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Pemoline hepatotoxicity in children
1Division of Gastroenterology and Nutrition, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Pemoline can cause severe liver damage in children, ranging from mild enzyme elevations to liver failure requiring transplantation. Monitoring liver enzymes is crucial during treatment with pemoline and methylphenidate.
Area of Science:
- Pediatric Hepatology
- Clinical Toxicology
- Pharmacovigilance
Background:
- Pemoline is a central nervous system stimulant previously used for Attention Deficit Hyperactivity Disorder (ADHD).
- Hepatotoxicity is a known, albeit rare, adverse effect of pemoline.
- The spectrum of pemoline-induced liver injury can vary significantly.
Observation:
- This report details five pediatric cases of pemoline hepatotoxicity.
- One case involved fulminant liver failure necessitating an orthotopic liver transplant.
- The onset of liver damage was variable, sometimes occurring late in the treatment course.
Findings:
- Pemoline demonstrably causes toxic liver damage in the pediatric population.
- The severity of pemoline hepatotoxicity is highly variable.
- A potential synergistic effect between pemoline and methylphenidate on liver damage was observed.
Implications:
- Clinicians should be vigilant for pemoline-induced liver injury in children.
- Regular monitoring of serum aminotransferases is recommended during pemoline therapy.
- Consideration of combined pemoline and methylphenidate use requires careful risk-benefit assessment due to potential synergistic hepatotoxicity.
Abstract:
Pemoline hepatotoxicity ranges from asymptomatic elevations in levels of serum aminotransferases to fulminant liver failure. We report five cases of pemoline hepatotoxicity in children (four boys, one girl), including the only reported case resulting in orthotopic liver transplantation. We conclude that pemoline causes toxic liver damage in children. The severity of the damage is highly variable, and its onset may be late in the course of treatment. Pemoline and methylphenidate may act synergistically to cause liver damage. The levels of serum aminotransferases should be monitored throughout treatment with these agents.