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Intravenous and oral amiodarone for arrhythmias in children
Insights
Oral amiodarone effectively treated tachycardias in 30 children. Dosing for infants should use body surface area, and while side effects occurred, they weren't dose-dependent.
Area of Science:
- Pediatric Cardiology
- Clinical Pharmacology
Background:
- Tachyarrhythmias in children can be life-threatening.
- Amiodarone is an antiarrhythmic drug used for resistant cases.
Purpose of the Study:
- To evaluate the efficacy and safety of oral amiodarone in pediatric patients.
- To determine optimal dosing strategies for infants versus older children.
Main Methods:
- Retrospective analysis of 30 children (one week to 14 years) treated with oral amiodarone.
- Dosage adjustments based on body weight and body surface area were assessed.
- Plasma concentrations of amiodarone and its metabolite, desethylamiodarone, were measured.
Main Results:
- Oral amiodarone effectively controlled arrhythmias in 28 of 30 children.
- Infants required higher weight-based doses than older children, suggesting body surface area dosing is preferable.
- Adverse effects were common but not significantly correlated with dose or plasma levels; notable effects included skin pigmentation, hepatic dysfunction, and sleep disturbance.
Conclusions:
- Oral amiodarone is an effective treatment for pediatric tachycardias.
- Dosing of amiodarone in infants should be based on body surface area.
- Close monitoring for adverse effects is recommended during amiodarone therapy in children.
Abstract:
Oral amiodarone was administered to 30 children (aged one week to 14 years) for treatment of resistant or life threatening tachycardias. Five children received initial intravenous medication. The mean duration of oral treatment ranged from two weeks to 64 months (mean 23 months). Infants required a higher oral dose than older children when this was calculated on the basis of body weight but not when it was calculated on the basis of body surface area, indicating that the prescribed dose of amiodarone for infants should be calculated on the basis of body surface area. Although plasma concentrations of amiodarone were similar in infants and children, the plasma concentration of the metabolite desethylamiodarone was lower in infants. The arrhythmias were effectively controlled, by amiodarone alone in 19 and by amiodarone in combination with other drugs in nine children; amiodarone was ineffective in the remaining two children. Unwanted effects were common but were not significantly related to the dose, duration of treatment, or plasma concentration of amiodarone when group results were analysed. Grey facial skin pigmentation developed in two patients who received high cumulative doses of amiodarone and in whom plasma concentrations of amiodarone were high. Four children with biochemical hepatic dysfunction had high plasma concentrations of amiodarone and a further four children who experienced sleep disturbance had required high doses of amiodarone.