Nexterone
Amiodarone solution (Nexterone) is an antiarrhythmic medication. It's used to stabilize serious and life-threatening heart rhythm problems, like ventricular fibrillation (VF) and ventricular tachycardia (VT), when other treatment options haven't worked well. Amiodarone solution comes in premixed (brand name Nexterone) or concentrate formulations for infusion. It's given intravenously (IV) in a hospital setting under the supervision of a cardiology team. Common side effects of the infusion include low blood pressure, nausea, and slow heart rate.
Once the heart rhythm stabilizes, the cardiology team might transition you to amiodarone oral tablets (Pacerone).
What is Amiodarone (Nexterone)?
What is Amiodarone (Nexterone) used for?
- Initial treatment and prevention of ventricular fibrillation (VF) and ventricular tachycardia (VT) that keeps coming back (when other treatments haven't worked)
How Amiodarone (Nexterone) works
Amiodarone (Nexterone) is a class III antiarrhythmic medication. It mainly works by blocking potassium channels in the heart. This slows down the electrical activity in the heart and stabilizes heart rhythm.
Drug facts
Side effects of Amiodarone (Nexterone)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
- Low blood pressure (16%)
- Slow heart rate (5%)
- Nausea (4%)
- Abnormal liver enzyme tests (3%)
- Sudden heart stop (3%)
Less Common Side Effects
- Injection site reactions (e.g., pain, redness, swelling)
- Fever
- Heart failure
- Diarrhea
- Breathing problems
- Vomiting
Amiodarone (Nexterone) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Dangerously low blood pressure: dizziness, lightheadedness, headache, confusion, blurry vision, nausea, vomiting, fast heart beat
- Lung damage: cough, trouble breathing, chest pain or tightness, wheezing, fever
- Serious heart problems: dizziness, fainting, chest pain, trouble catching your breath, tiredness, nausea, irregular heartbeat
- Serious liver problems: fever, chills, tiredness, vomiting, diarrhea, stomach pain, swollen belly, clay-colored stool, itchy skin, yellowing of the skin or whites of the eyes
- Thyrotoxicosis (dangerously high thyroid hormone level): diarrhea, shaking, tremors, agitation, anxiety, feeling hot
- Serious skin reactions: rash, blisters, peeling skin, flu-like symptoms
The following Amiodarone (Nexterone) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor or nurse immediately if any of the following side effects occur:
More common
Blurred vision
confusion
dizziness, faintness, or lightheadedness when getting up from a lying or sitting position suddenly
sweating
unusual tiredness or weakness
Less common
Black, tarry stools
bleeding gums
blistering, peeling, or loosening of the skin
blood in the urine or stools
chest pain or discomfort
chills
cold, clammy skin
decreased urine output
difficulty with breathing
dilated neck veins
dizziness
extreme fatigue
fainting
fast, pounding, or irregular heartbeat or pulse
fast, weak pulse
irregular heartbeat recurrent
joint or muscle pain
lightheadedness, dizziness, or fainting
no blood pressure or pulse
pinpoint red spots on the skin
red, irritated eyes
red skin lesions, often with a purple center
shortness of breath
slow or irregular heartbeat
sores, ulcers, or white spots in the mouth or on the lips
stopping of the heart
swelling of the face, fingers, feet, or lower legs
tightness in the chest
troubled breathing
unconsciousness
unusual bleeding or bruising
Incidence not known
Abdominal or stomach pain
agitation
back, leg, or stomach pains
bleeding gums
blurred or double vision
clay-colored stools
coma
confusion about identity, place, and time
cough or hoarseness
coughing or spitting up blood
cracks in the skin
dark-colored urine
decreased frequency or amount of urine
decreased urine output
difficulty swallowing
fever with or without chills
general body swelling
general feeling of tiredness or weakness
headache
high fever
holding false beliefs that cannot be changed by fact
hostility
increased blood pressure
increased thirst
indigestion
inflamed tissue from infection
irritability
large, hive-like swelling on the face, eyelids, lips, tongue, throat, hands, legs, feet, or sex organs
lethargy
light-colored stools
loss of appetite
loss of heat from the body
lower back or side pain
muscle cramps or spasms
muscle pain or stiffness
muscle twitching
muscular pain, tenderness, wasting, or weakness
noisy breathing
nosebleeds
painful or difficult urination
pains in the stomach, side, or abdomen, possibly radiating to the back
pale skin
persistent non-healing sore
pink growth
puffiness or swelling of the eyelids or around the eyes, face, lips, or tongue
rapid weight gain
rash
red, swollen skin
reddish patch or irritated area
redness, soreness, or itching skin
seeing, hearing, or feeling things that are not there
seizures
severe headache
shiny bump
sores, welting, or blisters
stupor
swollen or painful glands
unexplained bleeding or bruising
unpleasant breath odor
unusual excitement, nervousness, or restlessness
upper right abdominal pain
vomiting
vomiting of blood
weakness
white, yellow, or waxy scar-like area
yellow eyes and skin
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
Pros and cons of Amiodarone (Nexterone)
Pros
- IV amiodarone can start to work more quickly than amiodarone oral tablets
- Option for VF and VT when other medications haven't worked well
- Some side effects, like low blood pressure, can get better with a slower infusion rate
Cons
- Not for people with iodine allergy
- Infused through the veins, not good for people who don't like needles
- Not a good option for people who are pregnant
Pharmacist tips for Amiodarone (Nexterone)
- Your cardiologist will likely order blood work or other tests before you start and while you're taking amiodarone (Nexterone). These include electrocardiogram (ECG), liver enzyme levels, and thyroid function tests. These tests help your cardiologist see how well amiodarone (Nexterone) is working and if it's causing serious side effects.
