Drug-Induced Hepatitis Caused by Methylphenidate: A Case Report
DOI:
https://doi.org/10.20344/amp.23703Keywords:
Adolescent, Attention Deficit Disorder with Hyperactivity/drug therapy, Chemical and Drug Induced Liver Injury/diagnosis, Chemical and Drug Induced Liver Injury/etiology, Methylphenidate/adverse effectsAbstract
Methylphenidate (MPH) is a widely prescribed psychostimulant for the management of attention deficit hyperactivity disorder (ADHD). Although most adverse effects of MPH are transient and reversible, hepatotoxicity remains a rare but potentially serious complication. We present the case of a 12-year-old female patient with ADHD who had been receiving MPH treatment since the age of 8. After three and a half years of therapy, she did blood tests that showed a marked elevation in transaminases and gamma-glutamyl transferase. Extensive evaluation ruled out alternative causes of liver disease, and liver biopsy findings were consistent with drug-induced hepatitis. Discontinuation of MPH resulted in progressive normalization of liver enzyme levels. This case underscores the importance of regular laboratory monitoring during long-term psychostimulant therapy, particularly regarding liver function. Early recognition of abnormal biochemical findings allows for prompt discontinuation of the offending drug, reversal of hepatic injury, and prevention of more severe complications such as liver failure.
Downloads
References
Tong HY, Díaz C, Collantes E, Medrano N, Borobia AM, Jara P, et al. Liver transplant in a patient under methylphenidate therapy: a case report and review of the literature. Case Rep Pediatr. 2015;2015: 437298.
Wolraich ML, Hagan JF, Allan C, Chan E, Davison D, Earls M, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2019;144:e20192528.
Storebø OJ, Storm MR, Pereira Ribeiro J, Skoog M, Groth C, Callesen HE, et al. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database Syst Rev. 2023;2023:CD009885.
Methylphenidate. In: LiverTox: Clinical and Research Information on Drug-Induced Liver Injury. Bethesda: National Institute of Diabetes and Digestive and Kidney Diseases; 2012.
Francis P, Navarro V. Drug-induced hepatotoxicity. In: StatPearls. Treasure Island: StatPearls Publishing; 2025.
Andrade RJ, Aithal GP, Björnsson ES, Kaplowitz N, Kullak-Ublick GA, Larrey D, et al. EASL clinical practice guidelines: drug-induced liver injury. J Hepatol. 2019;70:1222-61.
Chaulagain A, Lyhmann I, Halmøy A, Widding-Havneraas T, Nyttingnes O, Bjelland I, et al. A systematic meta-review of systematic reviews on attention deficit hyperactivity disorder. Eur Psychiatry. 2023;66:e90.
Attention Deficit/Hyperactivity Disorder (ADHD) Agents. In: LiverTox: Clinical and research information on drug-induced liver injury. Bethesda: National Institute of Diabetes and Digestive and Kidney Diseases; 2012.
Bernhard MK, Hugle B, Merkenschlager A. Elevated liver enzymes under therapy with methylphenidate in a boy with T-cell leukemia. J Pediatr Neurol. 2009;7:297-9.
Torres EL, Valle V, Pachkoria K, Cueto Galán R, Lucena González MI, et al. Hepatotoxicidad por metilfenidato en el tratamiento del trastorno por déficit de atención con hiperactividad. Actualidad En Farmacología y Terapéutica. 2005;3:270-271.
Mehta H, Murray B, Loludice TA. Hepatic dysfunction due to intravenous abuse of methylphenidate hydrochloride. J Clin Gastroenterol. 1984;6:149-52.
Stecyk O, Loludice TA, Demeter S, Jacobs J. Multiple organ failure resulting from intravenous abuse of methylphenidate hydrochloride. Ann Emerg Med. 1985;14:597-9.
Goodman CR. Hepatotoxicity due to methylphenidate hydrochloride. N Y State J Med. 1972;72:2339-40.
Lewis JJ, Iezzoni JC, Berg CL. Methylphenidate-induced autoimmune hepatitis. Dig Dis Sci. 2007;52:594-7.
Aithal GP, Watkins PB, Andrade RJ, Larrey D, Molokhia M, Takikawa H, et al. Case definition and phenotype standardization in drug-induced liver injury. Clin Pharmacol Ther. 2011;89:806-15.
Downloads
Published
How to Cite
Issue
Section
License
Copyright (c) 2025 Acta Médica Portuguesa
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All the articles published in the AMP are open access and comply with the requirements of funding agencies or academic institutions. The AMP is governed by the terms of the Creative Commons ‘Attribution – Non-Commercial Use - (CC-BY-NC)’ license, regarding the use by third parties.
It is the author’s responsibility to obtain approval for the reproduction of figures, tables, etc. from other publications.
Upon acceptance of an article for publication, the authors will be asked to complete the ICMJE “Copyright Liability and Copyright Sharing Statement “(http://www.actamedicaportuguesa.com/info/AMP-NormasPublicacao.pdf) and the “Declaration of Potential Conflicts of Interest” (http:// www.icmje.org/conflicts-of-interest). An e-mail will be sent to the corresponding author to acknowledge receipt of the manuscript.
After publication, the authors are authorised to make their articles available in repositories of their institutions of origin, as long as they always mention where they were published and according to the Creative Commons license.
