A randomized hemodynamic comparison of intravenous amiodarone with and without Tween 80

In 20 patients undergoing coronary arteriography, the hemodynamiceffects of an experimental preparation of i.v. amiodarone 5mg kg^–1 without Tween 80 (N) (10 patients) were comparedwith those of the commercial form with Tween 80 (A) (10 patients).Analysis of variance demonstrated differences during the 3 minof injection and for 3 min afterwards: left ventricular systolicpressure decreased from 110+ 11 to 86±11 mmHg (p=0.001)after A and from 114±22 to 106±19 (p=0.05) afterN (comparison p=0.01) while related tachycardia was also morepronounced after A (comparison P=0.001). Left ventricular enddiastolic pressure transiently decreased after A while continuouslyincreasing after N (P=0.05). During the following 30 min bothA and N caused similar bradycardia, increase in ventricularfilling pressure, vascular resistance and decrease in cardiacand contractility indexes. Amiodarone blood levels were similarafter A or N. These data document a significant initial shortduration vasoplegia, mainly related to Tween 80, after A, whenamiodarone itself after producing a similar very slight effectcauses bradycardia, and a moderate and progressive negativeinotropic effect. It was concluded that while the experimental form would be ofinterest, the risk of severe hypotension after i.v. Cordaronecan be largely avoided by using a slower rate of infusion, especiallyin patients with hypovolemic status.