Propylthiouracil side effects

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Propylthiouracil Side Effects: A Comprehensive Overview

Common Side Effects of Propylthiouracil

Propylthiouracil (PTU) is a medication widely used in the treatment of hyperthyroidism, particularly Graves' disease. Despite its efficacy, PTU is associated with several side effects that are critical for clinicians to recognize and manage. Common side effects include transient granulocytopenia, hepatitis, and vasculitis 12. These adverse reactions necessitate careful monitoring of patients undergoing PTU therapy.

Hematological Side Effects: Agranulocytosis and Leukopenia

One of the most severe hematological side effects of PTU is agranulocytosis, a condition characterized by a dangerously low number of granulocytes, a type of white blood cell essential for fighting infections. Agranulocytosis has been reported in multiple studies, with incidences ranging from 1.9% to 2% of patients 35. Additionally, leukopenia, a reduction in the overall white blood cell count, has also been observed, though it is less common .

Hepatotoxicity: Hepatitis and Fulminant Hepatitis

Hepatotoxicity is another significant concern with PTU use. Cases of hepatitis, including fulminant hepatitis, have been documented, highlighting the need for regular liver function monitoring during treatment 278. Hepatocellular jaundice, a form of liver damage, has also been reported, further emphasizing the potential for severe liver-related side effects .

Immunological Reactions: Vasculitis and Lupus-like Syndrome

PTU can induce various immunological reactions, including vasculitis and lupus-like syndromes. Vasculitis, an inflammation of blood vessels, can present with symptoms such as fever, rash, and joint pain. In some cases, PTU-induced vasculitis has been associated with antineutrophil cytoplasmic autoantibody (ANCA) positivity 12. Additionally, PTU has been linked to lupus-like syndromes, characterized by symptoms such as rash, serositis, myocarditis, and renal involvement .

Respiratory Complications: Asthma and Eosinophilic Pleuritis

Respiratory complications, although rare, can occur with PTU treatment. Cases of PTU-induced asthma have been reported, where patients developed wheezing and dyspnea after starting the medication . Eosinophilic pleuritis, an inflammation of the pleura with a high eosinophil count, has also been documented as a rare side effect .

Hypersensitivity Reactions: Polyarthritis and Sensorineural Deafness

Hypersensitivity reactions to PTU can manifest in various forms, including polyarthritis, cutaneous vasculitis, and fever. In rare instances, PTU has been associated with reversible sensorineural deafness, highlighting the drug's potential to cause multi-organ involvement through immune-mediated mechanisms .

Conclusion

While propylthiouracil remains a valuable treatment option for hyperthyroidism, its use is not without risks. The potential for severe side effects such as agranulocytosis, hepatotoxicity, vasculitis, and hypersensitivity reactions necessitates vigilant monitoring and early intervention. Clinicians should be well-informed about these adverse reactions to ensure the safe and effective use of PTU in their patients.

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Most relevant research papers on this topic

Side Effects Propylthiouracil and Key Points in Pharmaceutical Care of Patients Receiving Propylthiouracil

Propylthiouracil may cause side effects, but early detection and discontinuation can improve patient safety.

Literature Review

2009·

0citations

·Li Zhong-dong

Propylthiouracil‐induced asthma

Propylthiouracil (PTU) treatment for hyperthyroidism may cause asthmatic attacks in patients, highlighting the need for careful monitoring and management of side-effects.

Case Report

2004·

3citations

·L. Nguyễn et al.

Agranulocytosis and hepatocellular jaundice: toxic reactions following propylthiouracil therapy.

Propylthiouracil therapy may cause agranulocytosis and hepatocellular jaundice in patients, with a higher incidence in those receiving a higher dose of propylthiouracil.

Case Report

1947·

52citations

·H. J. Livingston et al.

Propylthiouracil hypersensitivity with circumstantial evidence for drug-induced reversible sensorineural deafness: a case report.

Propylthiouracil-induced hypersensitivity can cause a variety of severe side effects, including reversible sensorineural deafness, and prompt recovery occurs upon drug withdrawal.

Case Report

1991·

10citations

·P. Fong et al.

Agranulocytosis during propylthiouracil therapy.

Propylthiouracil therapy should be carefully supervised, as serious reactions, including agranulocytosis, may occur and require immediate treatment.

Observational Study

1948·

36citations

·E. C. Bartels

Propylthiouracil-induced diffuse proliferative lupus nephritis: review of immunological complications.

Propylthiouracil (PTU) may occasionally induce lupus-like syndromes with renal involvement, highlighting the need for early and specific intervention in these cases.

Case Report

1997·

27citations

·G. V. Prasad et al.

Propylthiouracil: Clinical Overview of its Efficacy and its Side Effects more than 50 Years after the Introduction of its Use in Thyrostatic Treatment

Propylthiouracil is a valuable thyrostatic drug for treating Graves' disease, offering a good alternative to methimazole and being approved by the American Academy of Pediatrics for use in nursing mothers.

2009·

8citations

·Prof. M. Weissel et al.

Fulminant hepatitis during treatment with propylthiouracil.

THE effectiveness and relative lack of toxicity of propylthiouracil have made it valuable in the treatment of thyrotoxicosis. Untoward reactions, especially granulocytopenia, rarely hepatic injury, were encountered frequently with its predecessor, thiouracil. However, hematologic changes with propylthiouracil have proved so unusual that some clinicians consider periodic blood counts an unnecessary precaution during therapy.1 Abandonment of such a safeguard is to be decried since other authors2 3 4 report as high as a 2 to 4 per cent incidence of toxic reactions with propylthiouracil. In 1651 treated cases granulocytopenia occurred in 19.4 The literature contains several reports of liver damage in patients receiving . . .

1953·

35citations

·M. J. Eisen

Leukopenia following the use of propylthiouracil.

Propylthiouracil is generally conceded to be the least toxic antithyrotoxic agent at the moment. Serious reactions to this drug are almost lacking in the literature. Reports of two febrile and urticarial reactions in 129 cases 1 and of 1 case of leukopenia and sore throat in a series of 110 cases 2 have appeared. Astwood and VanderLaan have now treated over 100 patients without the development of any significant side effect. 3 In 260 patients treated with the drug at the Lahey Clinic depression of the white blood cell count has been noticed in 5 instances. 4 The development of pronounced leukopenia in a patient under treatment with this drug was therefore considered of sufficient importance to report. A second point of interest in the case is the increasing degree of thyrotoxicosis that developed while propylthiouracil was being administered in what was thought to be an adequate maintenance dose. REPORT

Case Report

1947·

17citations

·W. Eisenmenger et al.

Eosinophilic pleuritis due to propylthiouracil.

We report a patient who developed eosinophilic pleuritis due to propylthiouracil. Although immunologic side effects associated with thionamides previously have been described, this is the first reported case of an isolated eosinophilic pleural reaction.

Case Report

1993·

32citations

·K. Middleton et al.

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