Acute hepatitis complicating parenteral amiodarone does not preclude subsequent oral therapy.

James, Phillip; Hardman, S. M. C.

doi:10.1136/hrt.77.6.583

Cited by 29 publications

(27 citation statements)

References 4 publications

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“…Furthermore, six patients (including case 3 in our series) recovered after stopping intravenous amiodarone, despite immediately starting therapy with oral amiodarone (30,31,37,44). Another two patients were rechallenged later with oral amiodarone and none of them showed any hepatotoxic effects (33,41). In contrast, three patients developed a second episode of acute hepatocellular injury after reexposure to intravenous amiodarone (37,41,43).…”

Section: Discussionmentioning

confidence: 98%

Hepatotoxicity during rapid intravenous loading with amiodarone: Description of three cases and review of the literature*

Bravo

Drewe

Schlienger

et al. 2005

Critical Care Medicine

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Amiodarone is a highly effective antiarrhythmic agent for the treatment and prevention of atrial and ventricular arrhythmias. Acute liver damage after intravenous amiodarone, possibly induced by the solubilizer polysorbate 80, is rare but potentially harmful. Amiodarone loading should therefore be adapted to the necessity of an immediate effect of the drug, and liver function should be monitored closely in critically ill patients. Oral maintenance therapy with amiodarone is possible, even in patients who developed liver disease during intravenous loading.

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Section: Discussionmentioning

confidence: 98%

Hepatotoxicity during rapid intravenous loading with amiodarone: Description of three cases and review of the literature*

Bravo

Drewe

Schlienger

et al. 2005

Critical Care Medicine

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“…16–20 Acute liver injury following IV administration, however, is not believed to be caused by amiodarone; rather the hepatotoxicity is believed to be related to the diluent polysorbate 80 and to be secondary to hepatic ischemia accompanying the hypotensive episode. 9,21 …”

Section: Discussionmentioning

confidence: 99%

Hepatic Dysfunction in Patients Receiving Intravenous Amiodarone

Hashmi¹,

Keswani²,

Kim³

et al. 2016

Southern Medical Journal

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Objectives-Amiodarone is a commonly used anti-arrhythmic drug. Hepatotoxicity following chronic oral administration occurs in 1% to 3% of patients. Hepatotoxicity following intravenous (IV) administration is infrequent but may be associated with dramatic increases in serum transaminases. We describe the incidence of liver toxicity among patients receiving IV amiodarone during a 5-year period.Methods-This was a single-center retrospective review of patients receiving IV amiodarone for any cause. The outcome measures were development of elevated serum transaminases and the relation of transaminitis to all-cause 30-day mortality.Results-A total of 1510 patients received amiodarone intravenously between 2005 and 2011; 77 (5%) developed elevated liver enzymes. Enzyme elevation was divided into mild (100-300 IU/L), moderate (300-1000 IU/L), and severe (>1000 IU/L). The median alanine aminotransferase was 189 (37-10,006) IU/L and aspartate aminotransferase was 253 (84-12,005) IU/L. The 30-day mortality among those with transaminitis was 22%; however, no patient died of amiodaronerelated liver disease.Conclusions-Amiodarone can cause severe elevation in liver enzymes. The incidence of severe transaminitis is low; deaths following IV amiodarone are rarely caused by drug-induced liver failure. Keywordsamiodarone; intravenous; hepatotoxicity; arrhythmia; atrial fibrillation; mortality; polysorbate 80Amiodarone is a class III antiarrhythmic drug used to treat atrial and ventricular arrhythmias. 1,2 Its adverse effects involve many organ systems and result in cessation of the medication in 10% to 15% of patients. Common adverse effects of oral amiodarone include thyroid dysfunction, corneal microdeposits, hepatic dysfunction, and pulmonary fibrosis, 3,4 and asymptomatic elevations in liver enzymes are reported in 15% to 50% of long-term users. 5,6 Symptomatic liver injury is rare but potentially fatal, occurring in 1% to 3 % of long-term users. [7][8][9][10] Amiodarone often is given by intravenous (IV) bolus in the management of potentially lifethreatening arrhythmias. Adverse effects following IV amiodarone administration include injection site reactions, diaphoresis, flushing, sinus bradycardia, atrioventricular block, and hypotension. 3,4 Acute amiodarone hepatotoxicity also may follow intravenous amiodarone. 7 The presentation of acute hepatotoxicity varies from mild asymptomatic increases in serum transaminases (transaminitis) to fulminant hepatic failure. The clinical presentations, incidence, and outcomes are less well described. The aim of this study was to determine the incidence, prevalence, and clinical manifestations of acute hepatitis following the IV administration of amiodarone. We retrospectively reviewed the clinical data from patients receiving IV amiodarone therapy at the Michael E. DeBakey Veterans Affairs Medical Center between July 2005 and July 2011. We also assessed potentially important variables possibly predicting the presence, severity, and outcome of acute hepatic injury. HHS Public A...

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“…It has a long half life and may be administered either orally or intravenously [4] . The drug has many extracardiac side effects.…”

Section: Discussionmentioning

confidence: 99%

Acute hepatitis secondary to parenteral amiodarone does not preclude subsequent oral therapy

Lahbabi

Aqodad²,

Ibrahimi³

et al. 2012

WJH

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Amiodarone chlorhydrate is a diiodated benzofuran derivative used to treat cardiac rhythm abnormalities�� Hepatotoxicity is a relatively uncommon side effect of amiodarone and symptomatic hepatic dysfunction occurs in less than 1% to 3% of patients taking amiodarone�� We report here on an unusual case of amiodarone-induced hepatotoxicity�� A 29 year old woman with normal liver function was given amiodarone intravenously to treat her atrial fibrillation. She developed acute toxic hepatitis after 24 h�� The intravenous form of amiodarone was immediately avoided and replaced by the oral form, using conventional loading doses as soon as the deranged liver function tests had normalized, without recurrence of the hepatitis�� These observations show that the occurrence of acute hepatic impairment with intravenous amiodarone does not necessarily preclude the use of this drug by mouth and the necessity of monitoring the hepatic function of patients treated with amiodarone��

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Acute hepatitis complicating parenteral amiodarone does not preclude subsequent oral therapy.

Cited by 29 publications

References 4 publications

Hepatotoxicity during rapid intravenous loading with amiodarone: Description of three cases and review of the literature*

Hepatotoxicity during rapid intravenous loading with amiodarone: Description of three cases and review of the literature*

Hepatic Dysfunction in Patients Receiving Intravenous Amiodarone

Acute hepatitis secondary to parenteral amiodarone does not preclude subsequent oral therapy

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