Fact or Fallacy: Amiodarone Loading Dose and Formulation
by Meagan Macalalag, PharmD, Jeffrey Fish, PharmD, BCCCP, FCCM
Question: Is there a clinical difference among the doses within the recommended cumulative loading dose range for amiodarone? Should the difference in bioavailability between the different amiodarone formulations be accounted for in the cumulative loading dose?
Amiodarone is commonly used to manage atrial and ventricular arrhythmias, but questions remain about the optimal cumulative loading dose and how intravenous and enteral formulations should be counted toward that total. This Fact or Fallacy article reviews the evidence behind the recommended 6- to 10-gram loading range, including the clinical trials and pharmacokinetic principles that have shaped current practice. The authors also examine the impact of differences in bioavailability between intravenous and enteral amiodarone and offer an evidence-based recommendation for calculating the cumulative load when both formulations are used.
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2026 September/October Table of Contents
Question: Is there a clinical difference among the doses within the recommended cumulative loading dose range for amiodarone? Should the difference in bioavailability between the different amiodarone formulations be accounted for in the cumulative loading dose?
Amiodarone is commonly used to manage atrial and ventricular arrhythmias, but questions remain about the optimal cumulative loading dose and how intravenous and enteral formulations should be counted toward that total. This Fact or Fallacy article reviews the evidence behind the recommended 6- to 10-gram loading range, including the clinical trials and pharmacokinetic principles that have shaped current practice. The authors also examine the impact of differences in bioavailability between intravenous and enteral amiodarone and offer an evidence-based recommendation for calculating the cumulative load when both formulations are used.
Download PDF
2026 September/October Table of Contents