Severe liver injury after initiating therapy with atomoxetine in two children.
Two children presented with acute hepatitis after starting therapy with atomoxetine (Strattera). In one child, no competing diagnosis could be identified, and liver injury resolved completely on withdrawal of the medication. In the second child, the evaluation was suggestive of type 1 autoimmune hepatitis; she subsequently improved with removal of atomoxetine and concomitant immunosuppressive therapy. Atomoxetine may cause clinically significant hepatotoxicity either by metabolic idiosyncrasy or by inducing autoimmune hepatitis.
Lim
Joel R
JR
Division of Pediatric Gastroenterology/Hepatology/Nutrition, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis 46202-5225, USA. jdlim@iupui.edu
Faught
Philip R
PR
Chalasani
Naga P
NP
Molleston
Jean P
JP
D018759:Adrenergic Uptake Inhibitors / Q000009:adverse effects* / Q000276:immunology / Q000494:pharmacology / Q000627:therapeutic use; D000069445:Atomoxetine Hydrochloride; D056486:Chemical and Drug Induced Liver Injury / Q000209:etiology* / Q000628:therapy; D002648:Child; D019389:Cytochrome P-450 CYP2D6 / Q000378:metabolism; D005260:Female; D019693:Hepatitis, Autoimmune / Q000209:etiology*; D006801:Humans; D011437:Propylamines / Q000009:adverse effects* / Q000276:immunology / Q000494:pharmacology / Q000627:therapeutic use
D018759:Adrenergic Uptake Inhibitors; D011437:Propylamines; D000069445:Atomoxetine Hydrochloride; D019389:Cytochrome P-450 CYP2D6