LETTER
Chronic Severe Hemolytic Anemia from Phenazopyridine
Mumtaz A. Siddiqui
15 January 1995 | Volume 122 Issue 2 | Pages 156-157
TO THE EDITOR:
The case report by Thomas and colleagues [1] is interesting. Phenazopyridine (Sedural or Pyridium), an azo dye, is not an over-the-counter drug. The other common medications having phenazopyridine in combination with sulfamethoxazole and sulfisoxazole are Azo Gantanol and Azo Gantrisin, respectively [2]. None of the preparations of phenazopyridine is available over the counter. I wonder whether the patient or her husband was, in fact, getting the drug by "inadvertent" prescription.
Further, oxidative Heinz-body hemolytic anemia with "bite cells" (degmacytes) is well documented as occurring after chronic overdosing with phenazopyridine [2, 3]. Glucose-6-phosphate dehydrogenase deficiency in erythrocytes may predispose patients to hemolysis. Acute hemolytic anemia after a single 1-g dose of phenazopyridine has also been described [4].
1. Thomas RJ, Doddabele S, Karnad AB. Chronic severe hemolytic anemia related to surreptitious phenazopyridine abuse. Ann Intern Med. 1994; 121:308.
2. Physicians' Desk Reference. 48th ed. Montvale, New Jersey: Medical Economics; 1994; 1914-5: 1971.
3. Drug: Facts and Comparisons. 48th ed. St. Louis: Wolter Kluwer; 1994:2881-2.
4. Kornowski R, Averbuch M, Jaffe A, Schwartz D, Levo Y. Sedural toxicity. Harefuah. 1991; 120:324-5.
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