Amiodarone-Induced Life-Threatening Refractory Hypotension

Doshi, Devang R.; Jayawardana, Ravi

doi:10.12659/ajcr.893920

Cited by 12 publications

(6 citation statements)

References 9 publications

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“…However, unfortunately, we were unable to measure the serum level of the two excipients and the plasma concentration of amiodarone and DEA to confirm this hypothesis. There were several case reports on acute hypotension with IV amiodarone use thought to be due to an anaphylactic reaction [6]. However, the drug anaphylaxis has shown other associated symptoms or signs of an allergic reaction such as angioedema or urticaria with hypotension not seen in this case.…”

Section: Discussionmentioning

confidence: 62%

“…It acts by interference with potassium, sodium, and calcium channels and it also has beta-blocking effects. However, it is generally considered as a class III antiarrhythmic agent according to the Vaughan-Williams classification [6]. IV amiodarone is widely used in EDs to control life-saving arrhythmias in the setting of heart failure due to this lack of negative inotropic effects and high efficacy in cardiac arrhythmias resistant to other treatments [5].…”

Section: Discussionmentioning

confidence: 99%

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A Rare Case of Intravenous Amiodarone Toxicity

Santos¹,

Lagarto²,

Gouveia³

2022

Cureus

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Amiodarone is a highly effective treatment for life-threatening supraventricular and ventricular arrhythmias, namely in the setting of acutely decompensated heart failure. However, it could be associated with several serious adverse effects both in long-term oral therapy and in short-term use of intravenous (IV) preparation, including shock and liver injury. We report an unusual case of life-threatening refractory hypotension associated with acute hepatitis and renal failure a few hours after initiation of IV amiodarone. A 70-year-old man was admitted to the emergency department (ED) with dyspnea, chest discomfort, and a non-productive cough. Physical examination and complementary diagnostic tests helped diagnose acutely decompensated heart failure due to atrial fibrillation (AF) with a rapid ventricular response, and IV amiodarone was started. A few hours after initiating this drug, the patient developed hypotension with the need for inotropic therapy, acute elevation of amino transaminases, and renal failure. Renal function and liver transaminases returned to baseline after discontinuing amiodarone. A Roussel Uclaf Causality Assessment Method (RUCAM) score of 5 identifies our patient`s acute hepatitis as a possible adverse drug reaction. Refractory hypotension and liver injury with acute hepatitis after a short-term IV amiodarone therapy are extremely rare with few previously reported cases. Therefore, it is very important to perform continuous hemodynamic monitoring of the patient and liver function monitorization during short-term IV administration of this drug because these complications can be potentially fatal. A high index of suspicion is the key to functional organic recovery.

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Section: Discussionmentioning

confidence: 62%

Section: Discussionmentioning

confidence: 99%

A Rare Case of Intravenous Amiodarone Toxicity

Santos¹,

Lagarto²,

Gouveia³

2022

Cureus

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“…A consistent reduction of I Ca,L density has been observed in in AF experimental models as well as in CAF patients [ 32 ], and it is believed that the process was triggered by Ca 2+ overload secondary to the rapid atrial rates [ 33 ]. The molecular mechanisms underlying I Ca,L downregulation are complex and may include impaired Cav1.2 protein trafficking induced by impaired Src kinase activity, ankyrin-B dysfunction, ankyrin-B dysfunction, enhanced Cav1.2 α-subunit S-nitrosylation, Ca 2+ channel dephosphorylation because of serine/threonine protein phosphatase activation, Ca 2+ channel dephosphorylation because of serine/threonine protein phosphatase activation, activation of the Ca 2+ /calmodulin/calcineurin/nuclear factor of activated T cells system, causing transcriptional downregulation of the Cav1.2 α-subunit or a zinc-binding protein [ 7 , 34 – 36 ]. In addition to all these mechanisms, miRNAs have been recently proposed to be involved in AF-related I Ca,L downregulation [ 17 , 37 , 38 ].…”

Section: Discussionmentioning

confidence: 99%

Underexpression of CACNA1C Caused by Overexpression of microRNA-29a Underlies the Pathogenesis of Atrial Fibrillation

