prajmaline and Chemical-and-Drug-Induced-Liver-Injury

Prajmalium rarely causes idiosyncratic liver injury. Author describes the case of cholestatic hepatitis occurring in three weeks after cessation of short-term treatment with prajmalium. Eighteen months later, despite of good general status, physical and biochemical features of cholestasis were present. Pathologic examination of liver biopsy specimen revealed the chronic intracellular cholestasis with lymphocytic infiltration. Presented case indicate that even short-term treatment with potentially weekly hepatotoxic drug may cause the long-term intrahepatic cholestasis.

Topics: Anti-Arrhythmia Agents; Arrhythmias, Cardiac; Chemical and Drug Induced Liver Injury; Cholestasis, Intrahepatic; Female; Humans; Middle Aged; Prajmaline

The authors draw attention to a serious drug response to the derivative of the alkaloid ajmaline prajmalium (Neo-Gilurytmal, Giulini-GFR) which causes impairment of liver functions of various grades as a result of intrahepatic cholestasis. They draw attention to the necessity of a careful pharmacological case-history, evaluation of the premorbid stage, in particular former liver disease or contemporary administration of drugs which burden liver function (hormonal contraceptives, non-steroid antirheumatic drugs). It is essential to follow-up liver functions by laboratory tests already at the onset of treatment with Neo-Gilurytmal.

Topics: Acute Disease; Aged; Chemical and Drug Induced Liver Injury; Cholestasis, Intrahepatic; Humans; Male; Prajmaline

The case of 28 aged woman with cellular damage of liver is presented. Toxic side-effect of n-propylajmaline was confirmed after exclusion of Viral hepatitis or co-existed poly-parasitism (Ascaridiasis, Giardiasis), as reason of liver injury.

Topics: Adult; Chemical and Drug Induced Liver Injury; Diagnosis, Differential; Female; Hepatitis, Viral, Human; Humans; Liver Diseases, Parasitic; Prajmaline

3 patients developed transient cholestatic jaundice after administration of prajmalium bitartrate, a class I antiarrhythmic drug. The leukocyte inhibition tests showed 4%, 12% and 15% inhibition, respectively, while eosinophilia was seen in all 3, supporting the assumption that the transient hepatic damage was due to drug exposure. Discontinuing the drug resulted in improvement in the clinical and biochemical findings.

Topics: Adult; Chemical and Drug Induced Liver Injury; Cholestasis; Female; Humans; Male; Middle Aged; Prajmaline

Intrahepatic cholestasis and aplastic anemia after N-propylajmaline. A 43 year old female patient taking oral contraceptives for more than five years received the antiarrhythmic drug N-propylajmaline for treatment of ventricular arrhythmia. After twelve days (total dosage 510 mg N-propyl-ajmaline) acute severe intrahepatic cholestasis and aplastic anemia developed. The erythropoeisis improved after three weeks of treatment with corticosteroids. However, despite treatment with phenobarbital the jaundice receded very slowly. Even after nine years of follow-up cholestatic enzymes are still significantly elevated although serum bilirubin levels are in the normal range. This case report demonstrates that antiarrhythmic drugs may induce nearly irreversible intrahepatic cholestasis and severe hematological disturbances.

Topics: Adult; Ajmaline; Anemia, Aplastic; Biopsy; Cardiac Complexes, Premature; Chemical and Drug Induced Liver Injury; Cholestasis, Intrahepatic; Diagnosis, Differential; Female; Humans; Liver; Liver Function Tests; Prajmaline

Topics: Ajmaline; Arrhythmias, Cardiac; Chemical and Drug Induced Liver Injury; Cholestasis; Diagnosis, Differential; Humans; Male; Middle Aged; Prajmaline

Seven further cases with n-propyl-ajmaliumbitartrate (NPAB)-associated liver damage observed between 1976 and 1980 in two collaborating institutions are reported. The cause/effect relationship could be classified as probable in three cases and as potential in the remaining four patients. No drug rechallenge was carried out. In the clinical management, definite exclusion of biliary tract obstruction had a clear priority over histologic documentation of the degree of the transient liver damage. Follow-up data after 2 years 8 months to 5 years 9 months by personal reinvestigation of three patients and by questionnaire to family physicians and patients in the remaining four cases gave no clinical or serologic indication of persisting or relapsing liver damage. Liver biopsies were not considered to be warranted in the follow-up of these asymptomatic patients with normal liver function tests.

Topics: Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Chemical and Drug Induced Liver Injury; Female; Follow-Up Studies; Humans; Liver Function Tests; Male; Middle Aged; Prajmaline

Nine patients are reported who developed hepatic injury following the administration of therapeutic agents. The drugs incriminated were prajmalium bitartrate (4 patients), quinidine (3 patients), procainamide and nifedipine (one patient each). In all patients the clinical features indicated an allergic process, which in three cases was substantiated by positive response to reexposure. The detection of immunologic processes in our patients by various in vitro methods supports the assumption that immune mechanisms may be involved in the production of drug-induced hepatic disease and confirm allergy.

Topics: Aged; Chemical and Drug Induced Liver Injury; Drug Hypersensitivity; Female; Fluorescent Antibody Technique; Granuloma; Humans; Immunoglobulin A; Immunoglobulin G; Liver; Male; Microscopy, Electron; Middle Aged; Nifedipine; Prajmaline; Procainamide; Quinidine