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Propafenone-induced liver injury
S A Spinler1, C A Elder, K E Kindwall
1Philadelphia College of Pharmacy and Science, PA 19104.
The Annals of Pharmacotherapy
|July 1, 1992
Summary
Propafenone can cause rare liver injury, presenting as acute cholestatic liver injury. While dose reduction may help, discontinuing propafenone might be necessary for recovery.
Area of Science:
- Hepatology
- Clinical Pharmacology
- Internal Medicine
Background:
- Propafenone is an antiarrhythmic medication used to treat atrial fibrillation.
- Drug-induced liver injury (DILI) is a significant concern in pharmacotherapy.
- Understanding the specific patterns of DILI from propafenone is crucial for patient management.
Observation:
- A 71-year-old woman with atrial fibrillation developed elevated liver enzymes (alkaline phosphatase, alanine aminotransferase, aspartate aminotransferase, gamma glutamyltransferase) after starting propafenone.
- The liver enzyme elevations were greater than twice the upper limit of normal.
- The pattern suggested acute cholestatic liver injury.
Findings:
- Reducing propafenone dosage led to a slight decrease in liver enzymes, but they remained elevated.
- Discontinuation of propafenone resulted in normalization of aminotransferases and alkaline phosphatase, with a decrease in gamma glutamyltransferase.
- Propafenone-induced liver injury is rare, with reported cases showing hepatocellular, cholestatic, or mixed patterns.
Implications:
- Routine liver function test monitoring for all propafenone users is not recommended due to the low incidence (0.1-0.2%) and lack of fatalities.
- Baseline liver function tests with follow-up at one month are advisable for patients with pre-existing liver dysfunction.
- Clinicians should consider propafenone as a potential cause of liver injury in patients presenting with compatible symptoms and enzyme elevations.