- Some people experience low blood pressure, typically within hours, of starting amiodarone (Nexterone) infusion. This side effect is likely related to the infusion rate. Let your cardiology team know if you notice symptoms of low blood pressure, such as dizziness or feeling weak. They can slow down the infusion rate to help.
- Typically, people receive amiodarone (Nexterone) infusion for 2-3 weeks, until their condition becomes stable and they're able to take medications by mouth. After that, your cardiologist might transition you to the amiodarone oral tablet (Pacerone). If you're not sure, talk with your care team about next steps.
- If you and your cardiologist decide to stop amiodarone (Nexterone), this medication can still last in the body for many weeks. This means that you're still at risk for side effects and medication interactions for weeks after your dose.
- Avoid grapefruit or grapefruit juice while taking amiodarone (Nexterone) because it can raise the amount of the medication in your body, which raises your risk of side effects.
- Don't take amiodarone (Nexterone) during pregnancy because it can cause harm to growing babies. Let your healthcare team know if you're pregnant or want to become pregnant and they can let you know about safer treatment options.
Common questions about Amiodarone (Nexterone)
It can take a few days to weeks for amiodarone (Nexterone) to stabilize your heart rhythm. Your cardiologist will prescribe a higher loading dose during the first 24 hours so the medication can build up in your system. After that, they'll continue amiodarone (Nexterone) infusion with a lower maintenance dose. You might stay on the infusion for 2 to 3 weeks. Once your heart rhythm becomes stable and you're able to take medications by mouth, your cardiologist will likely replace amiodarone (Nexterone) infusion with amiodarone oral tablets (Pacerone).
Yes, people who receive amiodarone (Nexterone) infusion commonly experience low blood pressure, especially during the first few hours after starting treatment. But this side effect is likely related to the infusion rate, rather than the medication itself. If your blood pressure starts to drop, your cardiology team can slow down the infusion. If needed, they'll give you medications to bring your blood pressure back up. Rarely, blood pressure can drop dangerously low and won't respond well to treatments. In this case, your cardiologist might ask you to stop amiodarone (Nexterone). Let your care team know if you feel symptoms of low blood pressure, such as dizziness or weakness, after you start the infusion.
Amiodarone (Nexterone) can lower heart rate because it slows the electrical activity of the heart. This medication is FDA approved to treat fast heart rate (tachycardia). But sometimes, it can cause your heart rate to become too slow (bradycardia). Let your cardiologist know if you notice symptoms of very slow heart rate, like dizziness, tiredness, or chest pain.
Amiodarone (Nexterone) is a class III antiarrhythmic, not a beta blocker. Both amiodarone (Nexterone) and beta blockers can help with arrhythmia and lower heart rate, but they do so in different ways. Talk with your cardiologist if you have more questions about how amiodarone (Nexterone) works.
Amiodarone (Nexterone) can cause some rare but serious side effects. One example is lung toxicity. Symptoms include coughing or trouble breathing, and can appear within days to weeks after the start of treatment. Another example is liver problems. Most of the time, you can see signs of liver irritation only through blood tests. But rarely, you might feel symptoms of liver problems, like a swollen belly or nausea. To lower the risk of complications from amiodarone side effects, your cardiology team will likely order tests to check your lungs, liver, heart, and other parts of the body, before you start treatment. They'll continue to monitor you closely during your amiodarone (Nexterone) infusion. If needed, they might lower your dose of amiodarone (Nexterone) or ask you to stop taking this medication.
