Drug fever due to nomifensine treatment in patients with endogenous depression

Nomifensine was introduced as an effective antidepressant drug with few side effects. However, among our patients we have seen 2 typical cases of drug fever due to nomifensine. 2-4 weeks after start of nomifensine treatment, 75-150 mg/day, for recurrent endogenous depressions the patients developed shiverings and fever. Nomifensine was withdrawn and both became afebrile within 1 day. A provocation test with 50 mg nomifensine p.o. again resulted in shiverings and fever within 6-8 h. 1 of the patients was allergic to other drugs and suffered from asthma. During the acute episode of illness the serum concentration of alanine aminotransferase was elevated and it normalized after stopping the treatment. A liver biopsy at that time showed liver cell necrosis, and a moderate grade of steatosis and fibrosis was also present. The results indicate that nomifensine may cause drug fever. It is possible that patients with allergy and/or liver diseases in particular may be susceptible to drug fever due to nomifensine.