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Severe liver injury after initiating therapy with atomoxetine in two children

Joel R Lim1, Philip R Faught, Naga P Chalasani

  • 1Division of Pediatric Gastroenterology/Hepatology/Nutrition, James Whitcomb Riley Hospital for Children, Indiana University School of Medicine, Indianapolis 46202-5225, USA. jdlim@iupui.edu

The Journal of Pediatrics
|June 14, 2006
PubMed

Insights

Atomoxetine (Strattera) may cause acute hepatitis in children. Liver injury resolved after stopping the drug, suggesting a link between atomoxetine and hepatotoxicity.

Area of Science:

  • Pediatric Hepatology
  • Pharmacovigilance
  • Drug-Induced Liver Injury (DILI)

Background:

  • Atomoxetine is a selective norepinephrine reuptake inhibitor used for treating Attention-Deficit/Hyperactivity Disorder (ADHD).
  • Hepatotoxicity is a known, albeit rare, adverse effect associated with atomoxetine therapy.

Observation:

  • Two pediatric cases of acute hepatitis following atomoxetine initiation are presented.
  • In one case, no alternative cause for liver injury was found, and symptoms resolved upon atomoxetine withdrawal.
  • The second case suggested autoimmune hepatitis, which improved after discontinuing atomoxetine and initiating immunosuppressive treatment.

Findings:

  • Atomoxetine can precipitate clinically significant hepatotoxicity in children.
  • The mechanism may involve idiosyncratic metabolic reactions or the induction of autoimmune hepatitis.
  • Cessation of atomoxetine is crucial for managing drug-induced liver injury.

Implications:

  • Clinicians should monitor for signs of liver injury in pediatric patients treated with atomoxetine.
  • Consideration of atomoxetine as a potential cause of hepatitis is important, especially in cases with unexplained liver enzyme elevations.
  • Further research into the mechanisms of atomoxetine-induced hepatotoxicity is warranted.

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