
Significantly increases serum levels and/or toxic effects with prolonged amiodarone administration.
Significantly increases serum levels and/or toxic effects of phenytoin.
Significantly increases serum levels and/or toxic effects of procainamide.
Significantly increases serum levels and/or toxic effects of quinidine.
Additive effects on QTc interval; possible serious arrhythmias.
Additive effects on QTc interval; possible serious arrhythmias.
Additive effects on QTc interval; possible serious arrhythmias.
Additive effects on QTc interval; possible serious arrhythmias.
Additive effects on QTc interval; possible serious arrhythmias.
Additive effects on QTc interval; possible serious arrhythmias.
Additive effects on QTc interval; possible serious arrhythmias.
Increased risks for hypotension or arrhythmias.
Possible potentiation of bradycardia, AV block, or sinus arrest.
Possible potentiation of bradycardia, AV block, or sinus arrest.
Increased amiodarone levels.
Possible hypotension, bradycardia.
Decreased amiodarone levels.
May significantly increase serum levels and/or pharmacological effects
May significantly increase serum levels and/or pharmacological effects
May significantly increase serum levels and/or pharmacological effects
May significantly increase serum levels and/or pharmacological effects
May significantly increase serum levels and/or pharmacological effects
Monitorización
- ECG (for antiarrhythmic efficacy and proarrhythmic effects)
- Gastrointestinal signs (anorexia, vomiting)
- CBC (for neutropenia, thrombocytopenia)
- Serial liver enzymes and bilirubin (baseline and routine monitoring)
- Thyroid function tests
- Blood pressure
- Pulmonary radiographs (if clinical signs such as dyspnea or cough occur)
Farmacocinética
Vida media
Absorción
Oral absorption is slow and variable. In horses, oral bioavailability is low (6-34%). In humans, bioavailability ranges from 22-86%.
Distribución
Widely distributed throughout the body and highly lipophilic, accumulating in adipose tissue. In horses, it has a high apparent volume of distribution (31 L/kg) and is highly bound to plasma proteins (96%).
Metabolismo
Metabolized by the liver into the active metabolite desethylamiodarone.
Eliminación
Clearance in horses is 0.35 L/kg/hr. Neither amiodarone nor its active metabolite are dialyzable.
Sobredosis
Clinical overdosage experience is limited.
Expected Signs:
- Hypotension
- Bradycardia
- Cardiogenic shock
- AV block
- Hepatotoxicity
Treatment:
- Therapy is primarily supportive.
- Bradycardia may be managed with a pacemaker or beta-1 agonists (e.g., isoproterenol).
- Hypotension may be managed with positive inotropic agents or vasopressors.
- Note: Neither amiodarone nor its active metabolite are dialyzable.
Productos disponibles
Formulaciones
- Oral tablets
- Injection solution
- Compounded oral suspension
Etiquetado para humanos
- Amiodarone Oral Tablets: 100 mg, 200 mg & 400 mg (Cordarone, Pacerone, generic)
- Amiodarone Injection Solution: 50 mg/mL in 3 mL, 10 mL & 30 mL single-dose vials, 18 mL multiple-dose vials & 3 mL prefilled syringes (Nexterone, generic)
Estado regulador
Human-approved products used off-label under the cascade.
POM (Prescription Only Medicine). Used under the prescribing cascade.
Sin datos reguladores para: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
Almacenamiento y estabilidad
Tablets should be stored in tight containers at room temperature and protected from light. Injection should be stored at room temperature and protected from light or excessive heat (light protection is not necessary during active IV administration). Compounded oral suspension (5 mg/mL in Ora-Plus/Ora-Sweet) retains >90% potency for 91 days when stored at 5°C and protected from light.
Información para el cliente
A su mascota se le ha recetado amiodarona para tratar una anomalía del ritmo cardíaco grave y potencialmente mortal. Debido a que este es un medicamento muy potente, se requiere un monitoreo cuidadoso.
- Consentimiento informado: Dado que la experiencia con este fármaco en mascotas es limitada y conlleva un riesgo de toxicidad, su veterinario discutirá los riesgos y beneficios con usted antes de comenzar el tratamiento.
- Administración: Administre el medicamento exactamente como se le indicó. No omita dosis ni suspenda el medicamento abruptamente sin consultar a su veterinario.
- Efectos secundarios a vigilar: Contacte a su veterinario de inmediato si su mascota deja de comer, vomita, parece inusualmente letárgica, desarrolla tos o tiene dificultad para respirar.
- Pruebas de seguimiento: Su mascota necesitará análisis de sangre regulares para monitorear la función hepática y tiroidea, así como electrocardiogramas (ECG) periódicos para asegurar que el medicamento esté funcionando de manera segura.
La referencia de medicamentos de VetSheet está destinada a profesionales veterinarios autorizados como ayuda para la toma de decisiones clínicas, no como sustituto del criterio profesional ni del prospecto actual del fabricante.