Worsening heart failure in the setting of dronedarone initiation

The Annals of Pharmacotherapy
James C CoonsGeorge G Sokos

Abstract

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. 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....Continue Reading

References

Aug 1, 1981·Clinical Pharmacology and Therapeutics·C A NaranjoD J Greenblatt
Sep 7, 2007·The New England Journal of Medicine·Bramah N SinghUNKNOWN EURIDIS and ADONIS Investigators
Sep 20, 2007·JAMA : the Journal of the American Medical Association·Patricia Vassallo, Richard G Trohman
Jun 21, 2008·The New England Journal of Medicine·Lars KøberUNKNOWN Dronedarone Study Group
Feb 14, 2009·The New England Journal of Medicine·Stefan H HohnloserUNKNOWN ATHENA Investigators
Aug 19, 2009·Circulation·Chinmay PatelPeter R Kowey

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Citations

May 15, 2015·Expert Opinion on Drug Safety·Mónica TarapuésAlbert Figueras
Apr 1, 2015·Pharmacotherapy·Martin HuemerWilhelm Haverkamp
Jul 16, 2015·European Journal of Clinical Pharmacology·Valentino ContiDomenico Motola
May 5, 2011·The Annals of Pharmacotherapy·Constantinos Pantos, Iordanis Mourouzis
Sep 15, 2020·Curēus·Zarak H KhanRanda Abd Algayoum

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