Pemoline therapy resulting in liver transplantation.
OBJECTIVE
To describe a case of pemoline-induced liver failure resulting in liver transplantation.


METHODS
A 9-year-old white boy, diagnosed with attention deficit/hyperactivity disorder (ADHD) and treated with pemoline, developed signs and symptoms of liver failure. Pemoline therapy was discontinued, but the patient's liver function continued to decline. Ultimately, a liver transplantation was required.


CONCLUSIONS
Pemoline, an agent used in ADHD treatment, has been associated with hepatotoxicity with the majority of cases occurring in pediatric patients. To our knowledge, this is the second reported case of pemoline-induced liver failure resulting in liver transplantation. The mechanism of action remains unclear, with several hypotheses being postulated including hypersensitivity reactions, dose-related phenomena, and autoimmune-mediated reactions.


CONCLUSIONS
With increasing evidence linking pemoline to liver failure, this agent should not be considered first-line therapy for ADHD. Prior to initiating therapy, baseline liver function tests should be obtained and closely monitored, and parents and patients should be educated on the signs and symptoms of liver toxicity.
Adcock
K G
KG
University of North Carolina Hospitals and Clinics, Chapel Hill 27514, USA.
MacElroy
D E
DE
Wolford
E T
ET
Farrington
E A
EA
D001289:Attention Deficit Disorder with Hyperactivity / Q000188:drug therapy; D000697:Central Nervous System Stimulants / Q000009:adverse effects* / Q000627:therapeutic use; D056487:Chemical and Drug Induced Liver Injury, Chronic / Q000601:surgery*; D002648:Child; D006801:Humans; D008111:Liver Function Tests; D016031:Liver Transplantation; D008297:Male; D010389:Pemoline / Q000009:adverse effects* / Q000627:therapeutic use
D000697:Central Nervous System Stimulants; D010389:Pemoline