What is the standard initial amiodarone regimen for acute ventricular tachycardia?

• A. 300 mg IV bolus, may repeat 150 mg; follow with maintenance infusion per protocol
• B. 150 mg IV bolus, no maintenance
• C. Oral loading 200 mg
• D. 450 mg IV bolus

Answer: (A)

In acute ventricular tachycardia, you want a fast-acting IV loading dose to quickly suppress the arrhythmia and then keep the effect with a continuous infusion. The standard approach is to give a 300 mg IV bolus first, with a second 150 mg IV bolus if the rhythm remains VT or if the patient remains pulseless. After those initial boluses, you start a maintenance infusion per protocol to sustain therapeutic levels and prevent recurrence. This strategy aligns with ACLS-style regimens for VT/VF, where rapid loading is needed and oral dosing isn’t suitable in the acute setting.

A smaller IV bolus of 150 mg isn’t the typical initial step for an acute VT arrest because it underdoses in the immediate life-threatening phase and doesn’t guarantee rapid control. An oral loading dose isn’t appropriate when quick antiarrhythmic effect is required, and a 450 mg IV bolus isn’t a standard dose in this context.