The Journal of Pediatrics
Volume 148, Issue 6 , Pages 831-834, June 2006

Severe liver injury after initiating therapy with atomoxetine in two children

  • Joel R. Lim, MD

      Affiliations

    • Corresponding Author InformationReprint requests: Joel R. Lim, M.D., Assistant Professor of Clinical Pediatrics, Division of Pediatric Gastroenterology/Hepatology/Nutrition, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, 702 Barnhill Drive, Room ROC 4210, Indianapolis, Indiana 46202-5225.
    • ,
  • Philip R. Faught, MD
    • ,
  • Naga P. Chalasani, MD
    • ,
  • Jean P. Molleston, MD

From the Division of Pediatric Gastroenterology/Hepatology/Nutrition, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis; and the Departments of Pathology and Laboratory Medicine, and Gastroenterology and Hepatology, Indiana University School of Medicine, Indianapolis

Received 8 April 2005; received in revised form 21 October 2005; accepted 10 January 2006.

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.

Abbreviations:  ADHD, Attention deficit-hyperactivity disorder , ALT, Alanine aminotransferase , A phos, Alkaline phosphatase , AST, Aspartate aminotransferase , Bili D, Direct bilirubin , Bili T, Total bilirubin , CYP, Cytochrome P450 , GGT, Gamma glutamyl transpeptidase , RUCAM, Rousell Uclaf Causality Assessment Method

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PII: S0022-3476(06)00014-X

doi:10.1016/j.jpeds.2006.01.035

The Journal of Pediatrics
Volume 148, Issue 6 , Pages 831-834, June 2006

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