Amiodarone (Nexterone) isn't FDA-approved for atrial fibrillation (AFib), a type of heart rhythm problem. But amiodarone (Nexterone) is sometimes prescribed by cardiologists off-label for this condition. And once your condition is more stabilized, your care team will likely transition you from amiodarone infusion to oral amiodarone tablets. Talk with your healthcare team if you have more questions on amiodarone (Nexterone) and AFib.
Yes, amiodarone (Pacerone) is available as an oral pill. If you have a life-threatening heart rhythm condition, you cardiology team might try to stabilize your heart with amiodarone (Nexterone) infusion first. Once your condition is stable and you're able to take medications by mouth, your care team will ask you to switch from amiodarone infusion to amiodarone oral tablets.
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Risks and warnings for Amiodarone (Nexterone)
Amiodarone (Nexterone) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Low blood pressure
- Risk factors: Fast infusion rate
Hypotension (low blood pressure) is a common side effect of amiodarone (Nexterone) infusions. It typically occurs within the few hours of treatment. Low blood pressure is more likely related to how quickly the medication is infused, and not the medication itself. Let your cardiology team know if you notice symptoms of low blood pressure, such as dizziness or weakness. If needed, your team can slow down the amiodarone (Nexterone) infusion or give you other medications and treatments to bring your blood pressure back up. Or, they might ask you to stop amiodarone (Nexterone) and consider other options. Rarely, low blood pressure can be life-threatening and difficult treat.
Slow heart rate and heart block
Though rare, amiodarone (Nexterone) can cause slow heart rate and heart block. Your cardiology team will monitor you closely for these conditions and slow down or stop the infusion if needed. Some people might need a temporary pacemaker to help with heart block.
Worsening heart rhythm problems
- Risk factors: Taking water pills or laxatives | Electrolyte levels that are out of balance | Diarrhea
Sometimes, taking amiodarone (Nexterone) can worsen heart rhythm problems, which can be life-threatening. Before you start treatment, your cardiology team will check that your fluid and electrolyte levels are within a safe range, especially if you recently lost a lot of fluids.
Serious liver problems
Amiodarone (Nexterone) can cause serious liver problems. People who have life-threatening VT or VF will also show signs of liver irritation on their liver enzyme tests. So if you're taking amiodarone (Nexterone), it might be difficult for the cardiology team to know if the abnormal liver enzyme tests are caused by the heart condition or a side effect of the medication. To be safe, they'll monitor you closely for liver problems. If needed, they'll slow down the rate of amiodarone (Nexterone) infusion or ask you to stop this medication. Tell you medical team right away if you notice symptoms of liver problems, such as stomach pain, swollen belly, or yellowing of the skin or whites of the eyes.
Lung injury and serious lung problems
Though rare, people who have received amiodarone (Nexterone) infusions have reported lung injuries days to weeks after their treatment. Let your healthcare team know if you have symptoms of lung problems, like wheezing, cough, or fever.
If you're expected to continue amiodarone treatment with oral tablets, your cardiology team will order a chest X-ray before you start treatment and check your lung health regularly throughout treatment. Rarely, people who have received amiodarone have experienced life-threatening lung problems.
Vision problems
Though rare, people who took amiodarone (Nexterone) have experienced vision problems, including permanent blindness. This can happen at any time during treatment. Let your cardiology team know right away if you notice a change in your vision, including blurriness or trouble seeing things to the side.
If you're continuing with oral amiodarone, your care team might ask you to get regular eye exams during treatment. Also, tell your optometrist or eye specialist if you're taking amiodarone because you'll need to avoid certain eye procedures, like corneal refractive laser surgery.
Thyroid problems
- Risk factors: Not taking enough dietary iodine | Past thyroid problems
Amiodarone can affect your thyroid hormone levels and cause either low or high levels hormone levels. Your prescriber will check your thyroid function tests regularly throughout treatment with amiodarone (Nexterone), and if you're continuing with oral amiodarone.
High thyroid levels (hyperthyroidism) can cause an arrhythmia, which can be dangerous. Let your care team know right away if you notice symptoms of thyroid problems, including weight changes, mood changes, sweating more than usual, and dry or discolored skin.
Harm to unborn babies
Amiodarone (Nexterone) can cause harm to unborn babies if taken by mothers during pregnancy. If you're able to become pregnant, your healthcare team might ask you to take a pregnancy test to confirm you're not pregnant before you can start amiodarone (Nexterone), especially if you're continuing with oral amiodarone. You're recommended to use effective birth control during treatment with amiodarone.
