Amlodipine liver damage
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Amlodipine and Liver Damage: A Comprehensive Review
Introduction to Amlodipine and Liver Damage
Amlodipine, a widely prescribed calcium channel blocker, is primarily used to manage hypertension and angina. While it is generally well-tolerated, there have been reports of amlodipine-induced liver damage, raising concerns about its hepatotoxic potential.
Case Reports of Amlodipine-Induced Liver Injury
Elevated Liver Enzymes
Several case reports have documented instances of elevated liver enzymes following amlodipine administration. For instance, a 47-year-old male patient experienced a significant increase in liver transaminases after starting amlodipine, which normalized upon discontinuation of the drug . Similarly, an 88-year-old female developed elevated liver enzymes and right upper quadrant pain two weeks after beginning amlodipine therapy, with enzyme levels returning to normal after stopping the medication . Another case involved a 34-year-old post-stem cell transplant patient who showed elevated liver enzymes that normalized after discontinuing amlodipine .
Experimental Studies on Amlodipine and Liver Function
Protective Effects Against Hepatotoxicity
Interestingly, some studies suggest that amlodipine may have protective effects against certain types of liver damage. In rat models, amlodipine demonstrated hepatoprotective properties against acetaminophen-induced hepatotoxicity by reducing oxidative stress and inflammatory markers 45. These findings indicate that amlodipine might mitigate liver damage under specific conditions, although its exact mechanisms remain to be fully understood.
Hepatic Hemodynamics and Metabolic Function
A study on isolated perfused rat livers showed that amlodipine improved hepatic hemodynamics and metabolic function following ischemic/reperfusion injury. The treatment increased blood flow, oxygen delivery, and bile production while reducing alanine aminotransferase release, suggesting a cytoprotective effect on hepatocytes .
Clinical Trials and Observations
Alcoholic Hepatitis
A randomized controlled trial investigated the effects of amlodipine in patients with acute alcoholic hepatitis. The study found no significant improvement in survival rates, although amlodipine was well-tolerated with minimal side effects . This suggests that while amlodipine may not be effective in treating alcoholic hepatitis, it does not exacerbate liver conditions in these patients.
Post-Transplant Hypertension
In hypertensive liver transplant recipients, amlodipine effectively reduced systolic blood pressure and improved arterial wave reflection, indicating its utility in managing post-transplant hypertension without adverse effects on liver function .
Conclusion
The relationship between amlodipine and liver damage is complex. While there are documented cases of amlodipine-induced liver injury, experimental studies also highlight its potential protective effects under certain conditions. Clinicians should be aware of the rare but possible risk of hepatotoxicity with amlodipine and monitor liver function in patients, especially those with pre-existing liver conditions or those on multiple hepatotoxic medications. Further research is needed to elucidate the mechanisms behind these dual effects and to optimize the safe use of amlodipine in clinical practice.
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