Objective:To explore and analyze the clinical effect of low-dose Betaloc combined with amiodarone in treating ventricular arrhythmia.Methods:70 patients with ventricular arrhythmia who were admitted to the Department ...Objective:To explore and analyze the clinical effect of low-dose Betaloc combined with amiodarone in treating ventricular arrhythmia.Methods:70 patients with ventricular arrhythmia who were admitted to the Department of Cardiology of our hospital between August 2022 and August 2023 were selected as research subjects.They were divided into two groups using the coin-tossing method:the combination group(n=35)and the reference group(n=35).The combination group was treated with low-dose Betaloc and amiodarone,and the control group was treated with low-dose Betaloc alone.The treatment efficacy,cardiac function indicators,and related tested indicators of the two groups were compared.Results:The total efficacy of the treatment received by the combination group was much higher than that of the control group(P<0.05).Besides,after treatment,the cardiac function indicators such as left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),and cardiac index(CI)of the patients in the combination group were significantly better than those of the reference group(P<0.05).Furthermore,the high-sensitivity C-reactive protein(Hs-CRP),N-terminal prohormone of brain natriuretic peptide(NT-proBNP),adiponectin(APN),and other related test indicators of the patients in the combination group were significantly better than those of the reference group(P<0.05).Conclusion:Low-dose Betaloc combined with amiodarone has a noticeable effect in treating ventricular arrhythmia and deserves to be widely promoted.展开更多
Three-dimensional(3D)cell spheroid models combined with mass spectrometry imaging(MSI)enables innovative investigation of in vivo-like biological processes under different physiological and pathological conditions.Her...Three-dimensional(3D)cell spheroid models combined with mass spectrometry imaging(MSI)enables innovative investigation of in vivo-like biological processes under different physiological and pathological conditions.Herein,airflow-assisted desorption electrospray ionization-MSI(AFADESI-MSI)was coupled with 3D HepG2 spheroids to assess the metabolism and hepatotoxicity of amiodarone(AMI).High-coverage imaging of>1100 endogenous metabolites in hepatocyte spheroids was achieved using AFADESI-MSI.Following AMI treatment at different times,15 metabolites of AMI involved in Ndesethylation,hydroxylation,deiodination,and desaturation metabolic reactions were identified,and according to their spatiotemporal dynamics features,the metabolic pathways of AMI were proposed.Subsequently,the temporal and spatial changes in metabolic disturbance within spheroids caused by drug exposure were obtained via metabolomic analysis.The main dysregulated metabolic pathways included arachidonic acid and glycerophospholipid metabolism,providing considerable evidence for the mechanism of AMI hepatotoxicity.In addition,a biomarker group of eight fatty acids was selected that provided improved indication of cell viability and could characterize the hepatotoxicity of AMI.The combination of AFADESI-MSI and HepG2 spheroids can simultaneously obtain spatiotemporal information for drugs,drug metabolites,and endogenous metabolites after AMI treatment,providing an effective tool for in vitro drug hepatotoxicity evaluation.展开更多
Objective:To explore and analyze the clinical effect of small and medium doses of Betaloc combined with amiodarone in the treatment of ventricular arrhythmia.Methods:60 patients with ventricular arrhythmia that were t...Objective:To explore and analyze the clinical effect of small and medium doses of Betaloc combined with amiodarone in the treatment of ventricular arrhythmia.Methods:60 patients with ventricular arrhythmia that were treated in the Department of Cardiology of our hospital from May 2018-May 2023 were selected for this study,and they were divided into a research group(n=30)and a reference group(n=30).The study group was treated with small doses of Betaloc and amiodarone,while the reference group was treated with conventional treatment.The total efficacy of medication,QRS interval,standard deviation of normal-to-normal(NN)intervals(SDNN),root mean square of successive differences between normal heartbeats(RMSSD),standard deviation of the average NN intervals(SDANN),and incidence of adverse reactions were compared between the groups.Results:The effectiveness of medication in the study group was significantly higher than that in the reference group(P<0.05).Besides,there was no statistically significant difference(P>0.05)in the QRS interval and SDNN between the two groups before treatment.After treatment,the QRS interval and SDNN of the study group were significantly lower than those of the reference group(P<0.05).Before treatment,there was no significant difference in RMSSD and SDANN between groups(P>0.05).After treatment,RMSSD and SDANN in the study group were significantly better than those in the reference group(P<0.05),and the difference was statistically significant.The incidence of adverse reactions in the study group was significantly lower than that in the reference group(P<0.05),and the difference was statistically significant.Conclusion:Small doses of Betoprolol and amiodarone is more effective in the treatment of ventricular arrhythmia,which has the value of popularization and application.展开更多
