prajmaline and Cholestasis--Intrahepatic

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

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: Adult; Aged; Ajmaline; Arrhythmias, Cardiac; Cholestasis, Intrahepatic; Diagnosis, Differential; Female; Humans; Male; Middle Aged; Prajmaline