Amiodarone-Induced Acute Liver Injury

Pulmonary adverse events associated with amiodarone: a real-world pharmacovigilance study based on the FDA adverse event reporting system

BACKGROUND

Amiodarone is used to treat cardiac arrhythmias but carries a risk of pulmonary toxicity. Despite this well-known side effect, there is currently no large descriptive case series studying amiodarone-induced pulmonary toxicity.

METHODS

The reporting odds ratio (ROR) was utilized to quantify signals of amiodarone-related pulmonary adverse events (AEs) from 2004 to 2023. Severity comparisons between serious and non-serious cases were conducted using the Mann-Whitney U test or chi-square (χ2) test, and signal prioritization was achieved through rating scales.

RESULTS

A total of 4896 cases of amiodarone-related pulmonary AEs were found, and 56 signals were detected. 27 AEs were classified as serious adverse reactions, and 21 AEs were identified as new and unexpected signals. Even when stratified by age, weight, sex, and reporter type, the association between amiodarone and pulmonary diseases persisted. Seven strong clinical priority signals were defined. The median time to onset (TTO) for strong, moderate, and weak clinical priority signals was 221, 126, and 227 days, respectively. All disproportional signals exhibited an early failure-type pattern.

CONCLUSION

Our study offers a deeper and broader understanding of the pulmonary safety profile of amiodarone, which will aid healthcare professionals in mitigating the risk of pulmonary adverse events in clinical practice.

Chronic Oral Amiodarone as a Cause of Acute Liver Failure

Acute liver failure (ALF) is a rare condition that can have a variable clinical course and potentially fatal outcomes. Medication toxicity is a known etiology, however liver failure induced by amiodarone is rare and has been reported mostly in the setting of intravenous (IV) infusion. We present an 84-year-old patient who developed ALF after chronic use of oral amiodarone. The patient received supportive care and her symptoms improved.

Acute Multi-Organ Toxicity During 24-Hour Dosing of Intravenous Amiodarone: A Case Report

We present a unique case of a 60-year-old male with congestive heart failure who was admitted for a pre-syncopal episode and found to be in atrial fibrillation with rapid ventricular response (RVR). In order to effectively rate control the patient, he was administered an amiodarone bolus and intravenous (IV) infusion over 24 hours, along with a single oral 200 mg dose the following day. The patient subsequently developed acute hepatotoxicity along with features of acute kidney injury (AKI), pulmonary distress, and leukocytosis. After ruling out other etiologies for acute liver, pulmonary, and kidney injury, amiodarone-induced multi-organ toxicity was suspected and amiodarone was discontinued. Within hours of amiodarone discontinuation, the patient’s clinical status and organ function improved remarkably. In the setting of a patient being treated with IV amiodarone and presenting with sudden signs of dyspnea, acute elevation of transaminases and AKI within one to two days of initial dosing, acute amiodarone-induced organ toxicity should be considered.

Acute respiratory failure on a low dose of amiodarone - is it an underdiagnosed and undertreated condition?

Amiodarone-induced pulmonary toxicity (AIPT) has a variety of presentations. Amiodarone use has been rarely associated with the development of acute respiratory failure. We present a patient with a history of paroxysmal atrial fibrillation who developed acute respiratory distress syndrome despite taking a low dose of amiodarone and having no risk or precipitating factors. The diagnosis of AIPT was made after drug discontinuation and exclusion of other potential causes. The development of acute respiratory failure due to AIPT is often underdiagnosed and undertreated. Better identification of risk factors and developing appropriate diagnostic tools for risk stratification of patients receiving amiodarone is mandatory.

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Amiodarone use is rarely associated with the development of acute respiratory failure.

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The most clinical presentation of AIPT is a subacute illness presented by the nonproductive cough, progressive dyspnoea, and low-grade fever

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The diagnosis of AIPT is often made after drug discontinuation and exclusion of other potential causes.

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Identification of risk factors and developing appropriate diagnostic tools for risk stratification of patients receiving amiodarone is mandatory