Adverse drug reaction is defined by the World Health Organization as any response to a drug that is noxious and unintended and occurs at a dose normally used in man.Older people are at elevated risk of adverse drug re...Adverse drug reaction is defined by the World Health Organization as any response to a drug that is noxious and unintended and occurs at a dose normally used in man.Older people are at elevated risk of adverse drug reactions—because of changes in pharmacodynamics,concurrent use of multiple medications and the related drug interactions.However,adverse drug reactions are significantly underestimated in the elderly population that is also exposed to inappropriate drugs.Amiodarone is an antiarrhythmic drug used commonly for the treatment of atrial fibrillation and is increasingly prescribed in older people.While amiodarone is an efficient drug for rhythm control,it’s a carrier of different adverse reactions,and pro and cons must be carefully evaluated before its use especially in older people.展开更多
We report a case of intravenous(IV) amiodarone drug induced liver injury(DILI).The patient received IV N-acetylcysteine(NAC) which resulted in a rapid improvement in liver enzymes.While the specific mechanisms for the...We report a case of intravenous(IV) amiodarone drug induced liver injury(DILI).The patient received IV N-acetylcysteine(NAC) which resulted in a rapid improvement in liver enzymes.While the specific mechanisms for the pathogenesis of IV amiodaroneDILI and the therapeutic action of IV NAC are both unknown, this case strongly implies at least some commonality.Because IV amiodarone is indicated for the treatment of serious cardiac arrhythmias in an intensive care unit setting, some degree of ischemic hepatitis is likely a cofactor in most cases.展开更多
Amiodarone chlorhydrate is a diiodated benzofuran derivative used to treat cardiac rhythm abnormalities. Hepatotoxicity is a relatively uncommon side effect of amiodarone and symptomatic hepatic dysfunction occurs in ...Amiodarone chlorhydrate is a diiodated benzofuran derivative used to treat cardiac rhythm abnormalities. Hepatotoxicity is a relatively uncommon side effect of amiodarone and symptomatic hepatic dysfunction occurs in less than 1% to 3% of patients taking amiodarone. We report here on an unusual case of amiodarone-induced hepatotoxicity. A 29 year old woman with normal liver function was given amiodarone intravenously to treat her atrial fibrillation. She developed acute toxic hepatitis after 24 h. The intravenous form of amiodarone was immediately avoided and replaced by the oral form, using conventional loading doses as soon as the deranged liver function tests had normalized, without recurrence of the hepatitis. These observations show that the occurrence of acute hepatic impairment with intravenous amiodarone does not necessarily preclude the use of this drug by mouth and the necessity of monitoring the hepatic function of patients treated with amiodarone.展开更多
Objective:To evaluate the ameliorative role of grapefruit juice on the cytogenetic and testicular damage induced by the antiarrythmic drug amiodarone in albino rats.Methods:Animals were divided into four groups.Group ...Objective:To evaluate the ameliorative role of grapefruit juice on the cytogenetic and testicular damage induced by the antiarrythmic drug amiodarone in albino rats.Methods:Animals were divided into four groups.Group I was considered as control.Group II was given grapefruit juice at a dose level of 27 mL/kg body weight.Group III was orally administered amiodarone(18 mg/kg body weight)daily for 5 weeks.Animals were sacrificed after 5 weeks of treatment.Bone marrow was collected from the femurs for analysis of chromosomal aberrations and mitotic indices.Testes were removed and stained with H&E for histological examination.Sperms were collected from epidedymis for detection of sperm head abnormalities.Comet assay was used to detect DNA damage.Results:Amiodarone treatment caused a significant increase in the percentage of chromosomal aberrations,decreased the mitotic index and increased DNA damage.The testis showed many histopathological alterations,inhibition of spermatogenesis and morphometric changes.The number of sperm head abnormalities was increased.Treating animals with amiodarone and grapefruit juice caused a reduction in chromosomal aberrations,mitotic index,DNA damage and testicular alterations caused by amiodarone.Conclusions:The results of this study indicated that grapefruit juice ameliorates the cytotoxicty and testicular alterations induced by amiodarone in albino rats and this is may be due to the potent antioxidant effects of its components.展开更多
BACKGROUND:The presence of dual pathology can cause diagnostic dilemmas. We present a case of adenocarcinoma of the ampulla of Vater with concurrent amiodarone hepatotoxicity. METHODS:Painless jaundice associated with...BACKGROUND:The presence of dual pathology can cause diagnostic dilemmas. We present a case of adenocarcinoma of the ampulla of Vater with concurrent amiodarone hepatotoxicity. METHODS:Painless jaundice associated with a palpable gallbladder was investigated clinically,radiologically endoscopically and via liver biopsy. RESULTS:Liver biopsy showed amiodarone hepatotoxicity Endoscopic biopsy identified an ampullary adenoma However,the endoscopic ultrasound and intra-operative findings suggested a malignancy,which was confirmed postoperatively. CONCLUSIONS:While the classic findings of Courvoisier's Law are borne out in this case,the etiology of jaundice is twofold. Although dual pathology is uncommon it should always be considered.展开更多
