Drug-induced liver injury in early pregnancy associated with methyldopa administration during antihypertensive therapy

α-Methyldopa is one of the most common antihypertensive drugs used during pregnancy [1]. It is considered to be safe for the neonate and well tolerated by the woman [1, 2]. We present a case of drug-induced liver injury in a woman at 11 weeks’ gestation who developed this rare complication as a result of methyldopa therapy. The diagnosis was made at an early stage, and thus, it made it possible to avoid more serious complications such as hepatic failure, liver cirrhosis or death. Noteworthy, the patient was treated with α-methyldopa during previous pregnancies, yet no side effects were observed. Due to the increasing incidence of gestational hypertension, there is a growing need to increase alertness of rare complications during antihypertensive therapy.
We analysed the medical history of the patient and searched MEDLINE database. Selection criteria included published data in English – case reports, original research and reviews. Articles related to hypertension in pregnancy or hepatotoxicity of α-methyldopa were selected and analysed.
A 41-year-old multipara was admitted to the Department of Perinatology in the 1st Chair of Obstetrics and Gynecology, Medical University of Lodz at 11 weeks’ gestation due to elevated blood pressure (about 130/100 mm Hg). Such values of blood pressure maintained although she has been treated for hypertension with α-methyldopa (in a dose of 250 mg 3 times a day) for a month. Obstetric history included two pregnancies complicated by hypertension, resulting in delivery at term of two healthy neonates by cesarean sections. In routine examinations, 3 weeks prior to admission, all laboratory results were within normal limits (Table I). Laboratory tests at admission revealed elevated liver enzymes: alanine aminotransferase (ALT) increased to 325 U/l and aspartate aminotransferase (AST) to 290 U/l, while total bilirubin did not exceed the reference range – 0.3 mg/dl. Serum levels of bile acids were elevated to 15.8 mmol/l (upper limit of normal: 10 mmol/l). There were no abnormalities in the blood count and other biochemical tests such as electrolytes, amylase and prothrombin index. Slightly reduced serum levels of urea and total protein were observed. During the hospitalization, there was an upward trend in the biochemical parameters of liver injury (Table I). The symptoms were mild and included headache, general malaise, nausea and abdominal distension. Routine measurements of body temperature were within normal...


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