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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
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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.

Copyright ©2004 by the American College of Physicians

Ann Intern Med. 1996;125(9):738-740. doi:10.7326/0003-4819-125-9-199611010-00006
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Loratadine is a long-acting tricyclic antihistamine with selective peripheral histamine-1-receptor antagonistic activity [13]. 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 [23]. The increasing popularity of this drug results from its low propensity to cause drowsiness.

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Figure 1. Note the large areas of hepatocyte necrosis, lobular inflammation, and proliferating bile ductules with absence of fibrosis and nodule formation. Bile plugs are present within islands of residual hepatocytes. (Hematoxylin-eosin stain; original magnification, × 25).
Histologic section of the explanted liver of patient 1.
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Figure 2. Note the mononuclear portal and lobular inflammation that is predominantly lymphocytic and the absence of Mallory bodies, macro- or microvesicular steatosis, and evidence of chronic liver disease. (Hematoxylin-eosin stain; original magnification, × 50).
Histologic section of the liver biopsy specimen of patient 2.
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