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. 2016 Feb;109(2):83-6.
doi: 10.14423/SMJ.0000000000000413.

Hepatic Dysfunction in Patients Receiving Intravenous Amiodarone

Ali Hashmi  1 , Nicole R Keswani  1 , Sharon Kim  1 , David Y Graham  1
Affiliations

Hepatic Dysfunction in Patients Receiving Intravenous Amiodarone

Ali Hashmi et al. South Med J. 2016 Feb.

Abstract

Objectives: Amiodarone 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.

Methods: This 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.

Results: A 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.

Conclusions: Amiodarone 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.

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