Q: What is the cut-off limit to consider discontinuation of Amiodarone in patients with liver insufficiency?
Answer: Two folds
There could be various reasons for elevated liver enzymes in an ICU patient. Amiodarone is one of the most commonly used drugs for atrial fibrillation in ICU. As per practice Guidelines of the North American Society of Pacing and Electrophysiology, it would be appropriate not to use or discontinue Amiodarone if serum transaminases are increased two folds from the normal.
Hyperbilirubinemia usually does not occur with Amiodarone. Unfortunately, if it occurs it stays elevated or continues to rise even if Amiodarone is discontinued due to its long half-life.
#hepatology
#pharmacology
#cardiology
References:
1. Goldschlager N, Epstein AE, Naccarelli G, et al. Practical guidelines for clinicians who treat patients with amiodarone. Practice Guidelines Subcommittee, North American Society of Pacing and Electrophysiology. Arch Intern Med 2000; 160:1741.
2. Chang CC, Petrelli M, Tomashefski JF Jr, McCullough AJ. Severe intrahepatic cholestasis caused by amiodarone toxicity after withdrawal of the drug: a case report and review of the literature. Arch Pathol Lab Med 1999; 123:251.
Answer: Two folds
There could be various reasons for elevated liver enzymes in an ICU patient. Amiodarone is one of the most commonly used drugs for atrial fibrillation in ICU. As per practice Guidelines of the North American Society of Pacing and Electrophysiology, it would be appropriate not to use or discontinue Amiodarone if serum transaminases are increased two folds from the normal.
Hyperbilirubinemia usually does not occur with Amiodarone. Unfortunately, if it occurs it stays elevated or continues to rise even if Amiodarone is discontinued due to its long half-life.
#hepatology
#pharmacology
#cardiology
References:
1. Goldschlager N, Epstein AE, Naccarelli G, et al. Practical guidelines for clinicians who treat patients with amiodarone. Practice Guidelines Subcommittee, North American Society of Pacing and Electrophysiology. Arch Intern Med 2000; 160:1741.
2. Chang CC, Petrelli M, Tomashefski JF Jr, McCullough AJ. Severe intrahepatic cholestasis caused by amiodarone toxicity after withdrawal of the drug: a case report and review of the literature. Arch Pathol Lab Med 1999; 123:251.
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