Acute liver failure with amiodarone infusion

A case report and systematic review

P. Jaiswal, B. M. Attar, John Erikson Lim Yap, K. Devani, R. Jaiswal, Y. Wang, R. Szynkarek, D. Patel, M. Demetria

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

What is known and objective: Amiodarone, a commonly used class III antiarrhythmic agent notable for a relatively long half-life of up to 6 months and its pronounced adverse effect profile, is used for both acute and chronic management of cardiac arrhythmias. Chronic use of amiodarone has been associated with asymptomatic hepatotoxicity; however, acute toxicity is thought to be uncommon. There are only six reported cases of acute liver failure (ALF) secondary to amiodarone. In all these cases the outcome of death during the same hospitalization resulted. We aimed to report the only case of acute liver failure secondary to amiodarone infusion in the existing literature where the patient survived. Case summary: A 79-year-old woman admitted with atrial flutter was being treated with intravenous (IV) amiodarone when she abruptly developed coagulopathy, altered mental status and liver enzyme derangement. She was diagnosed with acute liver failure (ALF) secondary to an amiodarone adverse drug reaction, with a calculated score of seven on the Naranjo adverse drug reaction probability scale. Amiodarone was immediately withheld, and N-acetylcysteine (NAC) was initiated. Clinical improvement was seen within 48 hours of holding the drug and within 24 hours of initiating NAC. On post-hospital follow-up visit she was reported to have complete recovery. What is new and conclusion: This report emphasizes the importance of monitoring liver enzymes and mental status while a patient is being administered IV amiodarone. N-acetylcysteine administration may have possibly contributed to the early and successful recovery from ALF in our patient. To date, she is the only patient in the existing literature who has been reported to survive ALF secondary to amiodarone administration.

Original languageEnglish (US)
Pages (from-to)129-133
Number of pages5
JournalJournal of Clinical Pharmacy and Therapeutics
Volume43
Issue number1
DOIs
StatePublished - Feb 1 2018

Fingerprint

Acute Liver Failure
Amiodarone
Acetylcysteine
Drug-Related Side Effects and Adverse Reactions
Atrial Flutter
Liver
Enzymes
Half-Life
Cardiac Arrhythmias
Hospitalization

Keywords

  • N-acetylcysteine
  • acute hepatic failure
  • acute liver failure
  • amiodarone
  • systematic review
  • treatment

ASJC Scopus subject areas

  • Pharmacology
  • Pharmacology (medical)

Cite this

Acute liver failure with amiodarone infusion : A case report and systematic review. / Jaiswal, P.; Attar, B. M.; Yap, John Erikson Lim; Devani, K.; Jaiswal, R.; Wang, Y.; Szynkarek, R.; Patel, D.; Demetria, M.

In: Journal of Clinical Pharmacy and Therapeutics, Vol. 43, No. 1, 01.02.2018, p. 129-133.

Research output: Contribution to journalArticle

Jaiswal, P, Attar, BM, Yap, JEL, Devani, K, Jaiswal, R, Wang, Y, Szynkarek, R, Patel, D & Demetria, M 2018, 'Acute liver failure with amiodarone infusion: A case report and systematic review', Journal of Clinical Pharmacy and Therapeutics, vol. 43, no. 1, pp. 129-133. https://doi.org/10.1111/jcpt.12594
Jaiswal, P. ; Attar, B. M. ; Yap, John Erikson Lim ; Devani, K. ; Jaiswal, R. ; Wang, Y. ; Szynkarek, R. ; Patel, D. ; Demetria, M. / Acute liver failure with amiodarone infusion : A case report and systematic review. In: Journal of Clinical Pharmacy and Therapeutics. 2018 ; Vol. 43, No. 1. pp. 129-133.
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