Severe allergic and skin reactions
Although rare, amiodarone (Nexterone) can cause serious allergic reactions that can sometimes be life-threatening. Tell your care team right away if you experience signs of an allergic reaction, such as trouble breathing, rash, fast heartbeat, sweating, blisters, or peeling skin.
Amiodarone (Nexterone) dosage
Typical dosage for Amiodarone (Nexterone)
Amiodarone (Nexterone) comes as concentrate solution in vials and a pre-mixed injection (brand name Nexterone).
- Loading dose: The typical loading dose is about 1,000 mg infused over the first 24 hours. Usually, the cardiology team will give 150 mg as a rapid infusion over the first 10 minutes, then give 360 mg more slowly over the next 6 hours. After that, they'll give the rest of the loading dose (540 mg) even more slowly, over the remaining 18 hours.
- Maintenance dose: After the first 24 hours, the typical maintenance dose is 720 mg infused slowly every 24 hours, usually for 2 to 3 weeks. The cardiology team will typically give an additional 150 mg over 10 minutes to stabilize any breakthrough arrhythmias.
Once the heart rhythm stabilizes and you're able to take medication by mouth, the team will transition you to amiodarone oral tablets (Pacerone).
Interactions between Amiodarone (Nexterone) and other drugs
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are receiving this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is not recommended. Your doctor may decide not to treat you with this medication or change some of the other medicines you take.
- Bepridil
- Cisapride
- Colchicine
- Dronedarone
- Fingolimod
- Fluconazole
- Grepafloxacin
- Indinavir
- Ketoconazole
- Levomethadyl
- Mesoridazine
- Nelfinavir
- Pimozide
- Piperaquine
- Posaconazole
- Ritonavir
- Saquinavir
- Sparfloxacin
- Terfenadine
- Thioridazine
- Tipranavir
- Vernakalant
- Ziprasidone
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abametapir
- Abiraterone Acetate
- Acecainide
- Afatinib
- Agalsidase Alfa
- Alfentanil
- Alfuzosin
- Alprazolam
- Amisulpride
- Amitriptyline
- Amprenavir
- Anagrelide
- Apalutamide
- Apomorphine
- Aprepitant
- Aripiprazole
- Aripiprazole Lauroxil
- Armodafinil
- Arsenic Trioxide
- Artemether
- Asenapine
- Astemizole
- Atazanavir
- Azimilide
- Azithromycin
- Bedaquiline
- Bendamustine
- Benzhydrocodone
- Berotralstat
- Betrixaban
- Boceprevir
- Bretylium
- Buprenorphine
- Buserelin
- Carbamazepine
- Carvedilol
- Cenobamate
- Ceritinib
- Chloral Hydrate
- Chloroquine
- Chlorpromazine
- Cilostazol
- Ciprofloxacin
- Citalopram
- Clarithromycin
- Clofazimine
- Clomipramine
- Clopidogrel
- Clozapine
- Cobicistat
- Codeine
- Conivaptan
- Crizotinib
- Cyclobenzaprine
- Dabigatran Etexilate
- Dabrafenib
- Daclatasvir
- Darunavir
- Dasabuvir
- Dasatinib
- Deferasirox
- Degarelix
- Delamanid
- Delavirdine
- Desipramine
- Deslorelin
- Deutetrabenazine
- Dexamethasone
- Digoxin
- Dihydrocodeine
- Diltiazem
- Disopyramide
- Docetaxel
- Dofetilide
- Dolasetron
- Domperidone
- Donepezil
- Doxepin
- Doxorubicin
- Doxorubicin Hydrochloride Liposome
- Droperidol
- Ebastine
- Efavirenz
- Elagolix
- Eliglustat
- Encainide
- Encorafenib
- Enflurane
- Entrectinib
- Enzalutamide
- Eribulin
- Erlotinib
- Erythromycin
- Escitalopram
- Eslicarbazepine Acetate
- Etravirine
- Famotidine
- Felbamate
- Fentanyl
- Flecainide
- Fluoxetine
- Fluvoxamine
- Formoterol
- Fosamprenavir
- Fosaprepitant
- Foscarnet
- Fosnetupitant
- Fosphenytoin
- Fostemsavir