BACKGROUND Amiodarone is the drug most commonly used to manage arrhythmias.Long-term amiodarone administration causes hepatotoxicity due to iodine accumulation in the liver.Here,we present three cases of amiodarone-in...BACKGROUND Amiodarone is the drug most commonly used to manage arrhythmias.Long-term amiodarone administration causes hepatotoxicity due to iodine accumulation in the liver.Here,we present three cases of amiodarone-induced hepatotoxicity in patients on long-term oral amiodarone therapy who underwent dual-energy computed tomography(DECT).CASE SUMMARY We report the clinical and iodine density in the liver using DECT in three patients with amiodarone-induced hepatotoxicity.Liver enzymes were increased in these three patients,and abdominal DECT without contrast medium showed highly increased attenuation in the liver.Furthermore,the iodine concentration in the liver was increased.The first patient with amiodarone-induced reversible hepatotoxicity,showed a reversible course of liver function and a decrease in CT values after discontinuation of amiodarone.The second patient on long-term oral amiodarone had increased iodine concentration in the liver and liver damage,the patient eventually developed rapidly progressive pneumonia and died of multiple organ failure.The third patient,showed an increased iodine concentration in the liver and elevated liver enzymes.However,the patient refused radiofrequency ablation for atrial fibrillation and continued oral amiodarone to control atrial fibrillation,and routine liver function tests were required every 3-6 mo in this patient.CONCLUSION DECT is a potentially noninvasive diagnostic tool for quantifying iodine concentration in the liver and monitoring adverse reactions due to amiodarone.展开更多
BACKGROUND Amiodarone is a Class III antiarrhythmic drug,which has been adopted for the treatment of atrial fibrillation and ventricular arrhythmia.However,the use of amiodarone can cause lower limb muscle tremors,whi...BACKGROUND Amiodarone is a Class III antiarrhythmic drug,which has been adopted for the treatment of atrial fibrillation and ventricular arrhythmia.However,the use of amiodarone can cause lower limb muscle tremors,which is recognized as a rare side effect of this medication.CASE SUMMARY An 84-year-old female was administrated with amiodarone for paroxysmal supraventricular tachycardia and frequent ventricular tachycardia.The patient developed a bilateral gastrocnemius tremor in the course of medication,and the strength of the patient’s bilateral knee flexor and extensor reached 4/5 and 3/5,respectively.After the use of amiodarone was stopped,and the patient was given a small dose of levetiracetam,the lower limb tremor symptoms were significantly mitigated,along with activity and function.CONCLUSION Attention should be paid to the significance of the side effects of drugs in the elderly,which may be atypical in the elderly.The relevant side effects of drugs may not be as rare as reported due to individual differences and different pharmacokinetics.If the side effects are generated,the medication should be adjusted in time,and the progress of the side effects should be intervened.展开更多
The influence of amiodarone on intracellular transport of calcium ion in cardiomyocytes of rat was investigated. The experiments were performed on isolated papillary muscles of Wistar rats. Force-frequency dependence ...The influence of amiodarone on intracellular transport of calcium ion in cardiomyocytes of rat was investigated. The experiments were performed on isolated papillary muscles of Wistar rats. Force-frequency dependence (0.7, 1, 2, 3, 4 Hz), extrasystolic and postextrasystolic contractions and post-rest (4-60 s) reactions of rat myocardium after amiodarone treatment (1 μM) were investigated. Decay potentiation coefficient of contraction force was estimated. Results. The analyses of force-frequency dependence has shown that amiodarone prevent the decreasing of the force contraction at increasing of the stimulation frequency. Amiodarone promotes increase of the time constant t1(T50), that indicate the drug promotes acceleration of Са2+ transport inside the SR resulting increase of Са2+ in the places of its release from the sarcoplasmic reticulum (SR). Treatment of papillary muscle with amiodarone decreased amplitude of extrasystolic contractions. As known, postextrasystolic and post-rest reactions of myocardium characterize the SR function. We have found amiodarone increased potentiation of postextrasystolic and post-rest contractions. Preliminary caffeine perfusion of muscles preparations cancelled the amiodarone-induced increasing postextrasystolic and post-rest potentiation. However, potentiation decay coefficient before and after treatment with amiodarone didn’t have difference. Conclusions, amiodarone influences on intracellular calcium ions homeostasis by modulation SR functions related with most likely are stipulated either by activation of Са2+ transport from uptake sites to release sites or by prevent of Са2+ leakage from the SR.展开更多
Amiodarone is used worldwide to treat cardiac arrhythmias, as well as highly symptomatic cases of atrial fibrillation. With this expanded use, especially following its 1985 United States Food and Drug Administration a...Amiodarone is used worldwide to treat cardiac arrhythmias, as well as highly symptomatic cases of atrial fibrillation. With this expanded use, especially following its 1985 United States Food and Drug Administration approval, and its use as a long-term therapy in common practice, reports of cancers temporarily related to amiodarone have begun to increase. Animal studies, several clinical trials, numerous case reports, and a population-based cohort study have suggested that cancers may be associated with amiodarone use. This review focuses on the ever increasing evidence in the literature that suggests amiodarone therapy, especially with long-term use, may increase the potential risk of cancer development. It also expresses the need for more definitive studies to be conducted to provide clinicians with a clear answer to this important question.展开更多
