What is your loading dose goal and typical loading regimen for PO amiodarone in patients with atrial fibrillation?

I generally aim for a loading dose of 10 grams. This is a combination of both IV and PO amiodarone administered. For an outpatient, I utilize one of the original dosing schedules consisting of 200 mg TID x 3 weeks, followed by 200 mg daily (although this is a little more than 10 grams). For an inpatient, where we are trying to load more quickly), I will sometimes give 400 mg BID for 12-14 days and rarely 400 mg TID for about a week.

I dose amiodarone differently when treating AF compared to when treating VT. For AF, assuming that the patient has been adequately anticoagulated since we are not dealing with a life-threatening arrhythmia, I generally do an initial loading of 400mg BID for 7 days and then cutting back to 200mg daily for maintenance. For older patients, I sometimes go even gentler and do 400mg daily x 10 days and then 200mg daily for maintenance. I find that patients tend to have less nausea with this and has a higher compliance rate since it is a relatively simple regimen to follow. In my experience, I find that there will be some clinical effects once the patient has a minimum of 4 grams of amiodarone on board, even though the effects will not yet be opti...

I agree with all the above. These answers are very helpful.

The one time when I am cautious and don't use this loading protocol is when I am not sure if the patient will have a close follow-up.

It has not happened to me personally, but I have heard of cases where patients did not follow up as scheduled (for many different reasons) and kept getting refills from the pharmacy for high doses of Amiodarone. They finally came to the clinic a few months later having taken high doses of Amiodarone all along without having Thyroid tests, LFTs, or pulmonary tests done.

Otherwise, agree with everyone's answers.

Thanks!

Kind regards,
Rajat Jhanjee

I don’t think there is a consensus or guidelines on this. For atrial fibrillation rhythm control, the goal is generally 6-10 grams loading dose. Outpatient I would do 400 mg bid for 1 week, 400 mg QD for 2-4 weeks then 200 mg QD as maintenance. As an inpatient oral load is 400 mg TID x 5 days, or IV amiodarone load for 24 hours and transition to 400 mg bid for 5-7 days then 400 mg QD for 2-4 weeks then 200 mg QD. Disclosure- I am not an electrophysiologist.