- Galantamine
- Gatifloxacin
- Gemfibrozil
- Gemifloxacin
- Ginkgo Biloba
- Glasdegib
- Goldenseal
- Gonadorelin
- Goserelin
- Granisetron
- Halofantrine
- Haloperidol
- Halothane
- Histrelin
- Hydrocodone
- Hydroquinidine
- Hydroxychloroquine
- Hydroxyzine
- Ibutilide
- Idelalisib
- Iloperidone
- Imatinib
- Imipramine
- Indecainide
- Inotuzumab Ozogamicin
- Iohexol
- Isoflurane
- Isoniazid
- Isradipine
- Itraconazole
- Ivabradine
- Ivacaftor
- Ivosidenib
- Lacosamide
- Lapatinib
- Larotrectinib
- Ledipasvir
- Lefamulin
- Lemborexant
- Lenvatinib
- Letermovir
- Leuprolide
- Levofloxacin
- Lidocaine
- Lofexidine
- Lomitapide
- Lopinavir
- Loratadine
- Lorlatinib
- Lovastatin
- Lumacaftor
- Lumefantrine
- Macimorelin
- Mefloquine
- Meperidine
- Methadone
- Methotrimeprazine
- Metronidazole
- Mexiletine
- Mibefradil
- Miconazole
- Mifepristone
- Mirtazapine
- Mitotane
- Mizolastine
- Modafinil
- Moricizine
- Morphine
- Morphine Sulfate Liposome
- Moxifloxacin
- Nafarelin
- Nafcillin
- Nefazodone
- Netupitant
- Nevirapine
- Nilotinib
- Norfloxacin
- Octreotide
- Ofloxacin
- Olanzapine
- Ombitasvir
- Ondansetron
- Osilodrostat
- Osimertinib
- Ospemifene
- Oxaliplatin
- Oxcarbazepine
- Oxycodone
- Ozanimod
- Paclitaxel
- Palbociclib
- Paliperidone
- Panobinostat
- Papaverine
- Paritaprevir
- Paroxetine
- Pasireotide
- Pazopanib
- Pentamidine
- Pentazocine
- Perphenazine
- Pexidartinib
- Phenobarbital
- Phenytoin
- Pimavanserin
- Pipamperone
- Pitolisant
- Pixantrone
- Ponesimod
- Prednisone
- Prilocaine
- Primidone
- Probucol
- Procainamide
- Prochlorperazine
- Promethazine
- Propafenone
- Protriptyline
- Quetiapine
- Quinidine
- Quinine
- Ranitidine
- Ranolazine
- Regorafenib
- Relugolix
- Ribociclib
- Rifabutin
- Rifampin
- Rimegepant
- Risperidone
- Selpercatinib
- Sematilide
- Sertindole
- Sertraline
- Sevoflurane
- Simeprevir
- Simvastatin
- Siponimod
- Sirolimus
- Sodium Phosphate
- Sodium Phosphate, Dibasic
- Sodium Phosphate, Monobasic
- Sofosbuvir
- Solifenacin
- Sorafenib
- Sotalol
- Spiramycin
- St John's Wort
- Sufentanil
- Sulfamethoxazole
- Sulpiride
- Sultopride
- Sunitinib
- Tacrolimus
- Talazoparib
- Tamoxifen
- Tedisamil
- Telaprevir
- Telavancin
- Telithromycin
- Teriflunomide
- Tetrabenazine
- Ticagrelor
- Tocainide
- Tolterodine
- Topotecan
- Toremifene
- Tramadol
- Trazodone
- Triclabendazole
- Trifluoperazine
- Trimethoprim
- Trimipramine
- Triptorelin
- Ubrogepant
- Vandetanib
- Vardenafil
- Vemurafenib
- Venetoclax
- Venlafaxine
- Verapamil
- Vilanterol
- Vincristine
- Vincristine Sulfate Liposome
- Vinflunine
- Voclosporin
- Voriconazole
- Vorinostat
- Voxelotor
- Warfarin
- Zileuton
- Zolmitriptan
- Zotepine
- Zuclopenthixol
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Abarelix
- Acenocoumarol
- Apixaban
- Atorvastatin
- Clonazepam
- Cyclosporine
- Dicumarol
- Digitoxin
- Methotrexate
- Rifapentine
- Rivaroxaban
- Rosuvastatin
- Theophylline
Amiodarone (Nexterone) contraindications
Contraindications are specific health conditions or situations in which a person should not take a medication due to safety concerns. If you have any of the following conditions or if any of the following apply to you, let your healthcare provider know because Amiodarone (Nexterone) will not be safe for you to take.
- Allergy to iodine or other ingredients in the solution
- Cardiogenic shock
- Very slow heartbeat (e.g., sick sinus syndrome)
- Second- or third-degree heart block, unless you have a pacemaker
