아미오다론
Amiodarone
Amiodarone hydrochloride
다른 이름: Cordarone · Pacerone · Nexterone · amiodaroni hydrochloridum · L3428 · 51087N · SKF-33134-A · Amiodaronum
VetSheet 수의사 팀 검수업데이트 2026년 4월 5일근거 기반 수의학 참고자료
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
동물 종별 용량
🌎 NA — North America🌍 EU — Europe
개
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| 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.
말
| 적응증 | 용량 | 경로 | 빈도 | 기간 | 지역 |
|---|---|---|---|---|---|
| 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.
용량은 수의사 전문가를 위한 임상 참고자료입니다. 반드시 최신 약물 정보 및 개별 환자에 따라 확인하시기 바랍니다.
개요
아미오다론은 주로 중증의 난치성 심실 및 상심실성 부정맥에 사용되는 강력하고 광범위한 제3형 항부정맥제입니다.
복잡한 약동학적 특성과 심각한 독성 가능성 때문에, 일반적으로 기존의 독성이 적은 치료법이 실패한 경우에만 제한적으로 사용됩니다.
임상 요점:
- 구조적으로 아미오다론은 요오드화 벤조푸란 유도체입니다. 200mg 정제 하나에는 약 75mg의 요오드가 포함되어 있어 갑상선 기능에 영향을 줄 수 있습니다.
- 지용성이 매우 높아 조직에 광범위하게 분포하고 지방 조직에 축적되며, 이는 반감기가 매우 길고 변동성이 큰 원인이 됩니다.
- 수의학에서는 특히 잠재성 확장성 심근병증(DCM)이 있으면서 빠른 넓은 QRS군 심실 빈맥이나 실신을 보이는 도베르만 핀셔에게 가장 흔히 사용됩니다.
- 부작용(간독성 및 갑상선 기능 장애 포함)의 위험이 높으므로 철저한 모니터링이 필수적입니다.
작용 기전
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.
안전성·주의사항
금기사항
- Hypersensitivity to amiodarone or iodine
- Severe sinus-node dysfunction
- Severe sinus bradycardia
- 2nd or 3rd degree AV block
- Bradycardial syncope
부작용
- 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)
주의
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.
약물 상호작용
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
모니터링
- 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)
약동학
반감기
흡수
Oral absorption is slow and variable. In horses, oral bioavailability is low (6-34%). In humans, bioavailability ranges from 22-86%.
분포
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%).
대사
Metabolized by the liver into the active metabolite desethylamiodarone.
배설
Clearance in horses is 0.35 L/kg/hr. Neither amiodarone nor its active metabolite are dialyzable.
과다투여
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.
제품
제형
- Oral tablets
- Injection solution
- Compounded oral suspension
인용의약품
- 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)
규제 현황
Human-approved products used off-label under the cascade.
POM (Prescription Only Medicine). Used under the prescribing cascade.
규제 데이터 없음: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
보관·안정성
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.
보호자 정보
반려동물에게 심각하고 생명을 위협할 수 있는 부정맥을 치료하기 위해 아미오다론이 처방되었습니다. 이 약은 매우 강력한 약물이므로 세심한 모니터링이 필요합니다.
- 사전 동의: 반려동물에 대한 이 약의 사용 경험이 제한적이고 독성의 위험이 있으므로, 수의사가 치료를 시작하기 전에 위험과 이점에 대해 설명할 것입니다.
- 투여 방법: 처방된 대로 정확하게 투여하십시오. 수의사와 상의 없이 임의로 투약을 건너뛰거나 갑자기 중단하지 마십시오.
- 주의해야 할 부작용: 반려동물이 식욕을 잃거나, 구토를 하거나, 평소보다 무기력해 보이거나, 기침을 하거나, 호흡 곤란을 보이면 즉시 수의사에게 연락하십시오.
- 추적 검사: 간 및 갑상선 기능을 모니터링하기 위한 정기적인 혈액 검사와 약물이 안전하게 작용하고 있는지 확인하기 위한 주기적인 심전도(ECG) 검사가 필요합니다.
VetSheet 의약품 참고자료는 수의사 전문가의 임상 의사결정 지원을 위한 것이며, 전문적 판단이나 제조사의 최신 약물 정보를 대체할 수 없습니다.