title: Evaluation of the Hemodynamic Effects of Intravenous Amiodarone Formulations During the Maintenance Phase Infusion.
abstract: BACKGROUND
  Two of the excipients in intravenous formulations of amiodarone, polysorbate 80 and benzyl alcohol, have been shown to cause hypotension. A newer formulation of amiodarone, which contains cyclodextrin, is devoid of these excipients.
  
  
  OBJECTIVE
  To evaluate the change in mean arterial pressure when utilizing 2 intravenous amiodarone formulations.
  
  
  METHODS
  This was a retrospective cohort analysis conducted at an academic medical center. Patients received intravenous amiodarone containing either polysorbate 80/benzyl alcohol (control) or cyclodextrin (cyclodextrin). Patients received these formulations based on a standard institutional protocol of 1 mg/min for 6 hours, followed by 0.5 mg/min for at least 18 hours or until discontinued by the provider. All data were collected from the medical record and included changes in blood pressures, time to lowest systolic blood pressure, concurrent antihypertensive use, and number of patients requiring treatment for hypotension.
  
  
  RESULTS
  A total of 160 patients (120 control, 40 cyclodextrin) were included. There was a statistically significant difference in mean arterial pressure between the groups receiving the control formulation of amiodarone compared with the cyclodextrin formulation across the 24-hour maintenance phase infusion (P < 0.001). There was a significant difference between formulations with regard to the change in mean arterial pressure during the 0- to 6-hour and 12- to 18-hour time blocks. There was a statistically significant difference in the number of patients receiving fluid boluses for treatment of hypotension (P = 0.001).
  
  
  CONCLUSIONS
  The excipients in the formulation of intravenous amiodarone may have a significant role in the hypotensive effects seen throughout the duration the maintenance phase infusion.
authors.affiliation: Bill Gatton College of Pharmacy at East Tennessee State University, Johnson City, TN, USA.
authors.forename: Desirae E
authors.initials: DE
authors.lastname: Lindquist
authors.affiliation: University of Tennessee Health Science Center, College of Pharmacy, Department of Clinical Pharmacy, Knoxville, TN, USA.
authors.forename: A Shaun
authors.initials: AS
authors.lastname: Rowe
authors.affiliation: University of Tennessee Graduate School of Medicine, Knoxville, TN, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Heidel
authors.affiliation: University of Tennessee Medical Center, Department of Pharmacy, Knoxville, TN, USA.
authors.forename: Travis
authors.initials: T
authors.lastname: Fleming
authors.affiliation: University of Tennessee Medical Center, Department of Pharmacy, Knoxville, TN, USA jryates@utmck.edu.
authors.forename: John R
authors.initials: JR
authors.lastname: Yates
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000638:Amiodarone / Q000627:therapeutic use*; D000959:Antihypertensive Agents / Q000627:therapeutic use*; D001592:Benzyl Alcohols; D003505:Cyclodextrins; D004304:Dosage Forms; D005079:Excipients; D005260:Female; D006439:Hemodynamics / Q000187:drug effects*; D006801:Humans; D007022:Hypotension / Q000139:chemically induced; D007262:Infusions, Intravenous; D008297:Male; D008875:Middle Aged; D011136:Polysorbates; D012189:Retrospective Studies
chemical_list: D000959:Antihypertensive Agents; D001592:Benzyl Alcohols; D003505:Cyclodextrins; D004304:Dosage Forms; D005079:Excipients; D011136:Polysorbates; D000638:Amiodarone
keywords: amiodarone; arterial pressure; benzyl alcohol; hypotension; polysorbates