Cordarone: Advanced Antiarrhythmic Therapy for Sustained Cardiac Rhythm Control
Cordarone
| Product dosage: 100mg | |||
|---|---|---|---|
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| 270 | $0.94 | $405.00 $255.00 (37%) | 🛒 Add to cart |
| 360 | $0.88
Best per pill | $540.00 $315.00 (42%) | 🛒 Add to cart |
| Product dosage: 200mg | |||
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Cordarone (amiodarone hydrochloride) is a potent Class III antiarrhythmic agent indicated for the management of severe ventricular and supraventricular arrhythmias. With its multi-channel blocking properties and prolonged half-life, it offers a robust therapeutic option for patients refractory to other antiarrhythmic treatments. Its unique pharmacokinetic profile allows for sustained rhythm control, making it particularly valuable in high-risk cardiac cases where conventional therapies have proven inadequate. Expert clinicians rely on Cordarone for its demonstrated efficacy in maintaining sinus rhythm and preventing life-threatening arrhythmic events.
Features
- Active ingredient: Amiodarone hydrochloride
- Available formulations: 200 mg oral tablets; 150 mg/3 mL intravenous solution
- Multi-channel blocking action: potassium, sodium, and calcium channels
- Non-competitive alpha and beta-adrenergic inhibition
- Extensive tissue distribution with high lipid solubility
- Prolonged elimination half-life (25-110 days)
- CYP450 enzyme inhibition properties
- High iodine content (37.2% by weight)
Benefits
- Effective suppression of recurrent ventricular fibrillation and hemodynamically unstable ventricular tachycardia
- Superior maintenance of sinus rhythm in patients with atrial fibrillation compared to other antiarrhythmic agents
- Reduced hospitalization rates for arrhythmia-related cardiovascular events
- Long-term rhythm stability due to extended half-life and tissue accumulation
- Single-agent efficacy often eliminating need for combination antiarrhythmic therapy
- Proven mortality benefit in specific high-risk patient populations
Common use
Cordarone is primarily indicated for the treatment of documented, life-threatening recurrent ventricular fibrillation and recurrent hemodynamically unstable ventricular tachycardia in patients who have not responded adequately to other antiarrhythmic agents or who cannot tolerate alternative therapies. It is also used for the pharmacological cardioversion of atrial fibrillation and flutter, particularly when rhythm control is preferred over rate control strategies. The medication finds application in postoperative cardiac surgery patients experiencing arrhythmias and is sometimes used off-label for certain supraventricular tachyarrhythmias in specialized clinical scenarios. Its use requires careful patient selection and ongoing monitoring due to the potential for serious adverse effects.
Dosage and direction
Oral Administration: Loading dose: 800-1600 mg daily in divided doses for 1-3 weeks Maintenance dose: 200-400 mg daily, typically as a single dose Maximum daily dose: 400 mg for chronic therapy
Intravenous Administration: Initial infusion: 150 mg over 10 minutes followed by 360 mg over next 6 hours Maintenance infusion: 540 mg over remaining 18 hours Continuous infusion rate: 0.5-1.0 mg/minute
Dosage must be individualized based on therapeutic response, adverse effects, and serum concentrations when available. Hepatic and renal function should be considered when determining appropriate dosing. The extended half-life necessitates careful titration and gradual dose reduction when discontinuing therapy.
Precautions
Regular ophthalmologic examinations are mandatory due to risk of optic neuropathy and corneal microdeposits. Pulmonary function tests including chest X-ray and spirometry should be performed baseline and every 3-6 months during therapy. Thyroid function tests (TSH, T3, T4) must be monitored every 3-6 months due to iodine content. Liver function tests should be conducted regularly, with particular attention to transaminase levels. Electrolyte levels, especially potassium and magnesium, should be maintained within normal ranges. Patients require education about photosensitivity and appropriate sun protection measures. Regular ECG monitoring is essential to assess for QT interval prolongation and arrhythmia suppression.
