Intravenous amiodarone prolongs the QT interval and, though torsades is less common than with many other QT-prolonging drugs, the risk rises when potassium or magnesium is low or other QT-prolonging drugs are given alongside.
Check electrolytes and a baseline ECG, correct deficits, and review the drug chart for other QT-prolonging agents such as some antiemetics, macrolides and antipsychotics. Give infusions through a large or central vein where possible, because peripheral phlebitis is common at higher concentrations. Hypotension during the loading dose is usually rate-related.
- Check potassium and magnesium and correct them before or alongside the infusion.
- Record a baseline QTc and repeat the ECG during loading.
- Review co-prescribed QT-prolonging drugs.
- Use a large or central vein where possible to reduce phlebitis.
- If blood pressure falls during loading, slow the infusion.
Why it matters
Most drug-induced torsades happens when a QT-prolonging drug meets low electrolytes or a second QT drug.
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