Acute hepatitis is a very rare, but potentially fatal, adverse effect of intravenous amiodarone. We present a case of an 88-year-old man with history of ischemic dilated cardiomyopathy and severely depressed left vent...Acute hepatitis is a very rare, but potentially fatal, adverse effect of intravenous amiodarone. We present a case of an 88-year-old man with history of ischemic dilated cardiomyopathy and severely depressed left ventricular function that was admitted to our coronary care unit with diagnosis of decompensated heart failure and non-sustained ventricular tachycardia. A few hours after the beginning of intravenous amiodarone he developed an acute hepatitis. There was a completely recovery within the next days after amiodarone withdrawn and other causes of acute hepatitis have been ruled out. This case highlights the need for close monitoring of hepatic function during amiodarone infusion in order to identify any potential hepatotoxicity and prevent a fatal outcome. Oral amiodarone is, apparently, a safe option in these patients.展开更多
Objective To investigate the elfects of some class Ⅰ antiarrhythmic agents on QT dispersion and compared with those of amiodarone. Methods Group I was composed of 30 cases, they were all treated with class Ⅰ agents....Objective To investigate the elfects of some class Ⅰ antiarrhythmic agents on QT dispersion and compared with those of amiodarone. Methods Group I was composed of 30 cases, they were all treated with class Ⅰ agents. The drugs used include: mexiletine (8 cases), moricizine (9), propafenone (12) and apridine (1). GrouP Ⅱ was composed of other 30 patients, and were all treated with amiodarone. The ddlerences of QT intervals between ECG leads (QTd and QTcd) were measured belore and aler medication. Results Before medication, the QTmax and QTcmax in group Ⅱ were signilicantly longer than those of group Ⅰ, resulting in greater QTd and QTcd in grouP Ⅱ (QTd:66± 14ms vs 31± 16ms, P<0.01; QTcd:71±36ms vs 44± 18ms, P<0.01). Alter medication, QTmax and QTcmax of group Ⅰ were prolonged, leading to the lengthening of QTd (from 31±16ms to 45±17ms, P<0.01) and QTcd (from 44± 18 ms to 58± 21ms, P<0.05), indicating the increase of inhomogeneity of myocardial repolarization after the treatment of class Ⅰ agents. Alter amiodarone treatment, QTmin and QTmax in grouP Ⅱ were both prolonged, with a greater amplitude of QTmin prolongation, resulting in decreased QTd and QTcd in group Ⅱ (QTd /rom 66± 14ms to 36±22ms, P<0.01, QTcd from 71±36ms to 45±27ms, P<0.01). The signifcant dofference of QTd and QTcd between two groups disappeared aler medication. Conclusion The results of the present study may relect the opposite effects of amiodarone and these class Ⅰ agents on myocardial repolarization.展开更多
Change of interval–force dependence of rat papillary muscles at acute and course use of amiodarone was investigated. Methods. The experiments were performed on isolated papillary muscles of Wistar rats. The extrasyst...Change of interval–force dependence of rat papillary muscles at acute and course use of amiodarone was investigated. Methods. The experiments were performed on isolated papillary muscles of Wistar rats. The extrasystolic (0,2-1,5 s), postextrasystolic contractions and post-rest (4-60 s) reactions of rat left papillary muscles perfused Krebs-Henseleit solution with amiodarone (1 μM) and papillary muscles of rat treated amiodarone in dose 20 mg/kg/day for 14 days were investigated. Results. It has been found that both acute and course use of amiodarone decreases the amplitude of extrasystolic contraction. At the same time, only acute use of amiodarone leads to additional enhancement of potentialtion of contractile response at extrasystolic impulse and performance of post-rest test. Conclusion was made, that both acute and course use of amiodarone decreases excitability of cardiomyocytes but only at course use this antiarrythmic drug increases effective refractory period of myocardium. Acute exposure of amiodarone is accompanied with change of functional state of cardiomyocyte sarcoplasmatic reticulum.展开更多
Objective: To report a case of drug interaction leading to rhabdomyolysis. Case Summary: A 65-year old woman suf-fering from chronic atrial fibrillation was treated with amiodarone and acenocoumarol. Two weeks after a...Objective: To report a case of drug interaction leading to rhabdomyolysis. Case Summary: A 65-year old woman suf-fering from chronic atrial fibrillation was treated with amiodarone and acenocoumarol. Two weeks after administration of conventional dosage of colchicine for pericarditis, the patient developed rhabdomyolysis. colchicine-induced rhabdomyolysis was suspected. Colchicine was stopped and the patient underwent supportive therapy. Clinical symptoms improved rapidly. Discussion: Colchicine-induced neuromuscular toxicity and rhabdomyolysis have been reported with chronic treatment in therapeutic doses. Concomitant use of several drugs with colchicine may potentiate the development of myopathy. In our case, a co-administration of colchicine, a well known substrate of cytochrome P450 3A4 and P-glycoprotein, and amiodarone had possibly precipitated rhabdomyolysis. Amiodarone may increase colchicine toxicity by a dual mechanism. Amiodarone inhibits P-glycoprotein which may theoretically result in increased intrace- llular colchicine concentrations and decreased hepatic and renal excretion of the drug. Conclusion: Amiodarone may potentiate the development of colchicine-induced rhabdomyolysis.展开更多
