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

Abstract

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.

Mitochondrial dysfunction and delayed hepatotoxicity: another lesson from troglitazone

“…Examples include valproic acid [33], amiodarone [34][35][36], Wilson's disease [8], Alpers' syndrome [37] and (to some extent) alcohol [7]. These too have similarly pleiomorphic potential, extending from acute hepatitis to cirrhosis.…”

Hepatotoxicity After Continuous Amiodarone Infusion in a Postoperative Cardiac Infant

“…These laboratory findings are consistent with those found in previously published reports of amiodarone-induced hepatotoxicity in adults. In the study by Ra¨tz Bravo 6 in particular, AST and ALT elevations above 10 times the upper limit of normal were observed in 22 of the 25 case reports. Hyperbilirubinemia was observed in half of those cases.…”

“…However, 3 (of the 25) cases commented on a return of hepatotoxicity after rechallenge with intravenous amiodarone. 6 In contrast to adult reports, amiodarone hepatotoxicity literature in the congenital cardiac population is scarce. Given this population's increased risk of rhythm disturbance and subsequent exposure to amiodarone, we present the case of a 5-month-old female with suspected amiodarone-induced hepatotoxicity after continuous infusion for the treatment of postoperative JET.…”

“…1 Acute hepatotoxicity following intravenous (IV) amiodarone administration has been reported in several collections of adult case studies. [3][4][5] In 2005, Ra¨tz Bravo et al 6 reviewed 25 such adult cases reported between 1986 and 2002. Most cases occurred in patients aged 50 to 70 years with atrial tachyarrhythmia.…”

“…Liver enzyme abnormalities occurred within 3 days of starting parenteral amiodarone in approximately 88% of cases. 6 Establishing a causal relationship in these cases remains difficult, as most patients are critically ill with multiorgan dysfunction. However, 3 (of the 25) cases commented on a return of hepatotoxicity after rechallenge with intravenous amiodarone.…”