Amiodarone Hydrochloride and Angiotensin II Acetate

• Generic Name: amiodarone
• Dosage Forms: n.a.
• Other Brand Names: Pacerone, Cordarone, Nexterone

Treatment to suppress or prevent the recurrence of documented life-threatening ventricular arrhythmias (e.g., recurrent VF; recurrent, hemodynamically unstable VT) that do not respond to documented adequate dosages of other currently available antiarrhythmic agents or when alternative antiarrhythmic agents are not tolerated.

Used during cardiac arrest for treatment of refractory (i.e., unresponsive to CPR, defibrillation, and a vasopressor [e.g., epinephrine]) VF or pulseless VT. Considered the preferred antiarrhythmic drug for this use in current ACLS guidelines in adults; lidocaine may be used as an alternative. In pediatric patients, current evidence supports use of either amiodarone or lidocaine.

Also may be used for treatment of wide-complex tachycardias during periarrest period; included in current ACLS guidelines for both adult and pediatric tachycardia.

Treatment of sustained monomorphic VT not associated with angina, pulmonary edema, or hypotension, or hemodynamically stable monomorphic VT.

Treatment of polymorphic (irregular) VT associated with myocardial ischemia in the absence of QT interval prolongation.

Has been used for primary prevention of sustained VT (i.e., VT lasting >30 seconds and/or associated with hemodynamic compromise), VF, or sudden cardiac death in patients with nonsustained ventricular arrhythmia following MI.

Has been used in a limited number of patients for life-threatening ventricular arrhythmias associated with post-infarction aneurysm or with chronic myocarditis induced by Chagas’ disease.

Used for suppression and prevention of various supraventricular tachycardias (SVTs).

Because of higher risk of toxicity and proarrhythmic effects, antiarrhythmic agents generally reserved for patients who do not respond to or cannot be treated with AV nodal blocking agents (β-adrenergic blocking agents, diltiazem, verapamil).

Some experts state amiodarone may be useful when ventricular rate control is needed but AV nodal blocking agents are contraindicated (e.g., patients with preexcited atrial arrhythmias associated with an accessory pathway).

May be effective for conversion of atrial fibrillation to normal sinus rhythm (i.e., rhythm control); however, other antiarrhythmic agents (e.g., flecainide, dofetilide, propafenone, ibutilide) are preferred.

Used to maintain sinus rhythm in patients with atrial fibrillation or flutter.

Termination of paroxysmal supraventricular tachycardia (PSVT), including atrioventricular nodal reentrant tachycardia (AVNRT) and atrioventricular reentrant tachycardia (AVRT) (e.g., Wolff-Parkinson-White syndrome); generally reserved for use when other therapies are ineffective or contraindicated. Avoid IV use in patients with Wolff-Parkinson-White syndrome who have preexcited atrial fibrillation; may accelerate ventricular rate and potentially cause life-threatening ventricular arrhythmias.

Also used for long-term prevention of PSVT, including those refractory to other antiarrhythmic agents.

Has been used in the treatment of atrial tachycardia.

Has been effective in the prevention of supraventricular arrhythmias associated with bradycardia-tachycardia syndrome.

Has been used in treatment of chronic stable angina pectoris and Prinzmetal variant angina; because of potential toxicity, generally not considered a first-line agent but may have beneficial antianginal effect in patients receiving the drug for the management of arrhythmias.

Has been used in the management of ventricular and supraventricular arrhythmias associated with hypertrophic cardiomyopathy.

• Generic Name: angiotensin II
• Dosage Forms: n.a.
• Other Brand Names: Giapreza

Used to increase BP in patients with septic or other distributive shock.

Substantially and rapidly increases mean arterial pressure (MAP) in patients who remain hypotensive despite fluid and vasopressor therapy.

May have a catecholamine-sparing effect, but effects on mortality not established.