Structure Activity Relationship forms the basis of Rational Drug Design in the circles of pharmaceutical and medicinal chemistry. Appropriate knowledge of functional outcomes of structural modifications is crucial in ...Structure Activity Relationship forms the basis of Rational Drug Design in the circles of pharmaceutical and medicinal chemistry. Appropriate knowledge of functional outcomes of structural modifications is crucial in conferring desired pharmacological properties to a chemical compound. Amiodarone is a classical antiarrythmic agent with a long list of adverse effects. This article attempts to review the structure activity relationship of some of the homologues of amiodarone in order to determine the most clinically desirable molecule.展开更多
Background: Many patients are affected by idiopathicbronchiolitis obliterans organizing pneumonia (BOOP). There are several known causes of BOOP, and several systemic disorders have BOOP as an associated primary pulmo...Background: Many patients are affected by idiopathicbronchiolitis obliterans organizing pneumonia (BOOP). There are several known causes of BOOP, and several systemic disorders have BOOP as an associated primary pulmonary lesion. Numerous agents including cytotoxic and noncytotoxic drugs have the potential to cause pulmonary toxicity. Descriptions of amiodarone-related BOOP continue to be reported throughout the world. Case Report: We reported a patient with original clinical presentation who developed recurrent sustained ventricular tachycardia (SVT) despite the presence of implantable cardioverter-defibrillator (ICD), hypoxaemia and interstitial pneumonitis in both lung bases. After percutaneous transluminal coronary angioplasty, he developed bronchiolitis obliterans organizing pneumonia (BOOP). Conclusions: To our knowledge, such complications after percutaneous coronary procedure in patients with amiodarone therapy for arrhythmia prophylaxis, are not very frequent in literature.展开更多
文摘Objective:To explore and analyze the clinical effect of low-dose Betaloc combined with amiodarone in treating ventricular arrhythmia.Methods:70 patients with ventricular arrhythmia who were admitted to the Department of Cardiology of our hospital between August 2022 and August 2023 were selected as research subjects.They were divided into two groups using the coin-tossing method:the combination group(n=35)and the reference group(n=35).The combination group was treated with low-dose Betaloc and amiodarone,and the control group was treated with low-dose Betaloc alone.The treatment efficacy,cardiac function indicators,and related tested indicators of the two groups were compared.Results:The total efficacy of the treatment received by the combination group was much higher than that of the control group(P<0.05).Besides,after treatment,the cardiac function indicators such as left ventricular ejection fraction(LVEF),left ventricular end-systolic volume(LVESV),and cardiac index(CI)of the patients in the combination group were significantly better than those of the reference group(P<0.05).Furthermore,the high-sensitivity C-reactive protein(Hs-CRP),N-terminal prohormone of brain natriuretic peptide(NT-proBNP),adiponectin(APN),and other related test indicators of the patients in the combination group were significantly better than those of the reference group(P<0.05).Conclusion:Low-dose Betaloc combined with amiodarone has a noticeable effect in treating ventricular arrhythmia and deserves to be widely promoted.
基金funded by the National Natural Science Foundation of China(Grant No.:21874156)the Chinese Academy of Medical Science(CAMS)Innovation Fund for Medical Sciences(Grant No.:2021-1-I2M-028).
文摘Three-dimensional(3D)cell spheroid models combined with mass spectrometry imaging(MSI)enables innovative investigation of in vivo-like biological processes under different physiological and pathological conditions.Herein,airflow-assisted desorption electrospray ionization-MSI(AFADESI-MSI)was coupled with 3D HepG2 spheroids to assess the metabolism and hepatotoxicity of amiodarone(AMI).High-coverage imaging of>1100 endogenous metabolites in hepatocyte spheroids was achieved using AFADESI-MSI.Following AMI treatment at different times,15 metabolites of AMI involved in Ndesethylation,hydroxylation,deiodination,and desaturation metabolic reactions were identified,and according to their spatiotemporal dynamics features,the metabolic pathways of AMI were proposed.Subsequently,the temporal and spatial changes in metabolic disturbance within spheroids caused by drug exposure were obtained via metabolomic analysis.The main dysregulated metabolic pathways included arachidonic acid and glycerophospholipid metabolism,providing considerable evidence for the mechanism of AMI hepatotoxicity.In addition,a biomarker group of eight fatty acids was selected that provided improved indication of cell viability and could characterize the hepatotoxicity of AMI.The combination of AFADESI-MSI and HepG2 spheroids can simultaneously obtain spatiotemporal information for drugs,drug metabolites,and endogenous metabolites after AMI treatment,providing an effective tool for in vitro drug hepatotoxicity evaluation.
