Methyldopa Side Effects

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The 48-year-old chief executive officer of a leading auto manufacturer is put on niacin and a restricted diet for the treatment of high-LDL cholesterol.

HPI The patient is a "bon vivant" who enjoys drinking and eating gourmet food as well as smoking two packs a day of Cuban filter-free dark tobacco cigarettes. On a visit two months afterward, the patient's lab tests show improvement, but he complains of facial flushing and itching on the lower back, palms, and anus.

PE VS: mild hypertension (BP 145/95). PE: obesity; face, neck, and chest flushed; no skin rash demonstrable on inspection.

Labs Serum glucose elevated (157 mg/dL); LDL lowered considerably in comparison to last visit; triglycerides decreased, but not as markedly; HDL increased; AST and ALT mildly elevated; elevated uric acid; normal levels of 5-hydroxyindoleacetic acid (vs. carcinoid syndrome, which may also produce facial Hushing)

Imaging CXR: normal.

Treatment Flushing and itching are often transient. Aspirin diminishes symptoms by inhibiting prostaglandin synthesis.

Discussion Nicotinic acid (niacin) is a derivative of tryptophan, a constituent of NAD and NADP that is used in redox reactions. As a drug, it is used for its lipid-lowering properties (decreases VLDL, decreases LDL, and increases HDL cholesterol). Hepatitis, hyperglycemia, and exacerbation of peptic ulcer are other side effects.

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