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[Flecainide-induced hepatitis].

V Kühlkamp¹, R Haasis, L Seipel

¹Abteilung Innere Medizin III, Eberhard-Karls-Universität Tübingen.

Zeitschrift Fur Kardiologie

|October 1, 1988

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Flecainide, used for atrial fibrillation, may cause liver injury. A patient experienced elevated liver enzymes and abdominal pain after flecainide administration, suggesting a drug-induced hepatitis.

Area of Science:

Cardiology
Hepatology
Clinical Pharmacology

Background:

Atrial fibrillation is a common cardiac arrhythmia requiring pharmacologic management.
Flecainide is an antiarrhythmic drug frequently used for rhythm control in atrial fibrillation.
Drug-induced liver injury (DILI) is a significant concern in pharmacotherapy.

Observation:

A patient receiving flecainide (150 mg twice daily) for new-onset atrial fibrillation developed symptoms of gastrointestinal distress, including upper abdominal pain and nausea.
Laboratory tests revealed a marked elevation in aspartate aminotransferase (AST, formerly GOT) and alanine aminotransferase (ALT, formerly GPT) levels.
Cholestatic liver enzymes remained within normal limits, differentiating the liver injury pattern.

Findings:

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Flecainide administration was temporally associated with significant hepatocellular enzyme elevation.

Withdrawal of flecainide led to a rapid normalization of liver enzymes.

The clinical presentation and laboratory findings strongly suggest flecainide-induced hepatocellular hepatitis, likely allergic in nature.

Implications:

This case highlights the potential for flecainide to cause idiosyncratic hepatocellular injury.
Clinicians should consider flecainide-induced hepatitis in patients presenting with unexplained liver enzyme elevations during treatment.
Further investigation into flecainide's hepatotoxicity profile is warranted.