First Dose of Amiodarone in ACLS: Guidelines, Dosage, and Administration 2025 Guideline

First Dose of Amiodarone in ACLS: Guidelines, Dosage, and Administration

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Amiodarone is a critical antiarrhythmic medication used in Advanced Cardiovascular Life Support (ACLS) for managing life-threatening cardiac arrhythmias. Understanding the first dose of amiodarone in ACLS is essential for healthcare providers to ensure proper resuscitation and improve patient outcomes.

First Dose of Amiodarone in ACLS: Guidelines, Dosage, and Administration


When to Use Amiodarone in ACLS

The American Heart Association (AHA) recommends amiodarone in ACLS for:

  • Pulseless Ventricular Tachycardia (pVT)
  • Ventricular Fibrillation (VF)
  • Recurrent or refractory ventricular arrhythmias

It is considered when shockable rhythms persist despite defibrillation and epinephrine administration.

First Dose of Amiodarone in ACLS

According to the ACLS guidelines, the initial dose of amiodarone in cardiac arrest is:

  • First dose: 300 mg IV/IO push
  • Second dose (if needed): 150 mg IV/IO push

The first dose of amiodarone should be administered as soon as possible after the second unsuccessful defibrillation attempt for VF or pulseless VT.

How to Administer Amiodarone in ACLS

  • Administer the first dose of amiodarone (300 mg) as a rapid IV push.
  • If the arrhythmia persists, give a second dose of 150 mg after 3-5 minutes.
  • Always flush with at least 20 mL of normal saline after administration.
  • Continuous cardiac monitoring is required to assess response and detect potential complications.

Post-Resuscitation Amiodarone Infusion

If the patient achieves Return of Spontaneous Circulation (ROSC) but is still at risk of arrhythmias, a maintenance infusion is recommended:

  • Loading dose: 150 mg over 10 minutes
  • Maintenance infusion: 1 mg/min for 6 hours, then 0.5 mg/min for 18 hours

Precautions and Side Effects

  • Hypotension – Can be minimized by slowing the infusion rate.
  • Bradycardia – May require temporary pacing or atropine.
  • QT prolongation – Risk of torsades de pointes, so continuous ECG monitoring is necessary.

Amiodarone vs. Lidocaine in ACLS

Although amiodarone is the preferred antiarrhythmic, lidocaine can be an alternative if amiodarone is unavailable. The first dose of lidocaine in ACLS is 1-1.5 mg/kg IV/IO, followed by additional doses if needed.

Conclusion

The first dose of amiodarone in ACLS is 300 mg IV push, followed by 150 mg if necessary. Proper administration of amiodarone can improve survival in patients with refractory ventricular fibrillation or pulseless ventricular tachycardia. Healthcare providers must be familiar with ACLS protocols to optimize patient outcomes in cardiac arrest situations.

By following evidence-based ACLS guidelines, clinicians can enhance the effectiveness of resuscitation efforts and increase the chances of a successful outcome.

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