Amlodipine liver
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Amlodipine and Liver Health: A Comprehensive Overview
Amlodipine and Non-Alcoholic Fatty Liver Disease (NAFLD)
Amlodipine, a widely used antihypertensive drug, has shown promising effects in alleviating non-alcoholic fatty liver disease (NAFLD). Research indicates that amlodipine can modulate gut microbiota, which plays a crucial role in the pathogenesis of NAFLD, thereby improving liver health in patients suffering from both hypertension and NAFLD .
Hemodynamic Effects Post-Liver Transplantation
In hypertensive patients who have undergone liver transplantation, amlodipine has been found to effectively reduce systolic blood pressure (SBP) and arterial wave reflection, as measured by the augmentation index (AIx). This reduction in AIx suggests that amlodipine can lower central aortic pressure more effectively than other antihypertensive drugs like bisoprolol, making it a preferred choice for managing hypertension in these patients .
Metabolism of Amlodipine in the Liver
Amlodipine is primarily metabolized in the liver through the action of the cytochrome P450 enzyme CYP3A4. Studies have shown that CYP3A4, rather than CYP3A5, plays a significant role in the metabolic clearance of amlodipine. This metabolism involves the conversion of amlodipine to its pyridine derivative (M9), which undergoes further metabolic transformations .
Protective Effects Against Ischemic/Reperfusion Injury
Amlodipine has demonstrated protective effects against ischemic/reperfusion injury in the liver. In experimental models, amlodipine improved hepatic hemodynamic and metabolic functions, increased blood flow, oxygen delivery, and bile flow, and reduced hepatocyte injury. These findings suggest that amlodipine can enhance liver microcirculation and inhibit the release of toxic mediators during liver preservation and reperfusion .
Amlodipine in Alcoholic Hepatitis
Despite its hepatoprotective effects in animal models, a randomized controlled trial in humans with acute alcoholic hepatitis did not show a significant survival benefit from amlodipine treatment. However, the study confirmed that amlodipine is well-tolerated with few side effects in patients with advanced alcoholic liver disease .
Potential Hepatotoxicity
Although rare, there have been reports of amlodipine causing elevated liver enzymes, indicating potential hepatotoxicity. In a case study, a patient developed significantly elevated liver transaminases after starting amlodipine, which normalized upon discontinuation of the drug. This suggests that amlodipine can induce liver enzyme elevations in an idiosyncratic manner .
Amlodipine and Iron Overload in Thalassemia
Amlodipine has been investigated for its potential to reduce cardiac iron overload in patients with thalassemia major. Studies have shown that amlodipine, when used alongside standard iron chelation therapy, can significantly improve heart T2* values and reduce serum ferritin levels, indicating a reduction in iron overload 69.
Hepatoprotective Effects in Paracetamol-Induced Hepatotoxicity
Amlodipine has also shown hepatoprotective effects in cases of paracetamol-induced hepatotoxicity. In animal studies, amlodipine treatment reduced liver enzyme levels, oxidative stress markers, and inflammatory cytokines, thereby ameliorating liver damage caused by paracetamol overdose .
Conclusion
Amlodipine, beyond its primary use as an antihypertensive agent, exhibits a range of effects on liver health. It shows potential in alleviating NAFLD, protecting against ischemic/reperfusion injury, and reducing iron overload in thalassemia. However, its role in treating alcoholic hepatitis remains inconclusive, and there is a rare risk of hepatotoxicity. These findings highlight the multifaceted impact of amlodipine on liver function and underscore the need for further research to fully understand its benefits and risks.
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