Hepatic Dysfunction and Neurotoxicity in a Patient Receiving Long-Term Low-Dose Amiodarone Therapy

Arkun, Alp; Deusen, Shawn K Van; Grau, Timothy; Birkhahn, Robert

doi:10.1016/j.jemermed.2008.01.006

Cited by 7 publications

(4 citation statements)

References 10 publications

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“…Prior to the era of amiodarone-related lethal side effects, the appropriate maintenance dosing to treat significant arrhythmias ranged between 200 mg/day and 800 mg/day for months to years. 3,16,[27][28][29][30][31][32][33][34][35][36][37][38][39] After studies showed that side effects were dosing-related, lower dosing, which is 100 mg/day to 200 mg/day, was adopted, thus achieving a better balance between the acceptable side effects and satisfactory treatment outcomes. 4,14 The lowest dosing of amiodarone was reported by Jong et al in 2006 in a study designed to investigate the efficacy of low-dose amiodarone on sinus rhythm maintenance after atrial fibrillation cardioversion.…”

Section: Safety Of Low-dose Amiodaronementioning

confidence: 99%

Low-dose Amiodarone Is Safe: A Systematic Review and Meta-analysis

Chokesuwattanaskul

Shah

Chokesuwattanaskul

et al. 2020

J Innov Cardiac Rhythm Manage

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Amiodarone is commonly used for a variety of arrhythmias and, in some parts of the world, is the only available antiarrhythmic drug (AAD). Yet, amiodarone is known to have a wide range of potential side effects, many of which are dose-and duration-dependent. We sought to study the incidence of side effects leading to the discontinuation of low-dose amiodarone, arbitrarily defined as 200 mg/day or less, and very-low-dose amiodarone, defined as 100 mg/ day or less. In this study, literature databases were searched through June 2019. Studies that reported the incidence or prevalence of side effects of amiodarone were included. Effect estimates from individual studies were extracted and combined using the random-effects generic inverse variance method of DerSimonian and Laird. A total of 10 observational cohort studies involving 901 patients were included in the analysis. The pooled estimated incidence of overall side effects for low-dose amiodarone was 0.17 [95% confidence interval (CI): 0.12-0.22]. In addition, the pooled estimated incidence of side effects requiring medication discontinuation was 0.06 (95% CI: 0.03-0.11). As compared with 200 mg/day of amiodarone, the pooled estimated incidence of overall side effects was 0.11 (95% CI: 0.04-0.27), while the incidence of side effects requiring medication discontinuation was 0.02 (95% CI: 0.01-0.06) for the dose of 100 mg/day. In conclusion, verylow-dose amiodarone displays a low incidence of significant side effects requiring medication discontinuation.

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Section: Safety Of Low-dose Amiodaronementioning

confidence: 99%

Low-dose Amiodarone Is Safe: A Systematic Review and Meta-analysis

Chokesuwattanaskul

Shah

Chokesuwattanaskul

et al. 2020

J Innov Cardiac Rhythm Manage

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“…Antiarrhythmics used in Taiwan include amiodarone, mexiletine, propafenone, quinidine, and procainamide, all of which have shared, multiple aforementioned targets [ 2 , 15 ]. Although few case reports have described liver toxicity arising from the use of some antiarrhythmics, amiodarone has been extensively studied and has been demonstrated to induce chronic liver injury and cirrhosis in patient subgroups [ 5 , 8 , 9 ]. Primary HCC is the fifth leading cause of cancer deaths worldwide, and the second leading cause of cancer deaths in Taiwan [ 13 , 16 ].…”

Section: Discussionmentioning

confidence: 99%

“…Despite these limitations, antiarrhythmics are still widely prescribed for the management of symptomatic AF. Several case reports and reviews have addressed the potential adverse effects associated with these agents, including liver toxicity [ 3 – 6 ], hepatic dysfunction [ 7 , 8 ], steatohepatitis [ 9 ], liver injury [ 10 ], and intrahepatic cholestatic jaundice [ 11 ]. However, few systemic analyses have been conducted in this setting, and little evidence of an association between the use of antiarrhythmic agents and the risk of developing malignant neoplasm of liver and intrahepatic bile ducts (MNLIHD) has been reported.…”

Section: Introductionmentioning

confidence: 99%

Antiarrhythmic Agents and the Risk of Malignant Neoplasm of Liver and Intrahepatic Bile Ducts

Lim

Lin

et al. 2015

PLoS ONE

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BackgroundThe objective of this study was to determine the association between the use of antiarrhythmic agents and the risk of malignant neoplasm of liver and intrahepatic bile ducts (MNLIHD).MethodsWe used the research database of the Taiwan National Health Insurance Program to conduct a population-based, case-control study. We identified 9944 patients with antiarrhythmic history who were first diagnosed as having MNLIHD between 2005 and 2010. We identified an additional 19,497 patients with antiarrhythmic history in the same period who did not develop MNLIHD and were frequency-matched using age, sex, and index year to form a control group. Five commercially available antiarrhythmic agents, amiodarone, mexiletine, propafenone, quinidine, and procainamide, were analyzed.ResultsThe adjusted odds ratio (OR) of MNLIHD was 1.60 (95% confidence interval [CI], 1.45–1.77) for amiodarone users versus nonamiodarone users. In subgroup analysis, amiodarone use was significantly associated with an increased risk of MNLIHD with an adjusted OR of 18.0 (95% CI, 15.7–20.5) for patients with comorbidities compared to an OR of 2.43 (95% CI, 1.92–3.06) for those without comorbidities. After adjustment for age, sex, statins, anti-diabetes medications, non-steroidal antiinflammatory drugs, propafenone use, quinidine use, and comorbidities, the ORs were 1.49, 1.66, and 1.79 for MNLIHD associated with annual mean defined daily doses of ≤30, 31–145, and >145, respectively.ConclusionsThe results of the present study indicated that amiodarone might be associated with the development of MNLIHD in a dose-dependent manner, particularly among patients with comorbidities.

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“…While FW did not respond to lactulose therapy, one case report showed symptomatic improvement of amiodarone-induced hyperammonemia and neurotoxicity when treated with lactulose. 15 The case describes a 90-year-old man with diabetes who had been taking amiodarone 200 mg P.O. daily for 18 months.…”

Section: Wwwtnpjcommentioning

confidence: 99%