%0 Journal Article
%T Adderall Induced Acute Liver Injury: A Rare Case and Review of the Literature
%A Rohini R. Vanga
%A Bikram Bal
%A Kevin W. Olden
%J Case Reports in Gastrointestinal Medicine
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/902892
%X Adderall (dextroamphetamine/amphetamine) is a widely prescribed medicine for the treatment of attention-deficit/hyperactivity disorder (ADHD) and is considered safe with due precautions. Use of prescribed Adderall without intention to overdose as a cause of acute liver injury is extremely rare, and to our knowledge no cases have been reported in the English literature. Amphetamine is an ingredient of recreational drugs such as Ecstacy and is known to cause hepatotoxicity. We describe here the case of a 55-year-old woman who developed acute liver failure during the treatment of ADHD with Adderall. She presented to the emergency room with worsening abdominal pain, malaise, and jaundice requiring hospitalization. She had a past history of partial hepatic resection secondary to metastasis from colon cancer which was under remission at the time of presentation. She recovered after intensive monitoring and conservative management. Adderall should be used carefully in individuals with underlying liver conditions. 1. Introduction Acute hepatitis can result from wide variety of causes, among which viral and toxin induced injuries are the most common. Toxin induced liver injury contributes to 30% of acute liver injury [1]. Acetaminophen overdose is the most common cause of acute liver failure accounting for 39% of cases in United States [2]. Amphetamines and their derivatives are among the rarest causes of idiosyncratic drug reactions which are the presumptive cause in 13% of cases overall [2]. Amphetamine and Ecstasy (MDMA) remain popular recreational drugs in the western world but less common in United States. In Spain it is the second most common cause of acute hepatitis in patients under the age of 25 years, with viral hepatitis as the commonest cause [3]. Presentation can vary from subclinical elevation of liver enzymes to fulminant hepatic failure demanding orthotopic liver transplant [4]. It is extremely rare to develop liver toxicity at prescribed doses. To our knowledge, only one case has been reported in United States in a 14-year-old boy [5]. We report here the first case of Adderall induced acute liver injury in a 55-year-old female. Approval from Institutional Review Board was obtained for case report submission. 2. Case Report A 55-year-old female presented to Washington Hospital Center with three days history of malaise, anorexia, nausea, vomiting, jaundice, intense pruritus, and upper abdominal pain. She denied fever, chills, weight loss, and diarrhea. She also denied alcohol abuse, illicit drug use, and use of herbal supplementation. Her past
%U http://www.hindawi.com/journals/crigm/2013/902892/