Methyldopa-Induced Immune Hemolytic Anemia and Chronic Active Hepatitis

Shalev, Oded

doi:10.1001/archinte.1983.00350030206040

Cited by 21 publications

(7 citation statements)

References 12 publications

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“…The hepatotoxicity of major classes of antihypertensives is shown in Table 3. While there are some very well-known toxicities associated with antihypertensive medications, such as autoimmune hepatitis in a-methyldopa use, [85][86][87] most hepatotoxic reactions to these medications are idiosyncratic. Nevertheless, because antihypertensive use is so common, hepatotoxic reactions may often be recognized.…”

Section: Hepatotoxicity Of Antihypertensive Medicationsmentioning

confidence: 99%

“…88 More rarely, an acute hepatitis ensues which has classically been considered autoimmune or ''chronic active,'' but may also be granulomatous in nature. 85,86,89,90 Hepatic necrosis may occur. 88 While a-methyldopa use has decreased with advent of newer classes of antihypertensives, it is still commonly prescribed for hypertension in pregnancy and is one of the few antihypertensives considered safe Angiotensin II antagonists Losartan, candesartan, valsartan Hepatitis, 98,99 hepatomegaly, 100,101 cholestasis, ductopenia 102…”

Section: Hepatotoxicity Of Antihypertensive Medicationsmentioning

confidence: 99%

“…Enalapril, ramipril, captopril, fosinopril Cholestatic hepatitis, [103][104][105] ductopenia, 106 cirrhosis [107][108][109] Alpha-methyldopa Hepatitis, 89 granulomatous hepatitis, 90 autoimmune hepatitis, 85,86 hepatic necrosis 126,127 Hydralazine Hepatitis, 110 to use in pregnancy. 91 The value of enzyme monitoring is questionable given the frequency of asymptomatic transaminase elevations.…”

Section: Ace Inhibitorsmentioning

confidence: 99%

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Hepatotoxicity of Drugs Used for Treatment of Obesity and Its Comorbidities

Ghali

Lindor

2004

Semin Liver Dis

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Obesity is an increasingly prevalent problem with many associated health risks. Obese patients may present with liver diseases directly attributable to their obesity, such as nonalcoholic steatohepatitis (NASH). However, many such individuals are prescribed various potentially hepatotoxic medications for obesity itself, as well as for the complications of obesity. Clinically, it may be difficult to distinguish the two. Furthermore, many of these medications are in common use, and some are not commonly recognized as potentially injurious to the liver. While some medications have predictable hepatotoxicity, many more have associated idiosyncratic reactions. We review the literature and case-reports of hepatotoxicity associated with four categories of medications: those used primarily in the treatment of obesity, those used in the treatment of diabetes mellitus, those used in the treatment of hyperlipidemia, and those used in the treatment of hypertension. For each class, we present the described epidemiology, clinical presentation, pathology, and prognosis.

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Section: Hepatotoxicity Of Antihypertensive Medicationsmentioning

confidence: 99%

Section: Hepatotoxicity Of Antihypertensive Medicationsmentioning

confidence: 99%

Section: Ace Inhibitorsmentioning

confidence: 99%

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Hepatotoxicity of Drugs Used for Treatment of Obesity and Its Comorbidities

Ghali

Lindor

2004

Semin Liver Dis

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“…In an attempt to understand the mechanism of these findings [5], we postulated that there ought to be drug-binding to the RBC membrane and, given the chemical structure of the drug, oxidizing conditions might be an important factor in this binding. It has been suggested that levodopa interacts with anti gens in the RBC membrane and alters their structure [4][5][6][7] in such a way that they are no longer recognised as self by the helper cells.…”

Section: Introductionmentioning

confidence: 99%

Electron Microscopy of Red Blood Cells Altered by Auto-Immunity-Inducing Drugs

Rahamim¹,

Kahane²,

Sharon³

1990

Vox Sanguinis

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The fact that levodopa, a drug used for the treatment of Parkinson’s disease induces a direct Coombs-positive reaction in about 15% of treated patients, indicating the presence of auto-antibodies against the patient’s red blood cells (RBCs), is well known. Another known fact is that only 1% of those patients do actually develop auto-immune haemolytic anaemia. In this paper, we describe our findings utilizing the direct ELISA, a method for measuring the presence of IgM and IgG auto-antibodies on the patients’ red blood cells (RBCs), as well as an indirect ELISA, testing the presence of antibodies in their serum. The tests were performed on 8 patients, 7 of whom had been receiving the drug for long periods of time. Our results show that the serum antibodies precede the bound antibodies in a significant fashion and that the severity of the anaemia is directly related to the amount of auto-antibodies. Since auto-antibodies do not seem to be directed against the drug itself, some modification of the RBC must occur. For this reason, we attempted to determine whether patients receiving the drug show any morphological changes of their RBCs which could be determined by scanning electron microscopy (SEM) and whether these changes could be related to direct and indirect ELISA. In most levodopa-treated patients, a small number of echinocytes could be observed by SEM, while in 1 patient who suffered a severe anaemic phase, a very high percentage of the RBCs were echinocytes and spherocytes. In vitro treatment of normal human RBCs showed similar forms of transformed RBCs, possibly explaining the reason for the auto-immune response caused in patients with renal failure undergoing extracorporeal haemodialysis with formaldehyde-resterilizable membranes.

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“…Concretamente se cree que la metabolización farmacológica por la enzima P-450 da lugar a un antígeno que induce una respuesta inmunitaria celular y humoral. Además la metildopa provoca una inhibición de linfocitos CD8 siendo posible la formación de autoanticuerpos o patologías autoinmunes (1)(2)(3)(4)7,8).…”

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Hepatitis aguda tóxico-medicamentosa inducida por metildopa

Menor

Delgado

2005

Rev. esp. enferm. dig.

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Methyldopa-Induced Immune Hemolytic Anemia and Chronic Active Hepatitis

Cited by 21 publications

References 12 publications

Hepatotoxicity of Drugs Used for Treatment of Obesity and Its Comorbidities

Hepatotoxicity of Drugs Used for Treatment of Obesity and Its Comorbidities

Electron Microscopy of Red Blood Cells Altered by Auto-Immunity-Inducing Drugs

Hepatitis aguda tóxico-medicamentosa inducida por metildopa

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