文摘Objective:To explore and analyze the clinical effect of small and medium doses of Betaloc combined with amiodarone in the treatment of ventricular arrhythmia.Methods:60 patients with ventricular arrhythmia that were treated in the Department of Cardiology of our hospital from May 2018-May 2023 were selected for this study,and they were divided into a research group(n=30)and a reference group(n=30).The study group was treated with small doses of Betaloc and amiodarone,while the reference group was treated with conventional treatment.The total efficacy of medication,QRS interval,standard deviation of normal-to-normal(NN)intervals(SDNN),root mean square of successive differences between normal heartbeats(RMSSD),standard deviation of the average NN intervals(SDANN),and incidence of adverse reactions were compared between the groups.Results:The effectiveness of medication in the study group was significantly higher than that in the reference group(P<0.05).Besides,there was no statistically significant difference(P>0.05)in the QRS interval and SDNN between the two groups before treatment.After treatment,the QRS interval and SDNN of the study group were significantly lower than those of the reference group(P<0.05).Before treatment,there was no significant difference in RMSSD and SDANN between groups(P>0.05).After treatment,RMSSD and SDANN in the study group were significantly better than those in the reference group(P<0.05),and the difference was statistically significant.The incidence of adverse reactions in the study group was significantly lower than that in the reference group(P<0.05),and the difference was statistically significant.Conclusion:Small doses of Betoprolol and amiodarone is more effective in the treatment of ventricular arrhythmia,which has the value of popularization and application.
基金supported in part by Sapienza University grant#C26A15M78W(to IL)
文摘Adverse drug reaction is defined by the World Health Organization as any response to a drug that is noxious and unintended and occurs at a dose normally used in man.Older people are at elevated risk of adverse drug reactions—because of changes in pharmacodynamics,concurrent use of multiple medications and the related drug interactions.However,adverse drug reactions are significantly underestimated in the elderly population that is also exposed to inappropriate drugs.Amiodarone is an antiarrhythmic drug used commonly for the treatment of atrial fibrillation and is increasingly prescribed in older people.While amiodarone is an efficient drug for rhythm control,it’s a carrier of different adverse reactions,and pro and cons must be carefully evaluated before its use especially in older people.
文摘We report a case of intravenous(IV) amiodarone drug induced liver injury(DILI).The patient received IV N-acetylcysteine(NAC) which resulted in a rapid improvement in liver enzymes.While the specific mechanisms for the pathogenesis of IV amiodaroneDILI and the therapeutic action of IV NAC are both unknown, this case strongly implies at least some commonality.Because IV amiodarone is indicated for the treatment of serious cardiac arrhythmias in an intensive care unit setting, some degree of ischemic hepatitis is likely a cofactor in most cases.
文摘Amiodarone chlorhydrate is a diiodated benzofuran derivative used to treat cardiac rhythm abnormalities. Hepatotoxicity is a relatively uncommon side effect of amiodarone and symptomatic hepatic dysfunction occurs in less than 1% to 3% of patients taking amiodarone. We report here on an unusual case of amiodarone-induced hepatotoxicity. A 29 year old woman with normal liver function was given amiodarone intravenously to treat her atrial fibrillation. She developed acute toxic hepatitis after 24 h. The intravenous form of amiodarone was immediately avoided and replaced by the oral form, using conventional loading doses as soon as the deranged liver function tests had normalized, without recurrence of the hepatitis. These observations show that the occurrence of acute hepatic impairment with intravenous amiodarone does not necessarily preclude the use of this drug by mouth and the necessity of monitoring the hepatic function of patients treated with amiodarone.
基金Supported by CQAP,Faculty of Science,Menoufia University,Grant#CP4-062-MEN
文摘Objective:To evaluate the ameliorative role of grapefruit juice on the cytogenetic and testicular damage induced by the antiarrythmic drug amiodarone in albino rats.Methods:Animals were divided into four groups.Group I was considered as control.Group II was given grapefruit juice at a dose level of 27 mL/kg body weight.Group III was orally administered amiodarone(18 mg/kg body weight)daily for 5 weeks.Animals were sacrificed after 5 weeks of treatment.Bone marrow was collected from the femurs for analysis of chromosomal aberrations and mitotic indices.Testes were removed and stained with H&E for histological examination.Sperms were collected from epidedymis for detection of sperm head abnormalities.Comet assay was used to detect DNA damage.Results:Amiodarone treatment caused a significant increase in the percentage of chromosomal aberrations,decreased the mitotic index and increased DNA damage.The testis showed many histopathological alterations,inhibition of spermatogenesis and morphometric changes.The number of sperm head abnormalities was increased.Treating animals with amiodarone and grapefruit juice caused a reduction in chromosomal aberrations,mitotic index,DNA damage and testicular alterations caused by amiodarone.Conclusions:The results of this study indicated that grapefruit juice ameliorates the cytotoxicty and testicular alterations induced by amiodarone in albino rats and this is may be due to the potent antioxidant effects of its components.
文摘BACKGROUND:The presence of dual pathology can cause diagnostic dilemmas. We present a case of adenocarcinoma of the ampulla of Vater with concurrent amiodarone hepatotoxicity. METHODS:Painless jaundice associated with a palpable gallbladder was investigated clinically,radiologically endoscopically and via liver biopsy. RESULTS:Liver biopsy showed amiodarone hepatotoxicity Endoscopic biopsy identified an ampullary adenoma However,the endoscopic ultrasound and intra-operative findings suggested a malignancy,which was confirmed postoperatively. CONCLUSIONS:While the classic findings of Courvoisier's Law are borne out in this case,the etiology of jaundice is twofold. Although dual pathology is uncommon it should always be considered.
