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Chronic Severe Hemolytic Anemia from Phenazopyridine
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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].
Mumtaz A. Siddiqui
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
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