Literature review of the evidence regarding intravenous lipid administration in drug-induced cardiotoxicity

ABSTRACT

Introduction: Intravenous lipid emulsion (ILE) administration is capable of reversing the acute cardiac and neurological toxicity caused by local anesthetic agents. In recent years, ILE has also been explored as a potential antidote for cardiotoxicity caused by non-anesthetic agents too.

Areas covered: The potential mechanisms, safety, and efficacy of this approach are considered. Data were sought from published reports listed in PubMed and EMBASE, and abstracts of meetings of the North American Congress of Clinical Toxicology and European Association of Poisons Centres and Clinical Toxicologists. There were reports involving 298 patients where ILE has been administered for severe drug toxicity. Clinical improvement was observed in 57 of 59 patients with local anesthetic toxicity (96.6%); there were 239 patients where toxicity was due to non-anesthetic agents, and ILE apparently improved clinical outcome in 215 (72.1%).

Expert opinion: Response rates were similar between ILE treated toxicity caused by lipid soluble and non-lipid soluble drugs. Potential adverse effects of ILE include interference with laboratory assays, acute pancreatitis, and adult respiratory distress syndrome, although the rate of occurrence is difficult to ascertain.

KEYWORDS:

• Antidote
• cardiotoxicity
• carnitine
• clinical toxicology
• drug toxicity
• intralipid
• lipid emulsion
• poison

Article highlights

• Systemic toxicity associated with local anesthetic agents carries a high mortality and is often resistant to conventional resuscitation methods.

• Preclinical and clinical data indicate ILE is effective in preventing and reversing cardiotoxicity associated with local anesthetic agents.

• A number of mechanisms of action include removal of drug from the myocardium and restoration of cardiac oxidative fatty acid metabolism.

• Data from isolated case reports suggest that ILE may be effective in minimizing cardiotoxicity due to non-anesthetic agents.

• Potential adverse effects of ILE include interference with laboratory tests, hyperamylasemia, acute pancreatitis, and adult respiratory distress syndrome.

Declaration of interest

The authors have no relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript. This includes employment, consultancies, honoraria, stock ownership or options, expert testimony, grants or patents received or pending, or royalties.

Reviewer disclosures

A reviewer on this manuscript has disclosed that they are a co-founder, shareholder, and officer of ResQ Pharma, Inc.

Additional information

Funding

This paper was not funded.