基金Science and Technology Bureau of Jiaxing,Zhejiang Province of China,No.2017BY18018。
文摘BACKGROUND Amiodarone is the drug most commonly used to manage arrhythmias.Long-term amiodarone administration causes hepatotoxicity due to iodine accumulation in the liver.Here,we present three cases of amiodarone-induced hepatotoxicity in patients on long-term oral amiodarone therapy who underwent dual-energy computed tomography(DECT).CASE SUMMARY We report the clinical and iodine density in the liver using DECT in three patients with amiodarone-induced hepatotoxicity.Liver enzymes were increased in these three patients,and abdominal DECT without contrast medium showed highly increased attenuation in the liver.Furthermore,the iodine concentration in the liver was increased.The first patient with amiodarone-induced reversible hepatotoxicity,showed a reversible course of liver function and a decrease in CT values after discontinuation of amiodarone.The second patient on long-term oral amiodarone had increased iodine concentration in the liver and liver damage,the patient eventually developed rapidly progressive pneumonia and died of multiple organ failure.The third patient,showed an increased iodine concentration in the liver and elevated liver enzymes.However,the patient refused radiofrequency ablation for atrial fibrillation and continued oral amiodarone to control atrial fibrillation,and routine liver function tests were required every 3-6 mo in this patient.CONCLUSION DECT is a potentially noninvasive diagnostic tool for quantifying iodine concentration in the liver and monitoring adverse reactions due to amiodarone.
文摘BACKGROUND Amiodarone is a Class III antiarrhythmic drug,which has been adopted for the treatment of atrial fibrillation and ventricular arrhythmia.However,the use of amiodarone can cause lower limb muscle tremors,which is recognized as a rare side effect of this medication.CASE SUMMARY An 84-year-old female was administrated with amiodarone for paroxysmal supraventricular tachycardia and frequent ventricular tachycardia.The patient developed a bilateral gastrocnemius tremor in the course of medication,and the strength of the patient’s bilateral knee flexor and extensor reached 4/5 and 3/5,respectively.After the use of amiodarone was stopped,and the patient was given a small dose of levetiracetam,the lower limb tremor symptoms were significantly mitigated,along with activity and function.CONCLUSION Attention should be paid to the significance of the side effects of drugs in the elderly,which may be atypical in the elderly.The relevant side effects of drugs may not be as rare as reported due to individual differences and different pharmacokinetics.If the side effects are generated,the medication should be adjusted in time,and the progress of the side effects should be intervened.
文摘The influence of amiodarone on intracellular transport of calcium ion in cardiomyocytes of rat was investigated. The experiments were performed on isolated papillary muscles of Wistar rats. Force-frequency dependence (0.7, 1, 2, 3, 4 Hz), extrasystolic and postextrasystolic contractions and post-rest (4-60 s) reactions of rat myocardium after amiodarone treatment (1 μM) were investigated. Decay potentiation coefficient of contraction force was estimated. Results. The analyses of force-frequency dependence has shown that amiodarone prevent the decreasing of the force contraction at increasing of the stimulation frequency. Amiodarone promotes increase of the time constant t1(T50), that indicate the drug promotes acceleration of Са2+ transport inside the SR resulting increase of Са2+ in the places of its release from the sarcoplasmic reticulum (SR). Treatment of papillary muscle with amiodarone decreased amplitude of extrasystolic contractions. As known, postextrasystolic and post-rest reactions of myocardium characterize the SR function. We have found amiodarone increased potentiation of postextrasystolic and post-rest contractions. Preliminary caffeine perfusion of muscles preparations cancelled the amiodarone-induced increasing postextrasystolic and post-rest potentiation. However, potentiation decay coefficient before and after treatment with amiodarone didn’t have difference. Conclusions, amiodarone influences on intracellular calcium ions homeostasis by modulation SR functions related with most likely are stipulated either by activation of Са2+ transport from uptake sites to release sites or by prevent of Са2+ leakage from the SR.
文摘Amiodarone is used worldwide to treat cardiac arrhythmias, as well as highly symptomatic cases of atrial fibrillation. With this expanded use, especially following its 1985 United States Food and Drug Administration approval, and its use as a long-term therapy in common practice, reports of cancers temporarily related to amiodarone have begun to increase. Animal studies, several clinical trials, numerous case reports, and a population-based cohort study have suggested that cancers may be associated with amiodarone use. This review focuses on the ever increasing evidence in the literature that suggests amiodarone therapy, especially with long-term use, may increase the potential risk of cancer development. It also expresses the need for more definitive studies to be conducted to provide clinicians with a clear answer to this important question.
文摘Acute hepatitis is a very rare, but potentially fatal, adverse effect of intravenous amiodarone. We present a case of an 88-year-old man with history of ischemic dilated cardiomyopathy and severely depressed left ventricular function that was admitted to our coronary care unit with diagnosis of decompensated heart failure and non-sustained ventricular tachycardia. A few hours after the beginning of intravenous amiodarone he developed an acute hepatitis. There was a completely recovery within the next days after amiodarone withdrawn and other causes of acute hepatitis have been ruled out. This case highlights the need for close monitoring of hepatic function during amiodarone infusion in order to identify any potential hepatotoxicity and prevent a fatal outcome. Oral amiodarone is, apparently, a safe option in these patients.
