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Hepatotoxicity after intravenous amiodarone

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Abstract

Amiodarone is a class III antiarrhythmic agent with a long half-life which is used to control atrial and ventricular arrhythmias, including atrial flutter and fibrillation. We describe here the case of an elderly woman (77 years of age) who was hospitalized for acute atrial fibrillation, abdominal pain, and dyspnea. In the Emergency Department, treatment with intravenous amiodarone was begun. The following day, the patient developed acute liver damage; improved liver function occurred following the withdrawal of amiodarone. Complete recovery of liver function was documented after three weeks. Unfortunately, the patient died from a severe infectious disease, with multiple organ failure.

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References

  1. Hughes M, Binning A. Intravenous amiodarone in intensive care. Time for Reappraisal? Intensive Care Med 2000; 26: 1730–9.

    Article  CAS  Google Scholar 

  2. Connolly SJ. Evidence based analysis of amiodarone efficacy and safety. Circulation 1999; 100: 2025–34.

    Article  PubMed  CAS  Google Scholar 

  3. Latini R, Tognoni G, Kates RE. Clinical pharmacokinetics of amiodarone. Clin Pharmacokinet 1984; 9: 136–56.

    Article  PubMed  CAS  Google Scholar 

  4. Ursella S, Testa A, Mazzone M, Gentiloni Silveri N. Amiodaroneinduced thyroid dysfunction in clinical practice. Eur Rev Med Pharmacol Sci 2006; 10: 269–78.

    PubMed  CAS  Google Scholar 

  5. Mäntyjärvi M, Tuppurainen K, Ikäheimo K. Ocular side effects of amiodarone. Surv Ophthalmol 1998; 42: 360–6.

    Article  PubMed  Google Scholar 

  6. Lewis JH, Ranard RC, Caruso A et al. Amiodarone Hepatotoxicity: Prevalence and clinico-pathological correlation among 104 patients. Hepatology 1989; 9: 679–85.

    Article  PubMed  CAS  Google Scholar 

  7. Kum LC, Chan WW, Hui HH et al. Prevalence of amiodarone-related hepatotoxicity in 720 Chinese patients with or without baseline liver dysfunction. Clin Cardiol 2006; 29: 295–9.

    Article  PubMed  Google Scholar 

  8. Ratz Bravo AE, Drewe J, Schlienger RG, Krahenbuhl S, Pargger H, Ummenhofer W. Hepatotoxicity during rapid intravenous loading with amiodarone: Description of three cases and review of the literature. Crit Care Med 2005; 33: 128–34.

    Article  PubMed  Google Scholar 

  9. Camus P, Martin WJ 2nd, Rosenow EC 3rd. Amiodarone pulmonary toxicity. Clin Chest Med 2004; 25: 65–75.

    Article  PubMed  Google Scholar 

  10. Vorperian VR, Havighurst TC, Miller S, January CT. Adverse effects of low dose amiodarone: a meta-analysis. J Am Coll Cardiol 1997; 30: 791–8.

    Article  PubMed  CAS  Google Scholar 

  11. Zimetbaum P. Amiodarone for atrial fibrillation. N Engl J Med 2007; 356: 935–41.

    Article  PubMed  CAS  Google Scholar 

  12. Roy D, Talajic M, Dorian P et al. Amiodarone to prevent recurrence of atrial fibrillation. Canadian Trial of Atrial Fibrillation Investigators. N Engl J Med 2000; 342: 913–20.

    CAS  Google Scholar 

  13. Fuster V, Rydén LE, Cannom DS et al; European Heart Rhythm Association and the Heart Rhythm Society. ACC/AHA/ESC 2006 Guidelines for the Management of Patients With Atrial Fibrillation- Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines and the European Society of Cardiology Committee for Practice Guidelines (Writing Committee to Revise the 2001 Guidelines for the Management of Patients With Atrial Fibrillation). J Am Coll Cardiol 2006; 48: 854–906.

    Article  PubMed  Google Scholar 

  14. Page RL. Medical management of atrial fibrillation: future directions. Heart Rhythm 2007; 4 (Suppl 3): S91–4.

    Article  PubMed  Google Scholar 

  15. Somberg JC, Cao W, Cvetanovic I, Ranade V, Molnar J. Pharmacology and toxicology of a new aqueous formulation of intravenous amiodarone (Amio-Aqueous) compared with Cordarone IV. Am J Ther 2005; 12: 9–16.

    Article  PubMed  Google Scholar 

  16. Rhodes A, Eastwood JB, Smith SA. Early acute hepatitis with parenteral amiodarone: a toxic effect of the vehicle? Gut 1993; 34: 565–6.

