Methimazole-induced urticaria in hyperthyroid patients: A safe re-administration protocol

IF 2.2 4区医学 Q3 PHARMACOLOGY & PHARMACY Therapie Pub Date : 2024-09-01 DOI:10.1016/j.therap.2023.12.006

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Abstract

Purpose

The safety profile of methimazole (MMI) seems to be better than propylthiouracil in the management of hyperthyroidism. It is therefore advisable to use IMM as the first choice in Graves’ patients. It is important to keep this drug in patients regardless of minor side effects. We report a case series of MMI-induced urticaria and provide a stepwise protocol for the safe re-administration of MMI.

Methods

It was a retrospective case series including all patients having manifested urticaria following MMI intake for hyperthyroidism; notified to the Pharmacovigilance Unit of the Clinical Pharmacology Department (March 2013–January 2022).

Results

We have included 11 patients (SR: 0.22). The median time interval between the start of MMI and the onset of urticaria averaged 14.5 days. The median daily dose of MMI was 40 mg. MMI was interrupted in all patients. Urticaria has progressively resolved after drug interruption and antihistamine intake. Reintroduction of MMI was performed in 10/11 patients as follows: one quarter of the daily dose on the first day, half of the daily dose on the 4th day, the three quarters of the daily dose on the 7th day, to reach the scheduled total dose on the 10th day. Cetirizine was added at the time of reintroduction and withdrawn 2 weeks later. All the patients were successfully controlled.

Conclusion

Given the importance of this drug in the management of hyperthyroidism, MMI should not be withdrawn in cases of urticaria. After the resolution of urticaria, a gradual reintroduction of MMI should be attempted with concomitant antihistamine therapy.

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甲亢患者甲巯咪唑诱发的荨麻疹：安全的再给药方案

目的在治疗甲状腺功能亢进症时，甲巯咪唑（MMI）的安全性似乎优于丙基硫氧嘧啶。因此，建议将甲巯咪唑作为巴塞杜氏病患者的首选药物。重要的是，无论是否存在轻微的副作用，患者都应继续使用这种药物。我们报告了一个甲状腺激素诱发荨麻疹的病例系列，并提供了一个安全再用甲状腺激素的分步方案。方法这是一个回顾性病例系列，包括所有因甲状腺功能亢进服用甲状腺激素后出现荨麻疹的患者；临床药理学部药物警戒组收到了通知（2013 年 3 月至 2022 年 1 月）。开始服用 MMI 与荨麻疹发病之间的中位时间间隔平均为 14.5 天。MMI 的中位日剂量为 40 毫克。所有患者都中断了 MMI 的治疗。在中断用药并服用抗组胺药后，荨麻疹逐渐缓解。10/11名患者按照以下方法重新开始服用甲磺酸甲酯：第一天服用每日剂量的四分之一，第四天服用每日剂量的一半，第七天服用每日剂量的四分之三，第十天达到预定的总剂量。西替利嗪在重新用药时加入，2 周后停药。结论鉴于该药物在治疗甲状腺功能亢进症中的重要性，在荨麻疹病例中不应停用 MMI。在荨麻疹缓解后，应尝试在同时使用抗组胺药物治疗的情况下逐步重新引入甲状腺激素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Therapie 医学-药学

CiteScore

3.50

自引率

7.70%

发文量

132

审稿时长

57 days

期刊介绍： Thérapie is a peer-reviewed journal devoted to Clinical Pharmacology, Therapeutics, Pharmacokinetics, Pharmacovigilance, Addictovigilance, Social Pharmacology, Pharmacoepidemiology, Pharmacoeconomics and Evidence-Based-Medicine. Thérapie publishes in French or in English original articles, general reviews, letters to the editor reporting original findings, correspondence relating to articles or letters published in the Journal, short articles, editorials on up-to-date topics, Pharmacovigilance or Addictovigilance reports that follow the French "guidelines" concerning good practice in pharmacovigilance publications. The journal also publishes thematic issues on topical subject. The journal is indexed in the main international data bases and notably in: Biosis Previews/Biological Abstracts, Embase/Excerpta Medica, Medline/Index Medicus, Science Citation Index.