2016

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BackgroundThe objective of this study was to investigate the molecular mechanism of atrial fibrillation (AF), as well as the negative regulatory relationship between miR-29a-3p and CACNA1C.Material/MethodsWe searched the online miRNA database (www.mirdb.org) and identified the miR-29a-3p binding sequence within the 3′-UTR of the target gene, and then conducted luciferase assay to verify it. The cells were transfected with miR-29a-3p and ICa,L was determined in those cells.ResultsWe validated CACNA1C to be the direct target gene of miR-29a-3p. We also established the negative regulatory relationship between miR-29a-3p and CACNA1C via studying the relative luciferase activity. We also conducted real-time PCR and Western blot analysis to study the mRNA and protein expression level of CACNA1C among different groups of cells treated with scramble control, 30nM miR-29a-3p mimics, and 60nM miR-29a-3p mimics, indicating a negative regulatory relationship between miR-29a-3p and CACNA1C. We next analyzed whether miR-29a-3p transfection in cardiomyocytes produced the effects on the ICa,L induced by electrical remodeling, and found a tonic inhibition of IBa by endogenous miR-29a-3p in atrial myocytes.ConclusionsWe validated the negative regulation between miR-29a-3p and CACNA1C, and found that miR-29a-3p might a potential therapeutic target in the treatment of AF.

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“…Currently, several pharmaceutical products are commercially available based on cyclodextrin. For example, Nexterone is an injectable IV formulation of amiodarone (the API) by using sulfobutylether-7-beta-cyclodextrin to improve its solubility. , This new formula was approved by the FDA in 2008, as PM101 under Nexterone, the same brand as the previously approved formulation of amiodarone . Nicorette, a sublingual tablet, uses cyclodextrins to mask the taste of nicotine. , In this case, the nicotine/β-cyclodextrin complex avoids the irritating effect of nicotine on the mucous membrane because nicotine is enwrapped into the cyclodextrin cavities and cannot directly contact the mucous membrane .…”

Section: Microencapsulation Technology For Pharmaceutical Applicationsmentioning

confidence: 99%

“…For example, Nexterone is an injectable IV formulation of amiodarone (the API) by using sulfobutylether-7-beta-cyclodextrin to improve its solubility. 62,63 This new formula was approved by the FDA in 2008, as PM101 under Nexterone, the same brand as the previously approved formulation of amiodarone. 63 Nicorette, a sublingual tablet, uses cyclodextrins to mask the taste of nicotine.…”

Section: Coacervationmentioning

confidence: 99%

Microencapsulation for Pharmaceutical Applications: A Review

Yan,

Kim

2024

ACS Appl. Bio Mater.

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In order to improve bioavailability, stability, control release, and target delivery of active pharmaceutical ingredients (APIs), as well as to mask their bitter taste, to increase their efficacy, and to minimize their side effects, a variety of microencapsulation (including nanoencapsulation, particle size <100 nm) technologies have been widely used in the pharmaceutical industry. Commonly used microencapsulation technologies are emulsion, coacervation, extrusion, spray drying, freeze-drying, molecular inclusion, microbubbles and microsponge, fluidized bed coating, supercritical fluid encapsulation, electro spinning/spray, and polymerization. In this review, APIs are categorized by their molecular complexity: small APIs (compounds with low molecular weight, like Aspirin, Ibuprofen, and Cannabidiol), medium APIs (compounds with medium molecular weight like insulin, peptides, and nucleic acids), and living microorganisms (such as probiotics, bacteria, and bacteriophages). This article provides an overview of these microencapsulation technologies including their processes, matrix, and their recent applications in microencapsulation of APIs. Furthermore, the advantages and disadvantages of these common microencapsulation technologies in terms of improving the efficacy of APIs for pharmaceutical treatments are comprehensively analyzed. The objective is to summarize the most recent progresses on microencapsulation of APIs for enhancing their bioavailability, control release, target delivery, masking their bitter taste and stability, and thus increasing their efficacy and minimizing their side effects. At the end, future perspectives on microencapsulation for pharmaceutical applications are highlighted.

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Amiodarone-Induced Life-Threatening Refractory Hypotension

Cited by 12 publications

References 9 publications

A Rare Case of Intravenous Amiodarone Toxicity

A Rare Case of Intravenous Amiodarone Toxicity

Underexpression of CACNA1C Caused by Overexpression of microRNA-29a Underlies the Pathogenesis of Atrial Fibrillation

Microencapsulation for Pharmaceutical Applications: A Review

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