Comedication with interacting drugs predisposes amiodarone users in cardiac and surgical intensive care units to acute liver injury
| Autor: | Hsin Ying Chou, Jan Show Chu, Ping-Ing Lee, Yunn-Fang Ho |
|---|---|
| Rok vydání: | 2018 |
| Předmět: |
Adult
Male medicine.medical_specialty Adolescent adverse drug reaction Amiodarone Observational Study 030204 cardiovascular system & hematology intensive care unit law.invention Young Adult 03 medical and health sciences 0302 clinical medicine Risk Factors law Internal medicine Humans Medicine Drug Interactions 030212 general & internal medicine Risk factor Aged Proportional Hazards Models Retrospective Studies Liver injury business.industry Proportional hazards model Cumulative dose Hazard ratio General Medicine Middle Aged medicine.disease Intensive care unit Intensive Care Units risk factor Polypharmacy Regression Analysis Female Chemical and Drug Induced Liver Injury business Anti-Arrhythmia Agents drug-induced liver injury Adverse drug reaction Research Article medicine.drug |
| Zdroj: | Medicine |
| ISSN: | 0025-7974 |
| DOI: | 10.1097/md.0000000000012301 |
| Popis: | 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. |
| Databáze: | OpenAIRE |
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