Document Detail

Worsening heart failure in the setting of dronedarone initiation.
MedLine Citation:
PMID:  20628043     Owner:  NLM     Status:  MEDLINE    
OBJECTIVE: To describe a challenging patient case in which dronedarone was selected for a patient with atrial fibrillation and heart failure; the drug may have been associated with worsening heart failure, leading to acute renal and hepatic failure.
CASE SUMMARY: A 47-year-old male with a history of heart failure with New York Heart Association class III-IV symptoms presented to our institution with ventricular fibrillation and ventricular tachycardia storm. Torsade de pointes secondary to a combination of dofetilide and hypokalemia was determined to be the etiology. Upon stabilization, the patient was initiated on dronedarone 400 mg orally twice daily by the electrophysiology service for atrial fibrillation. The patient had a questionable history of amiodarone intolerance. By hospital day 9 (day 4 of dronedarone therapy), the patient demonstrated a clinical picture consistent with acute renal and hepatic failure possibly due to worsening heart failure. Dronedarone was discontinued on hospital day 10. He was subsequently transferred to an outside hospital where he required milrinone therapy for cardiogenic shock. Laboratory markers of renal and hepatic function improved over the remainder of his hospitalization and he was discharged on hospital day 20.
DISCUSSION: Dronedarone is a newly approved antiarrhythmic agent with multichannel blocking properties similar to amiodarone. Use of the Naranjo probability scale determined that this patient's worsening heart failure leading to acute renal and hepatic failure was possibly caused by dronedarone. The implication from the ANDROMEDA trial as well as our experience in this case is that dronedarone should be used cautiously in patients with heart failure and avoided in patients specifically outlined in the product labeling.
CONCLUSIONS: This case report, to our knowledge, represents the first published postmarketing report of worsening heart failure complicated by multiorgan dysfunction in the setting of dronedarone initiation. Dronedarone use must be approached with caution in patients with a history of heart failure.
James C Coons; Kara M Plauger; Amy L Seybert; George G Sokos
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Publication Detail:
Type:  Case Reports; Journal Article     Date:  2010-07-13
Journal Detail:
Title:  The Annals of pharmacotherapy     Volume:  44     ISSN:  1542-6270     ISO Abbreviation:  Ann Pharmacother     Publication Date:  2010 Sep 
Date Detail:
Created Date:  2010-08-26     Completed Date:  2010-12-02     Revised Date:  2011-06-29    
Medline Journal Info:
Nlm Unique ID:  9203131     Medline TA:  Ann Pharmacother     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1496-500     Citation Subset:  IM    
Cardiology, Department of Pharmacy Services, Allegheny General Hospital, Pittsburgh, PA, USA.
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MeSH Terms
Acute Kidney Injury / chemically induced*
Amiodarone / adverse effects,  analogs & derivatives*,  therapeutic use
Anti-Arrhythmia Agents / adverse effects*,  therapeutic use
Atrial Fibrillation / drug therapy,  physiopathology
Disease Progression
Heart Failure / drug therapy*,  physiopathology
Liver Failure, Acute / chemically induced*
Middle Aged
Reg. No./Substance:
0/Anti-Arrhythmia Agents; 0/dronedarone; 1951-25-3/Amiodarone
Comment In:
Ann Pharmacother. 2011 May;45(5):689; author reply 690   [PMID:  21540402 ]

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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