Can Adderall (amphetamine and dextroamphetamine) cause transaminitis?

Adderall Can Cause Transaminitis

Yes, Adderall (amphetamine and dextroamphetamine) can cause transaminitis, with documented cases of acute liver injury occurring during treatment. 1

Mechanism and Risk

• Adderall contains amphetamine compounds that can cause idiosyncratic drug-induced liver injury, similar to other medications that undergo hepatic metabolism 1
• The risk appears to be higher in individuals with underlying liver conditions or previous liver surgery 1
• Transaminitis from Adderall appears to be rare but can range from mild elevations to severe hepatotoxicity 1

Clinical Presentation

• Patients may present with symptoms including abdominal pain, malaise, and jaundice 1
• Laboratory findings typically show elevated liver enzymes (AST and ALT), which may be detected during routine monitoring 2
• The pattern of liver injury is typically hepatocellular, characterized by predominantly elevated transaminases 3

Monitoring and Management

• For patients on Adderall, monitoring liver function is prudent, especially in those with risk factors for liver disease 1

• If transaminitis occurs:

  • For mild elevations (<3× upper limit of normal): continued monitoring may be appropriate 4
  • For significant elevations (>3× upper limit of normal): consideration should be given to discontinuing Adderall 4
  • For severe hepatotoxicity (AST or ALT >5× ULN): immediate discontinuation is recommended 4

• After discontinuation, liver enzymes should be monitored until normalization 4

• Recovery typically occurs with conservative management and discontinuation of the medication 1

Differential Diagnosis

• When transaminitis is detected in a patient taking Adderall, other common causes should be evaluated: 2

  • Nonalcoholic fatty liver disease
  • Alcoholic liver disease
  • Other drug-induced liver injury
  • Viral hepatitis
  • Metabolic disorders

• Initial evaluation should include: 2

  • Assessment for metabolic syndrome
  • Complete blood count with platelets
  • Serum albumin, iron studies
  • Hepatitis B and C testing

Special Considerations

• Patients with a history of liver disease or abnormal baseline liver function should use Adderall with caution 1
• Similar to other medications that can cause idiosyncratic drug-induced liver injury, the risk of hepatotoxicity with Adderall may not be dose-dependent 3
• The time course from initiation of Adderall to development of transaminitis can vary from days to months 1

Comparison to Other Medications

• The risk of hepatotoxicity with Adderall appears to be lower than with some other classes of medications such as certain antibiotics 4
• Other commonly prescribed medications that can cause transaminitis include certain antihypertensives 5 and beta-blockers 6