Comedication with amiodarone-interacting drugs significantly increased the risk of acute liver injury (HR 2.07) among critically ill patients receiving amiodarone.
Observational (n=131)
No
Does concurrent use of interacting drugs and higher cumulative amiodarone dose increase the risk of acute liver injury in ICU patients receiving amiodarone?
In ICU patients, the risk of amiodarone-associated acute liver injury is significantly increased by higher body surface area-standardized cumulative doses and the concurrent use of amiodarone-interacting medications.
Hazard Ratio: 2.07 (95% CI 1.02–4.22)
p-value: p=0.04
Risk factors and underlying mechanisms for liver injury associated with amiodarone remain elusive. This study aimed to investigate the drug-related covariates for acute liver injury by amiodarone-an intriguing compound of high lipophilicity, with a long half-life and notable efficacy.The medical, pharmacy, and laboratory records of new amiodarone users admitted to the cardiac or surgical intensive care units of a medical center were examined retrospectively. A Cox regression model with time-varying dose-related variables of amiodarone was utilized to estimate the hazard ratio (HR) of amiodarone-associated liver injury while adjusting for concomitant therapy and relevant covariates.Of the 131 eligible patients among 6,572 amiodarone users (46,402 prescriptions), 6 were identified as amiodarone-associated liver injury cases. In comparison to controls (n = 125), this liver injury cohort (n = 6) had significantly higher numbers of amiodarone-interacting (2.7 ± 2.0 vs 0.9 ± 0.9 drugs, P = .02) and hepatotoxic (3.8 ± 0.8 vs 2.5 ± 1.7 drugs, P = .03) comedications. The number of comedications with amiodarone-interacting potential (HR 2.07, 95% confidence interval CI 1.02-4.22, P = .04) and amiodarone cumulative doses standardized by body surface area (HR 6.82, 95% CI 1.72-27.04, P = .01) were independent risk factors for liver injury associated with amiodarone.Drug-related (amiodarone cumulative dose, interacting drugs) factors were significant predictors of amiodarone-associated acute liver injury. A prudent evaluation of each medication profile is warranted to attain precision medicine at the level of patient care, especially for those treated by medications with complex physicochemical and pharmacokinetic properties, such as amiodarone.
Ho et al. (Sat,) conducted a observational in Amiodarone users in intensive care units (n=131). Comedication with amiodarone-interacting drugs vs. Fewer or no amiodarone-interacting comedications was evaluated on Amiodarone-associated acute liver injury (HR 2.07, 95% CI 1.02-4.22, p=0.04). Comedication with amiodarone-interacting drugs significantly increased the risk of acute liver injury (HR 2.07) among critically ill patients receiving amiodarone.