Chen Chia-Chi, Wu Chien-Chih
1Department of Pharmacy, College of Medicine, National Taiwan University Hospital, National Taiwan University, Taipei, Taiwan; and 2Graduate Institute of Clinical Pharmacy, College of Medicine, National Taiwan University, Taipei, Taiwan.
Am J Ther. 2016 Jan-Feb;23(1):e260-3. doi: 10.1097/MJT.0000000000000149.
Amiodarone is a class III antiarrhythmic drug widely used for the treatment of both supraventricular and ventricular arrhythmias in intensive care unit. Hepatotoxicity of amiodarone is usually mild and delayed onset. Acute hepatotoxicity is a rare side effect and usually correlated to intravenous form use. In this case, acute hepatocellular injury occurred within 24 hours after the administration of intravenous amiodarone. Liver enzyme significantly improved after holding intravenous amiodarone use. Because ventricular arrhythmia persisted and side effects occurred to alternative therapy, low dose of oral amiodarone was resumed and hepatotoxicity did not occur afterward. Acute hepatotoxicity of intravenous amiodarone is possibly related to polysorbate 80, the solubilizer of amiodarone infusion or higher dose. As a result, when intravenous amiodarone is prescribed, closely monitoring liver enzyme is highly suggested. If acute hepatitis takes place secondary to intravenous amiodarone, oral therapy should not be resumed afterward. If there is no alternative treatment, lower dose of oral amiodarone (≤200 mg/d) could be tried and should monitor liver function regularly.
胺碘酮是一种III类抗心律失常药物，广泛用于重症监护病房治疗室上性和室性心律失常。胺碘酮的肝毒性通常较轻且起病延迟。急性肝毒性是一种罕见的副作用，通常与静脉用药有关。在本病例中，静脉注射胺碘酮后24小时内发生了急性肝细胞损伤。停用静脉胺碘酮后肝酶显著改善。由于室性心律失常持续存在且替代治疗出现副作用，因此恢复了低剂量口服胺碘酮治疗，此后未再发生肝毒性。静脉胺碘酮的急性肝毒性可能与胺碘酮注射液的增溶剂聚山梨酯80或较高剂量有关。因此，当开具静脉胺碘酮处方时，强烈建议密切监测肝酶。如果静脉胺碘酮继发急性肝炎，之后不应恢复口服治疗。如果没有替代治疗方法，可以尝试较低剂量的口服胺碘酮（≤200mg/d），并应定期监测肝功能。