    Article  PubMed  CAS  Google Scholar 

  17. Tatsuishi T, Oyama Y, Iwase K et al. Polysorbate 80 increases the susceptibility to oxidative stress in rat thymocytes. Toxicology 2005; 207: 7–14.

    Article  PubMed  CAS  Google Scholar 

  18. Bravo Gonzalez RC, Huwyler J, Boess F, Walter I, Bittner B. In vitro investigation on the impact of the surface-active excipients Cremophor EL, Tween 80 and Solutol HS 15 on the metabolism of midazolam. Biopharm Drug Dispos 2004; 25: 37–49.

    Article  PubMed  Google Scholar 

  19. Mountfield RJ, Senepin S, Schleimer M, Walter I, Bittner B. Potential inhibitory effects of formulation ingredients on intestinal cytochrome P450. Int J Pharmacol 2000; 211: 89–92.

    Article  CAS  Google Scholar 

  20. Yamreudeewong W, DeBisschop M, Martin LG, Lower DL. Potentially significant drug interactions of class III antiarrhythmic drugs. Drug Safety 2003; 26: 421–38.

    Article  PubMed  CAS  Google Scholar 

  21. Simon JP, Zannad F, Trechot P, Thisse JY, Houplon M, Mot E. Acute hepatitis after a loading dose of intravenous amiodarone. Cardiovasc Drugs Ther 1990; 4: 1467–8.

    Article  PubMed  CAS  Google Scholar 

  22. Yasuda SU, Sausville EA, Hutchins JB, Kennedy T, Woosley RL. Amiodarone-induced lymphocyte toxicity and mitochondrial function. J Cardiovasc Pharmacol 1996; 28: 94–100.

    Article  PubMed  CAS  Google Scholar 

  23. Tapio H, Jari H, Kimmo M, Juha H. Prevention of atrial fibrillation after cardiac surgery. Scand Cardiovasc J 2007; 41: 72–8.

    Article  PubMed  Google Scholar 

  24. Buckley MS, Nolan PE Jr, Slack MK, Tisdale JE, Hilleman DE, Copeland JG. Amiodarone prophylaxis for atrial fibrillation after cardiac surgery: meta-analysis of dose response and timing of initiation. Pharmacother 2007; 27: 360–8.

    Article  CAS  Google Scholar 

  25. Aasbo JD, Lawrence AT, Krishnan K, Kim MH, Trohman RG. Amiodarone prophylaxis reduces major cardiovascular morbidity and length of stay after cardiac surgery: a meta-analysis. Ann Intern Med 2005; 143: 327–36.

    Article  PubMed  CAS  Google Scholar 

  26. Lee SH, Chang CM, Lu MJ et al. Intravenous amiodarone for prevention of atrial fibrillation after coronary artery bypass grafting. Ann Thorac Surg 2000; 70: 157–61.

    Article  PubMed  CAS  Google Scholar 

  27. Fromenty B, Fisch C, Berson A, Letteron P, Larrey D, Pessayre D. Dual effect of amiodarone on mitochondrial respiration. Initial protonophoric uncoupling effect followed by inhibition of the respiratory chain at the levels of complex I and complex II. J Pharmacol Exp Ther 1990; 255: 1377–84.

    PubMed  CAS  Google Scholar 

  28. Ribeiro SM, Campello AP, Nascimento AJ, Kluppel ML. Effect of amiodarone (AMD) on the antioxidant enzymes, lipid peroxidation and mitochondrial metabolism. Cell Biochem Funct 1997; 15: 145–52.

    Article  PubMed  CAS  Google Scholar 

  29. Vereckei A, Blazovics A, Gyorgy I et al. The role of free radicals in the pathogenesis of amiodarone toxicity. J Cardiovasc Electrophysiol 1993; 4: 161–77.

    Article  PubMed  CAS  Google Scholar 

  30. Waldhauser KM, Torok M, Ha HR et al. Hepatocellular toxicity and pharmacological effect of amiodarone and amiodarone derivatives. J Pharmacol Exp Ther 2006; 319: 1413–23.

    Article  PubMed  CAS  Google Scholar 

  31. Alberti A, Chemello L, Benvegnu L. Natural history of hepatitis C. J Hepatol 1999; 31 (Suppl 1): 17–24.

    Article  PubMed  Google Scholar 

  32. Rizzioli E, Incasa E, Gamberini S et al. Acute toxic hepatitis after amiodarone intravenous loading. Am J Emerg Med 2007; 25: 1082–4.

    Article  PubMed  Google Scholar 

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Correspondence to Angelo Cataldi MD.

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Cataldi, A., Gonella, D., Robutti, N. et al. Hepatotoxicity after intravenous amiodarone. Aging Clin Exp Res 20, 593–596 (2008). https://doi.org/10.1007/BF03324889

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