What is known concerning liver and kidney toxicity during treatment with amphetamine or methylpheni

Fråga: What is known concerning liver and kidney toxicity during treatment with amphetamine or methylphenidate? A 14-year-old boy has undergone a liver transplantation and is now treated with tacrolimus, Ursofalk (ursodeoxycholic acid) and prednisolone. Due to hyperactivity the patient will be treated with amphetamine and/or methylphenidate.

Sammanfattning: No information could be found in the literature about liver toxicity or kidney toxicity after therapeutic doses of amphetamine. However, interstitial nephritis and acute renal failure have been described in abusers of amphetamine.

Methylphenidate in therapeutic doses has been associated with hepatotoxicity in one case. Nothing was found in the literature on nephrotoxicity caused by methylphenidate.

Svar: Amphetamine is an indirect-acting sympathomimetic agent. It can be prescribed on licence for treatment of narcolepsy and to children with minimal brain dysfunction (MBD). Concerning the question whether amphetamine could negatively affect the liver, it has been looked at before (1-3). Nothing could be found in the literature about hepatotoxicity caused by the therapeutic use of amphetamine. However, it can be mentioned that several cases of toxic hepatitis have been reported after use of Ecstacy, (3,4-methylenedioxymethylamphetamine) a synthetic amphetamine, used as a "recreational" drug by the younger population.

Acute interstitial nephritis and acute renal failure after oral amphetamine abuse have been reported (4). Another two cases of myoglobinuria and acute renal failure due to amphetamine abuse were found (5,6).

The Swedish Adverse Reactions Advisory Committee has not received any report of hepatotoxic- or nephrotoxic effect in connection with amphetamine use.

Methylphenidate is a piperidine derivative that is structurally related to amphetamine and with actions and uses similar to that of amphetamine. Hepatotoxicity with raised liver enzyme values was seen in a 67-year-old woman who took methylphenidate 30 mg per day. Normalisation of the values occurred within ten days after discontinuation. Rechallenge was positive within 2 days (2.5 mg/day) (7). Methylphenidate-induced hepotocellular injury was reported in a 19-year-old woman who developed jaundice, fever, and malaise after intravenous abuse of methylphenidate hydrochloride tablets (8).

Nothing has been found in the literature concerning kidney disease and methylphenidate.

Liver and kidney reactions reported to the WHO-centre in Uppsala, more often relate to the use of methylphenidate than amphetamine.