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

Lahbabi, M.; Aqodad, N.; Ibrahimi, A.; M, Lahlou; Aqodad, Hafid

doi:10.4254/wjh.v4.i6.196

Cited by 17 publications

(22 citation statements)

References 9 publications

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“…If polysorbate 80 is the cause of the acute hepatotoxicity, it would seem prudent for the pharmaceutical industry to find a more suitable diluent. 9,23–26 …”

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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“…If polysorbate 80 is the cause of the acute hepatotoxicity, it would seem prudent for the pharmaceutical industry to find a more suitable diluent. 9,23–26 …”

Section: Discussionmentioning

confidence: 99%

Hepatic Dysfunction in Patients Receiving Intravenous Amiodarone

Hashmi¹,

Keswani²,

Kim³

et al. 2016

Southern Medical Journal

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“…Most patients described in the reviewed cases had evidence of poor forward output, hepatic venous congestion, impaired circulation and acute kidney injury, predisposing them to ischemic hepatitis. Finally, another report by Lahbabi et al ascribes responsibility of liver toxicity to solubilizers such as polysorbate 80 in the IV amiodarone preparation 9. Polysorbate 80 has been implicated in the E-Ferol syndrome characterized by renal failure, hepatosplenomegaly, and jaundice.…”

Section: Discussionmentioning

confidence: 99%

Hyperacute drug-induced hepatitis with intravenous amiodarone: case report and review of the literature

Nasser

Larsen²,

Waanbah³

et al. 2013

DHPS

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Amiodarone is a benzofuran class III antiarrhythmic drug used to treat a wide spectrum of ventricular tachyarrhythmias. The parenteral formulation is prepared in polysorbate 80 diluent. We report an unusual case of acute elevation of aminotransaminase concentrations after the initiation of intravenous amiodarone. An 88-year-old Caucasian female developed acute hepatitis and renal failure after initiating intravenous amiodarone for atrial fibrillation with a rapid ventricular response in the setting of acutely decompensated heart failure and hepatic congestion. Liver transaminases returned to baseline within 7 days after discontinuing the drug. Researchers hypothesized that this type of injury is related to liver ischemia with possible superimposed direct drug toxicity. The CIOMS/RUCAM scale identifies our patient’s acute hepatitis as a highly probable adverse drug reaction. Future research is needed to understand the mechanisms by which hyperacute drug toxicity occurs in the setting of impaired hepatic perfusion and venous congestion.

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“…The drug shows hepatotoxicity and hepatic dysfunction in humans . A study revealed that an intravenous dose of amiodarone caused hepatotoxicity in a 29‐year‐old woman, but, after termination of this dose, and subsequent start of an oral therapy of amiodarone, hepatotoxicity did not recur . Hepatotoxicity associated with benzofuran derivatives is linked with mitochondrial toxicity, followed by necrosis .…”

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confidence: 99%