Intravenous and oral amiodarone for arrhythmias in children

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.