Wednesday June 13, 2007
Hypotension from intravenous Amiodarone

Continuing our theme from yesterday on Amiodarone, it would be of interest to know that hypotension from IV amiodarone bolus is mostly not due to amiodarone itself but due to its solubilized vehicle called polysorbate 80.

Polysorbate 80 itself can decreases heart rate by depressing AV nodal conduction and has property of increasing atrial and ventricular myocardial refractory period but can cause hypotension due to histamine releasing effect.

Polysorbate 80 is also blamed for Acute amiodarone-induced hepatitis but literature is scant on it.


References: click to get abstract/article

1. Pharmacology and Toxicology of a New Aqueous Formulation of Intravenous Amiodarone (Amio-Aqueous) Compared with Cordarone IV. - American Journal of Therapeutics. 12(1):9-16, January/February 2005.

2. Effects of amiodarone with and without polysorbate 80 on myocardial oxygen consumption and coronary blood flow during treadmill exercise in the dog - J Cardiovasc Pharmacol. 1991 Jul;18(1):11-6.

3. Histamine-releasing properties of Polysorbate 80 in vitro and in vivo: correlation with its hypotensive action in the dog - Agents Actions, 1985 Sep;16(6):470-7.

4. I.V. Amiodarone: What Do We Really Know About It? Cardiac Electrophysiology Review, Volume 2, Number 1 / March, 1998

5. Early acute hepatitis with parenteral amiodarone: a toxic effect of the vehicle? - Gut, Vol 34, 565-566, 1993