Spectrum of methyldopa liver injury

The administration of alpha methyldopa resulted in serious liver injury to seven patients, requiring hospitalization. All patients presented with symptoms indistinguishable from viral hepatitis. Histological changes ranged from those compatible with acute hepatitis to chronic active hepatitis and subacute hepatic necrosis. One patient with subacute hepatic necrosis rapidly progressed to hepatic failure and died; autopsy revealed postnecrotic cirrhosis. Inadvertent rechallenge after recovery resulted in dramatic recurrence of symptoms in one patient, confirming the fact that a hypersensitivity phenomenon is involved. A high state of awareness among physicians of this unpredictable toxic effect of the drug may reduce its unrecognized perpetuation.