胺碘酮
Amiodarone
Amiodarone hydrochloride
別名: Cordarone · Pacerone · Nexterone · amiodaroni hydrochloridum · L3428 · 51087N · SKF-33134-A · Amiodaronum
由 VetSheet 獸醫團隊審訂更新於 2026年4月5日本內容以實證獸醫文獻為本
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
各物種劑量
🌎 NA — North America🌍 EU — Europe
狗
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
馬
| 適應症 | 劑量 | 途徑 | 頻次 | 療程 | 地區 |
|---|---|---|---|---|---|
| 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.
劑量為合格獸醫專業人員的臨床參考。請務必對照最新仿單及個別病患確認。
概覽
胺碘酮是一種強效、廣效的第三類抗心律不整藥物，主要用於治療嚴重且難治的心室與心上室性心律不整。
由於其複雜的藥代動力學特性及顯著的潛在毒性，通常僅在傳統且毒性較低的療法無效時才考慮使用。
臨床要點：
- 在結構上，胺碘酮是一種含碘的苯駢呋喃衍生物。一顆 200 毫克的錠劑約含有 75 毫克的碘，這可能會影響甲狀腺功能。
- 它具有高度脂溶性，導致其在組織中廣泛分佈並蓄積於脂肪組織中，這也是其半衰期極長且變異性大的原因。
- 在獸醫學中，最常用於患有隱性擴張性心肌病 (DCM) 的杜賓犬，特別是出現快速寬泛心室性心搏過速或暈厥的病例。
- 由於不良反應（包括肝毒性與甲狀腺功能障礙）的風險較高，必須進行嚴格的監測。
作用機轉
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.
安全性與警告
禁忌症
- Hypersensitivity to amiodarone or iodine
- Severe sinus-node dysfunction
- Severe sinus bradycardia
- 2nd or 3rd degree AV block
- Bradycardial syncope
不良反應
- 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)
注意事項
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.
藥物交互作用
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
監測
- 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)
藥物動力學
半衰期
吸收
Oral absorption is slow and variable. In horses, oral bioavailability is low (6-34%). In humans, bioavailability ranges from 22-86%.
分佈
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%).
代謝
Metabolized by the liver into the active metabolite desethylamiodarone.
排除
Clearance in horses is 0.35 L/kg/hr. Neither amiodarone nor its active metabolite are dialyzable.
過量
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.
可用產品
劑型
- Oral tablets
- Injection solution
- Compounded oral suspension
人用標示
- 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)
各地核准狀態
Human-approved products used off-label under the cascade.
POM (Prescription Only Medicine). Used under the prescribing cascade.
暫無法規資料: 🇺🇸 US · 🇭🇰 HK · 🇹🇼 TW · 🇯🇵 JP · 🇰🇷 KR · 🇦🇺 AU
儲存與穩定性
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.
飼主須知
您的寵物被處方了胺碘酮，以治療嚴重且可能危及生命的心律不整。由於這是一種非常強效的藥物，需要仔細的監測。
- 知情同意： 由於此藥物在寵物上的使用經驗有限且具有潛在毒性，您的獸醫師會在開始治療前與您討論其風險與益處。
- 給藥方式： 請嚴格按照處方給藥。未經獸醫師同意，請勿漏服或突然停藥。
- 需注意的副作用： 如果您的寵物出現食慾不振、嘔吐、異常嗜睡、咳嗽或呼吸困難，請立即聯繫您的獸醫師。
- 後續追蹤： 您的寵物需要定期進行血液檢查以監測肝臟和甲狀腺功能，並定期進行心電圖 (ECG) 檢查以確保藥物安全有效地發揮作用。
VetSheet 藥物參考供合格獸醫專業人員作臨床決策輔助之用，不能取代專業判斷或廠商最新仿單。