Alpha methyldopa induced hepatotoxicity in pregnancy

Padmasri Ramalingappa, Hema V. Aradhya, Nagabushan Hanumantharaya, Priyadarshini Bolarigowda

Abstract


We report a case of gestational hepatitis due to alpha-methyldopa and briefly review the literature on alpha-methyldopa-induced hepatotoxicity in pregnancy. A 32 year old woman, primigravida with 34 weeks of gestation with pre eclampsia, presented with symptoms of nausea, dark coloured urine and jaundice. She was on alpha methyldopa (Aldomet) 250 mg thrice a day since the last five weeks. Laboratory investigations revealed raised bilirubin, serum aspartate transaminases and serum alanine transaminases. Platelets were normal. Peripheral smear did not show haemolysis. With the exclusion of viral, haemolytic and obstructive causes, drug induced jaundice was considered as a differential diagnosis. Alpha methyldopa was withdrawn and replaced with nifedipine for her pre eclampsia treatment. Her repeat bilirubin level done two weeks later showed a drop. She went into labour at 38 weeks and delivered vaginally. In postpartum follow up her liver tests returned to normal in two weeks, about six weeks after stopping methyldopa. Hepatotoxicity should be considered as one of the adverse drug reaction of alpha methyldopa. It is not possible at present to predict which patients will develop liver disease following the administration of this drug. An awareness of the possibility of methyldopa induced hepatotoxicity should be present in the clinician’s mind and liver function tests should be done at regular intervals. The occasional occurrence of this harmful side effect is not a contraindication to the use of this antihypertensive agent.


Keywords


Alpha methyldopa, Hepatotoxicity, Pregnancy

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References


James PR, Nelson-Piercy C. Management of hypertension before, during, and after pregnancy. Heart. 2004;90:1499-504.

Skerjanec A, Campbell NR, Robertson S, Tam YK. Pharmacokinetics and presystemic gut metabolism of methyldopa in healthy human subjects. J Clin Pharmacol. 1995;35(3):275-80.

Godosis D, Komaitis S, Tziomalos K, Baltatzi M, Ntaios G, Savopoulos CG, Hatzitolios, AI. Cardiovascular diseases in pregnancy. Am J Cardiovasc Dis. 2012;2(2):96-101.

Elkington SG, Schreiber WM, Conn HO. Hepatic injury caused by L-alpha-methyldopa. Circulat. 1969;40:589-96.

Picaud A, Walter P, de Préville G, Nicolas P. Fatal toxic hepatitis in pregnancy. A discussion of the role of methyldopa. J Gynaecol Obstet Biol Reprod. 1990;19(2):192-6.

Rodman JS, Deutsch DJ, Gutman SI. Methyldopa hepatitis. A report of six cases and review of the literature. Am J Med. 1976;60(7):941-8.

Carstairs KC, Breckenridge A, Dollery CT, Worlledge SM. Incidence of a positive direct Coombs test in patients on alpha-methyldopa. Lancet. 1966 Jul 16;2(7455):133-5.

Vest AR, Cho LS. Hypertension in pregnancy. Cardiol Clin. 2012;(30):407-23.

Khalil A, Harrington K, Muttukrishna S, Jauniaux E. Effect of antihypertensive therapy with alpha-methyldopa on uterine artery Doppler in pregnancies with hypertensive disorders. Ultrasound Obstet Gynaecol. 2010;35(6):688-94.

Ozdemir OM, Ergin H, Ince T. A newborn with positive antiglobulin test whose mother took methyldopa in pregnancy. Turk J Paediatr. 2008;50(6):592-4.