What is the initial amiodarone dose for shockable VF/pVT in ACLS, and what is the second dose if persistent?

• A. 150 mg IV push; second dose 300 mg if persistent
• B. 300 mg IV push; second dose 150 mg if persistent
• C. 450 mg IV push; no second dose
• D. 100 mg IV push; second dose 200 mg

Answer: (B)

When a shockable rhythm like VF or pulseless VT doesn’t respond to defibrillation, amiodarone is used as an antiarrhythmic to help terminate the rhythm and prevent recurrence. The fastest way to achieve therapeutic levels is a rapid 300 mg IV push as the first dose. If the rhythm persists after that, a second, smaller 150 mg IV push is given to increase the chances of conversion without delaying further treatment.

This approach—300 mg upfront, then 150 mg if persistence or recurrence occurs—is preferred because it delivers a substantial early loading dose to stabilize the myocardium, with a subsequent dose to sustain effect. After the arrest, an infusion may be started to maintain antiarrhythmic activity (commonly 1 mg/min for several hours, then tapering), but the initial and second bolus dosing is the key point for shockable VF/pVT. Dosing options that start with a smaller initial amount or swap the order of the doses do not align with these guidelines.