Amiodarone hydrochloride - Arrhythmias

The Surrey Heartlands Integrated Care System Area Prescribing Committee (APC) has agreed the National Shared Care Protocol for Amiodarone (with some local adaption) for patients within adult services.

Tthe NHS England guidance ‘Items which should not routinely be prescribed in primary care: Guidance for CCGs’ Version 2, June 2019 states that amiodarone is only to be initiated by specialists in exceptional circumstances where other treatments cannot be used or have failed: 

1) in line with NICE Guidance CG180 https://www.nice.org.uk/guidance/CG180 in patients: 
- prior and post electrocardioversion / ablation; OR 
- who have heart failure or left ventricular impairment; OR 
- requiring pharmacological cardioversion; OR 
- undergoing cardiothoracic surgery 

2) in patients with ventricular tachycardia / ventricular fibrillation and tachyarrhythmias associated with Wolff-Parkinson-White syndrome.

 In these circumstances amiodarone must be initiated by a specialist and only continued in primary care under a shared care arrangement. Amiodarone should always be initiated with a treatment plan including dose schedule and when amiodarone is intended to be stopped. As such amiodarone will be considered AMBER on the traffic light system for the above indications.