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Amiodarone (Nexterone) injection for the treatment and prophylaxis of frequently recurring ventricular fibrillation

Introduction: Intravenous (IV) amiodarone is the most used and effective drug to manage life-threatening ventricular arrhythmias. However, its administration is associated with important adverse effects, the most frequent of which is hypotension. Nexterone® is a novel IV amiodarone formulation, proved to be devoid of hypotensive effects in clinical studies and may represent an improved and safer instrument in this setting. Areas covered: The Medline Database was searched for articles on the efficacy and safety of IV amiodarone in ventricular arrhythmias and cardiac arrest. This article summarizes the key findings of the most relevant studies conducted so far, with a special attention to the limitations of the currently available IV amiodarone and the potential advantages of the recently approved Nexterone. The role given to IV amiodarone in the guidelines on Advanced Cardiovascular Life Support is also reported and discussed. Expert opinion: Available studies demonstrated a convincing efficacy of IV amiodarone in ventricular arrhythmias and cardiac arrest. The new formulation seems to resolve concerns about tolerability. However, despite proven antiarrhythmic efficacy of the drug, no improved survival was showed in different settings. The search for an antiarrhythmic drug able to impact on hard endpoint as survival to hospital discharge is therefore far from being concluded.