Hepatotoxicity during rapid intravenous loading with amiodarone: Description of three cases and review of the literature.
OBJECTIVE
Atrial fibrillation is the most common arrhythmia after cardiac surgery. Amiodarone can effectively prevent and control postoperative atrial and ventricular fibrillation. Acute hepatic damage after intravenous amiodarone, which can be fatal, is not well recognized. We describe three cases of acute hepatocellular injury after intravenous amiodarone administration in critically ill patients. Another 25 published cases and six cases reported to the Swiss Pharmacovigilance Center (Swissmedic) are discussed.


METHODS
This study consisted of a series of three case reports and review of the literature.


METHODS
: This study was conducted at an operative critical care unit at the University Hospital Basel, Switzerland.


METHODS
Three hemodynamically compromised patients after open heart surgery developed significant increases of transaminases (up to more than 100-fold of the upper limit of normal) shortly after the introduction of intravenous amiodarone. INTERVENTIONS AND MEASUREMENT: Cessation of intravenous amiodarone and of other potentially hepatotoxic drugs.


RESULTS
Liver parameters significantly improved or returned to normal in all three patients, even after start of oral amiodarone in two patients.


CONCLUSIONS
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.
Rätz Bravo
Alexandra E
AE
Division of Clinical Pharmacology & Toxicology, University Hospital of Basel, CH-4031 Basel, Switzerland.
Drewe
Juergen
J
Schlienger
Raymond G
RG
Krähenbühl
Stephan
S
Pargger
Hans
H
Ummenhofer
Wolfgang
W
D000368:Aged; D000638:Amiodarone / Q000008:administration & dosage / Q000633:toxicity*; D000889:Anti-Arrhythmia Agents / Q000008:administration & dosage / Q000633:toxicity*; D001281:Atrial Fibrillation / Q000188:drug therapy*; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology*; D003422:Critical Care; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D007262:Infusions, Intravenous; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000188:drug therapy*; D014693:Ventricular Fibrillation / Q000188:drug therapy*
D000889:Anti-Arrhythmia Agents; D000638:Amiodarone