文摘Objective To investigate the elfects of some class Ⅰ antiarrhythmic agents on QT dispersion and compared with those of amiodarone. Methods Group I was composed of 30 cases, they were all treated with class Ⅰ agents. The drugs used include: mexiletine (8 cases), moricizine (9), propafenone (12) and apridine (1). GrouP Ⅱ was composed of other 30 patients, and were all treated with amiodarone. The ddlerences of QT intervals between ECG leads (QTd and QTcd) were measured belore and aler medication. Results Before medication, the QTmax and QTcmax in group Ⅱ were signilicantly longer than those of group Ⅰ, resulting in greater QTd and QTcd in grouP Ⅱ (QTd:66± 14ms vs 31± 16ms, P<0.01; QTcd:71±36ms vs 44± 18ms, P<0.01). Alter medication, QTmax and QTcmax of group Ⅰ were prolonged, leading to the lengthening of QTd (from 31±16ms to 45±17ms, P<0.01) and QTcd (from 44± 18 ms to 58± 21ms, P<0.05), indicating the increase of inhomogeneity of myocardial repolarization after the treatment of class Ⅰ agents. Alter amiodarone treatment, QTmin and QTmax in grouP Ⅱ were both prolonged, with a greater amplitude of QTmin prolongation, resulting in decreased QTd and QTcd in group Ⅱ (QTd /rom 66± 14ms to 36±22ms, P<0.01, QTcd from 71±36ms to 45±27ms, P<0.01). The signifcant dofference of QTd and QTcd between two groups disappeared aler medication. Conclusion The results of the present study may relect the opposite effects of amiodarone and these class Ⅰ agents on myocardial repolarization.
文摘Change of interval–force dependence of rat papillary muscles at acute and course use of amiodarone was investigated. Methods. The experiments were performed on isolated papillary muscles of Wistar rats. The extrasystolic (0,2-1,5 s), postextrasystolic contractions and post-rest (4-60 s) reactions of rat left papillary muscles perfused Krebs-Henseleit solution with amiodarone (1 μM) and papillary muscles of rat treated amiodarone in dose 20 mg/kg/day for 14 days were investigated. Results. It has been found that both acute and course use of amiodarone decreases the amplitude of extrasystolic contraction. At the same time, only acute use of amiodarone leads to additional enhancement of potentialtion of contractile response at extrasystolic impulse and performance of post-rest test. Conclusion was made, that both acute and course use of amiodarone decreases excitability of cardiomyocytes but only at course use this antiarrythmic drug increases effective refractory period of myocardium. Acute exposure of amiodarone is accompanied with change of functional state of cardiomyocyte sarcoplasmatic reticulum.
文摘Objective: To report a case of drug interaction leading to rhabdomyolysis. Case Summary: A 65-year old woman suf-fering from chronic atrial fibrillation was treated with amiodarone and acenocoumarol. Two weeks after administration of conventional dosage of colchicine for pericarditis, the patient developed rhabdomyolysis. colchicine-induced rhabdomyolysis was suspected. Colchicine was stopped and the patient underwent supportive therapy. Clinical symptoms improved rapidly. Discussion: Colchicine-induced neuromuscular toxicity and rhabdomyolysis have been reported with chronic treatment in therapeutic doses. Concomitant use of several drugs with colchicine may potentiate the development of myopathy. In our case, a co-administration of colchicine, a well known substrate of cytochrome P450 3A4 and P-glycoprotein, and amiodarone had possibly precipitated rhabdomyolysis. Amiodarone may increase colchicine toxicity by a dual mechanism. Amiodarone inhibits P-glycoprotein which may theoretically result in increased intrace- llular colchicine concentrations and decreased hepatic and renal excretion of the drug. Conclusion: Amiodarone may potentiate the development of colchicine-induced rhabdomyolysis.
文摘Structure Activity Relationship forms the basis of Rational Drug Design in the circles of pharmaceutical and medicinal chemistry. Appropriate knowledge of functional outcomes of structural modifications is crucial in conferring desired pharmacological properties to a chemical compound. Amiodarone is a classical antiarrythmic agent with a long list of adverse effects. This article attempts to review the structure activity relationship of some of the homologues of amiodarone in order to determine the most clinically desirable molecule.
文摘Background: Many patients are affected by idiopathicbronchiolitis obliterans organizing pneumonia (BOOP). There are several known causes of BOOP, and several systemic disorders have BOOP as an associated primary pulmonary lesion. Numerous agents including cytotoxic and noncytotoxic drugs have the potential to cause pulmonary toxicity. Descriptions of amiodarone-related BOOP continue to be reported throughout the world. Case Report: We reported a patient with original clinical presentation who developed recurrent sustained ventricular tachycardia (SVT) despite the presence of implantable cardioverter-defibrillator (ICD), hypoxaemia and interstitial pneumonitis in both lung bases. After percutaneous transluminal coronary angioplasty, he developed bronchiolitis obliterans organizing pneumonia (BOOP). Conclusions: To our knowledge, such complications after percutaneous coronary procedure in patients with amiodarone therapy for arrhythmia prophylaxis, are not very frequent in literature.
