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[Flecainide-induced hepatitis]
V Kühlkamp1, R Haasis, L Seipel
1Abteilung Innere Medizin III, Eberhard-Karls-Universität Tübingen.
Abstract:
Flecainide was given to a patient in a dose of 150 mg twice daily to convert a newly developed atrial fibrillation; concomitant therapy was unchanged. After the fourth dose the patient complained of upper abdominal pain and nausea. GOT and GPT, normal at admission to the hospital, became markedly elevated and reached a maximum of 960 IU/I (GOT) and 993 IU/I (GPT) one day later, although the enzymes which indicate cholestasis remained at a normal level or did not increase. On the assumption of a drug-induced allergic reaction, flecainide was withdrawn, after which liver enzymes rapidly returned to control values. Although neither a reexposition with flecainide nor a liver biopsy was obtained, a flecainide-induced hepatitis seems probable.
Insights
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:
- 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.