Hepatic Dysfunction in Patients Receiving Intravenous Amiodarone

OBJECTIVESAmiodarone is a commonly used antiarrhythmic 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 t...

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Bibliographic Details
Published in:	Southern medical journal (Birmingham, Ala.) Vol. 109; no. 2; pp. 83 - 86
Main Authors:	Hashmi, Ali, Keswani, Nicole R, Kim, Sharon, Graham, David Y
Format:	Journal Article
Language:	English
Published:	United States by the Southern Medical Association 01-02-2016
Subjects:	Adult Aged Aged, 80 and over Amiodarone - administration & dosage Amiodarone - adverse effects Anti-Arrhythmia Agents - administration & dosage Anti-Arrhythmia Agents - adverse effects Chemical and Drug Induced Liver Injury - etiology Female Humans Infusions, Intravenous Male Middle Aged Retrospective Studies
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Summary:	OBJECTIVESAmiodarone is a commonly used antiarrhythmic 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. METHODSThis 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. RESULTSA 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 amiodarone-related liver disease. CONCLUSIONSAmiodarone 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.
Bibliography:	ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0038-4348 1541-8243
DOI:	10.14423/SMJ.0000000000000413