Methyldopa Hepatotoxicity: A Paradoxical High-Risk Pregnancy

Abstract

Alpha methyldopa is one of the preferred medications for hypertension control in pregnant women because of its low teratogenic profile. However, when pregnant women on this medication develop an acute or chronic liver damage, methyldopa is not thought to be responsible. At 18 weeks gestation of a high-risk pregnancy, a patient with chronic hypertension controlled on methyldopa 500 mg three times daily, presented with jaundice, dark-colored urine and elevated liver function enzymes. Following worsening symptoms, inconclusive radiological and negative immunological laboratory investigations, she was hospitalized and a diagnosis of drug-induced hepatotoxicity was confirmed with a liver biopsy. Her symptoms resolved with withdrawal of the offending medication and prednisone taper, which led to diabetes mellitus in pregnancy. Paradoxically, following the diagnosis and discontinuation of methyldopa, the patients blood pressure remained controlled off antihypertensives.




J Clin Gynecol Obstet. 2015;4(3):271-274
doi: http://dx.doi.org/10.14740/jcgo343w