Contraindications
- Severe sinus node dysfunction with marked sinus bradycardia
- Second- or third-degree AV block without functioning pacemaker
- Cardiogenic shock
- Known hypersensitivity to amiodarone or iodine
- Severe hepatic impairment
- Pregnancy (except in life-threatening circumstances)
- Breastfeeding
- Concurrent use of drugs that prolong QT interval and pose risk of torsades de pointes
- Thyroid dysfunction unless no alternative therapy exists
Possible side effects
Common (≥1%): Corneal microdeposits (virtually 100% with long-term use), photosensitivity, blue-gray skin discoloration, nausea, vomiting, constipation, elevated liver enzymes, sinus bradycardia
Serious (<1% but potentially severe): Pulmonary toxicity (fibrosis, pneumonitis), hepatotoxicity including cirrhosis, hypothyroidism or hyperthyroidism, peripheral neuropathy, optic neuritis/neuropathy, torsades de pointes, hematological abnormalities, corneal ulceration
The risk-benefit ratio must be carefully evaluated, with many side effects being dose- and duration-dependent. Some adverse effects may persist long after discontinuation due to the drug’s extended half-life.
Drug interaction
Cordarone significantly interacts with numerous medications due to its CYP450 inhibition and QT-prolonging effects:
- Warfarin: Increased anticoagulant effect requiring dose reduction
- Digoxin: Increased serum levels necessitating 50% dose reduction
- Statins: Increased risk of myopathy, particularly with simvastatin
- Beta-blockers and calcium channel blockers: Enhanced bradycardic effects
- Phenytoin: Altered metabolism of both agents
- Cyclosporine: Increased serum concentrations
- QT-prolonging agents (fluoroquinolones, antipsychotics): Additive QT prolongation risk
- Theophylline: Increased serum levels requiring monitoring
Missed dose
If a dose is missed, it should be taken as soon as remembered unless it is nearly time for the next scheduled dose. Patients should never double the dose to make up for a missed administration. Due to Cordarone’s long half-life and extensive tissue distribution, occasional missed doses are unlikely to significantly affect therapeutic efficacy in well-maintained patients. However, consistent adherence is important for optimal arrhythmia control. Patients should maintain a regular dosing schedule and contact their healthcare provider if multiple doses are missed.
Overdose
Symptoms may include bradycardia, hypotension, heart block, hepatic dysfunction, and QT prolongation leading to torsades de pointes. Management involves immediate discontinuation of the drug, gastric lavage if recent ingestion, and supportive care including hemodynamic monitoring. Bradycardia may require temporary pacing, while torsades de pointes should be managed with magnesium sulfate and electrical cardioversion if necessary. Charcoal hemoperfusion and plasmapheresis are not effective due to extensive tissue binding. There is no specific antidote, and management remains supportive with close monitoring in an intensive care setting.
Storage
Store at controlled room temperature (20-25°C or 68-77°F) in the original container protected from light and moisture. Keep tightly closed and away from excessive heat. Do not freeze. Keep out of reach of children and pets. The intravenous formulation should be stored in the original carton and protected from light until administration. Do not use if discoloration or particulate matter is visible in the solution. Proper disposal of unused medication is essential due to environmental concerns regarding iodine content.
Disclaimer
This information is provided for educational purposes only and does not constitute medical advice. Cordarone is a prescription medication that should only be used under the supervision of a qualified healthcare professional familiar with its complex pharmacology and monitoring requirements. The prescribing physician must carefully evaluate the risk-benefit ratio for each individual patient. Patients should not initiate, adjust, or discontinue therapy without medical supervision. Full prescribing information including boxed warnings should be reviewed before administration.
Reviews
“Cordarone remains the most effective antiarrhythmic in my practice for difficult-to-treat ventricular arrhythmias. While the monitoring requirements are substantial, the clinical results in appropriately selected patients are unparalleled.” - Cardiac Electrophysiologist, 15 years experience
“The drug’s efficacy comes with significant management challenges. We’ve implemented a systematic monitoring protocol that has helped us detect early signs of toxicity before they become clinically significant.” - Cardiology Pharmacy Specialist
“Patient education is crucial with Cordarone. Those who understand the importance of regular monitoring and recognize early warning signs tend to have better long-term outcomes with fewer adverse effects.” - Advanced Practice Nurse, Arrhythmia Clinic