Predictors of Intravenous Amiodarone Induced Liver Injury

Abstract

SUMMARY A miodarone is one of the most effective antiarrhythmic agent for the treatment and prevention of various tachyarrhythmias. In our study, we tried to focus on the acute hepatotoxicity from intravenous (IV) amiodarone rather than the oral form being extensively studied. The mechanism of liver injury with IV amiodarone seems to be mulifactorial. Ischemic injury due to hemodynamic unstability may have a role.5 Solubilizers in the IV amiodarone preparation such as polysorbate 80 were reported to be responsible for hepatotoxicity. Importantly, the mechanism of injury with IV amiodarone is different from that in chronic exposure to oral therapy, therefore, acute hepatic injury following IV amiodarone does not preclude subsequent oral therapy. Several factors may predispose to IV amiodarone induced liver injury (AILI) particularly in critically ill and hemodynamically unstable intensive care unit patients. The aim of our prospective study is to address the predictors of AILI and its severity as the prediction of amiodarone induced liver injury (AILI) and its severity may help careful patient monitoring or the choice of other measures alternative to amiodarone in high risk patients. Little is known regarding predictors of AILI. The study included 180 intensive and coronary care unit patients who received IV amiodarone therapy. Patients were divided into 2 groups:  Cases: Included 90 patients who developed AILI  Controls: Included 90 patients who did not develop AILI. We concluded that Parenteral amiodarone induced liver injury (AILI) and its severity could be predicted by underlying heart disease (cardiomyopathy, low EF), liver disease (congestive hepatomegally, elevated bilirubin and aminotransferases), hemodynamic instability (DC cardioversion, inotropic support), and increasing dose of amiodarone. In high risk patients, we recommend that benefit of IV amiodarone should be weighed against its possible hazard, especially in non life threatening conditions such as atrial fibrillation.