Amiodarone and D5

[Kaisu]

Having been trained in a different system than the one I currently run in, it came as a shock to me that here all the medics insist that amiodarone must be diluted in D5 for intravenous administration.

I had been trained to mix it in NS, and have administered it that way with great success and no adverse affect.

Can someone please educate me?

[Aussieaid]

My understanding is that you can dilute it with either D5W or Normal Saline for pushes but it is more stable in D5W for longer infusions either intermittent or continuous.

[flamingemt2011]

http://www.vhpharmsci.com/PDTM/Monographs/amiodarone.htm

I would never use normal saline.

[triemal04]

Generally speaking amiodarone can be mixed with NS or D5W without any real issues. Only catch would be if it was a mix that was going to be used over a longer period of time (hours or days, depending on what reference you look at), and some say it also depends on the concentration; I think anything over 2 or 3mg/ml in NS is supposed to be a no-no.

Non-issue for EMS, even if you're dealing with a transport that lasts several hours.

Of course, amiodarone also reacts with plastics and really should be kept in glass bottles for longer infusions...but nobody talks about that one...

[DwayneEMTP]

http://www.vhpharmsc.../amiodarone.htm

I would never use normal saline.

See, I think that this is an excellent opportunity for you to begin making arguments instead of simple, useless statements.

No one cares what you would 'never do' without some logical idea as to why you would never do it. Good on you for posting your protocols, but a simple, "I don't know why" would have made you look less arrogant and much less silly.

Dwayne

[Kaisu]

My impression was that for EMS, there really is no need to worry about the NS vs. the D5. I was hoping someone had some studies. I do appreciate the comments so far.

[croaker260]

I am curious as well. I found several references that state it should not be mixed in concentrations grater than X, but no the rational. Is it a clinical or a chemcial reason?

[tcripp]

We had this conversation at our service last year when we didn't carry D5W on board. I'm not sure what sparked the conversation, but I believe the decision came down to the fact that it was recommended by the manufacturer.

We now carry D5W (100 mL) and have specific instructions for mixing/running so that we are all on the same page.

[Aussieaid]

Below are a couple of studies that showed there was no instability with either D5W or NS. No degradation even started until at least 18 days which is not even a consideration.

http://www.ncbi.nlm.nih.gov/pubmed/3706337

http://www.ijpc.com/abstracts/abstract.cfm?ABS=1285

I think you the manufacturer's recommendations are just ultra conservative. In the end it will come down to company protocols but you can safely use either admixture.

[Kaisu]

Thank you Aussieaid. That is the kind of information I was looking for.

It always upsets me when people say "you have to do so and so..." without any reason for it except what they've been told. I will continue to mix it in NS unless company protocols tell me otherwise. It is always good to have studies to back it up.