Cardiology Clinical Pharmacist, Security Forces Hospital, Riyadh, Saudi Arabia
Objective: The serum transaminases document is severe elevated in a patient who was receiving Carvedilol.
Case Summary: A 65-year-old Saudi man admitted to hospital with acute heart failure (EF 15%), acute liver failure and acute kidney injury. He was admitted to CCU and started treatment. Within one week the kidney and the liver function improved. After that the doctor changed Bisoprolol to Carvedilol for one day only, the laboratory tests showed elevated serum transaminases. So, discontinued Carvedilol immediately and restart bisoprolol the liver function returned to the normal within four weeks.
Conclusion: Carvedilol may cause liver enzymes elevated in liver impairment patient. This reaction resolves if the patient is switched to another beta- blocker. Carvedilol is contraindication in sever hepatic impairment.
Carvedilol, Hepatotoxicity, Transaminases.
Heart failure is a complex syndrome that can result from the heart muscle is unable to pump enough blood through to meet the body's needs for blood and oxygen. That will lead to shortness of breath, fatigue and weakness, swelling (edema) in legs, ankles and feet, rapid or irregular heartbeat, reduced ability to exercise.
a. Diuretics are to reduce symptom (edema). No benefit on mortality.
b. Angiotensin-converting enzyme inhibitors (ACEIs) is neurohormonal blocked, vasodilatation, mortality benefit.
c. Angiotensin receptor blockers (ARBs) is neurohormonal blocked, vasodilatation, mortality benefit.
d. Beta-adrenergic blockers are neurohormonal blocked, mortality benefit.
e. Aldosterone antagonists, benefits in NYHA class III and IV heart failure, mortality benefit.
f. Hydralazine and nitrates reduces afterload and preload. Alternative in patients who cannot tolerate an ACEI/ARB or as an add-on therapy to ACEI/ARB and beta-blockers in African Americans patients.
g. Digoxin improves heart failure symptoms, and decreased rate of heart failure hospitalizations.
β-blockers indicated to improve signs and symptoms, exercise tolerance, and hemodynamics and reduce mortality in patients with heart failure .
Carvedilol was approved by the Food and Drug Administration in 1997 for the treatment of heart failure . Carvedilol is a nonselective β-blocker without intrinsic sympathomimetic activity. It has antagonist activity against alpha1, beta1 and beta2 receptors.
A 65 years old Saudi man was admitted to hospital with Acute Heart Failure (EF 15%), Acute Liver failure (ALT 1544 U/L, AST 1253 U/L, Bilirubin T 100 umol/l, Gamma GT 999 U/L), Acute Kidney Injury (Cr 140 umol/l) (herbal causes).
He was admitted to CCU and start Aspirin 81 mg, Bisoprolol 1.25 mg, Furosemide 40 mg IV bid, Lisinopril 2.5 mg, Digoxin 125 mcg, Spironolactone 12.5 mg.
After one week the kidney function returned to normal and the liver function improved within three weeks. Then the doctor change Bisoprolol to Carvedilol 3.125 mg bid for one day only after that the serum transaminases elevated. So, discontinued carvedilol immediately and restart bisoprolol the liver function returned to normal within four weeks [7-9].
The hepatotoxicity adverse effect resolves if the patient is switched from carvedilol to another beta blocker. The liver function test abnormalities return to normal if discontinuation of carvedilol.
Carvedilol may cause liver enzymes elevated in liver impairment patient. This reaction resolves if the patient is switched to another beta- blocker. Carvedilol is contraindication in sever hepatic impairment.
Availability of data
Data is available in the records of the hospital.
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Consent for publication
Written informed consent was obtained from the patient for publication of this case report.
The authors declare that they have no competing interests.