RSS Feeds
Subfulminant Liver Failure and Severe Hepatotoxicity Caused by Loratadine Use
- Thomas D. Schiano, MD;
- Somashekhar V. Bellary, MD;
- Michael J. Cassidy, MD;
- Rebecca M. Thomas, MD; and
- Martin Black, MD
- From Temple University Hospital, Philadelphia, Pennsylvania. Requests for Reprints: Martin Black, MD, Gastroenterology Section, Temple University Hospital, 8th Floor, Parkinson Pavilion, 3401 North Broad Street, Philadelphia, PA 19140. Current Author Addresses: Dr. Schiano: Gastroenterology/Hepatology Division, University of Chicago Hospital, 5841 South Maryland Avenue, Chicago, IL 60637-1470.
Loratadine is a long-acting tricyclic antihistamine with selective peripheral histamine-1-receptor antagonistic activity [1-3]. In a dosage of 10 mg/d, loratadine was found to be superior to placebo and similar in efficacy to other antihistamines for alleviating symptoms of allergic rhinitis [2, 3]. The increasing popularity of this drug results from its low propensity to cause drowsiness.
Jaundice and hepatic necrosis associated with loratadine had previously been recognized in only one patient. This patient, who was also taking ketoconazole, subsequently received a liver transplant (Iezzoni DG. Personal communication). It was not clear whether loratadine was hepatotoxic in this patient. We describe two patients who developed severe necroinflammatory liver injury while taking loratadine; one patient subsequently required liver transplantation.
Case Reports
Patient 1
A 42-year-old woman presented with a 2-month history of abdominal pain on the right side and jaundice after cholecystectomy had been done for these symptoms at another hospital 1 month earlier. She had been receiving loratadine, 10 mg, for allergic arthritis for 14 months after having been switched from terfenadine. Loratadine therapy was discontinued at the time of surgery, and the patient was receiving no other medications. The patient drank alcohol socially and was not taking any over-the-counter medications. She had no family history of liver disease or other significant medical disorders. Physical examination was remarkable for scleral icterus, ascites, and mild abdominal tenderness of the right upper quadrant with hepatosplenomegaly. No cutaneous stigmata of chronic liver …
