METYROSINE
(me-tye'roe-seen)
Demser
Classifications: hormones and synthetic substitutes; enzyme inhibitor
Pregnancy Category: C
|
250 mg capsules
Blocks the enzyme tyrosine hydroxylase to inhibit the conversion of tyrosine to DOPA, which is the initial and rate-setting
step in synthesis of catecholamines (dopamine, epinephrine, norepinephrine).
In patients with pheochromocytoma, reduces catecholamine synthesis as much as 80%, ameliorating hypertensive attacks and
associated symptoms.
Short-term management of pheochromocytoma until surgery is performed, in long-term control when surgery is contraindicated,
and in patients with malignant pheochromocytoma.
Has been used in selected patients with schizophrenia to potentiate antipsychotic effects of phenothiazines.
Control of essential hypertension. Safety during pregnancy (category C), lactation, or in children <12 y is not established.
Impaired liver or kidney function.
Pheochromocytoma
Adult: PO 250 mg q.i.d., may increase to 2–3 g/d in divided doses (max: 4 g/d)
|
Oral
- Give each dose with a full glass of water and be consistent about time medication is to be taken.
- Store at 15°–30° C (59°–86° F).
CNS: Sedation, fatigue; extrapyramidal signs: drooling, difficulty in speaking (dysarthria), tremors, jaw stiffness (trismus); frank parkinsonism, psychic disturbances (anxiety, depression, hallucinations, disorientation, confusion),
headache, muscle spasms. GI: Diarrhea, nausea, vomiting, abdominal pain, dry mouth. Skin: Rash, urticaria. Urogenital: Transient dysuria, crystalluria, hematuria, impotence, failure of ejaculation. Endocrine: Breast swelling, galactorrhea. Body as a Whole: Peripheral edema, nasal stuffiness, shortness of breath. Hematologic: Eosinophilia.
False increases in urinary catecholamines may occur because of catechol metabolites of metyrosine.
Drug: Alcohol and other cns depressants add to sedation and CNS depression; droperidol, haloperidol, phenothiazines potentiate extrapyramidal effects.
Absorption: Readily absorbed from GI tract. Peak: 2–3 d. Duration: 3–4 d. Distribution: Crosses blood–brain barrier. Elimination: Excreted in urine. Half-Life: 3.4–7.2 h.
Assessment & Drug Effects
- Monitor therapeutic effectiveness with frequent assessment of vital signs.
- Monitor I&O ratio and pattern. Fluid intake must be enough (e.g., 10–12 glasses or more) to maintain urinary output of
2000 mL or more to minimize risk of crystalluria.
- Perform routine urinalysis; if crystals occur, increase fluid intake further. If crystalluria persists, decrease drug dosage
or discontinued.
- Lab tests: Obtain baseline and periodic measurements of urinary catecholamines and their metabolites (metanephrines and VMA).
Metabolite excretion should decrease in patients with pheochromocytoma. Other baseline and regular determinations include
kidney and liver function tests (in patients with dysfunction), and blood and urine glucose tests.
- Supervise ambulation. Sedative effects occur commonly within the first 24 h after drug is started. Maximal sedative effects
in 2 or 3 d.
Patient & Family Education
- Notify physician if following adverse effects occur: Diarrhea, particularly if it is severe or persists, painful urination,
jaw stiffness, drooling, difficult speech, tremors, disorientation. Dosage reduction or discontinuation of drug may be indicated.
- Avoid driving and potentially hazardous activities until response to drug is known.
- Be aware that abrupt withdrawal of metyrosine may result in psychic stimulation, feeling of increased energy, temporary changes
in sleep pattern (usually insomnia). Symptoms may last for 2 or 3 d.
- Carry medical identification at all times if on prolonged therapy and notify all physicians and dentists involved in care
about drug regimen.
- Do not breast feed while taking this drug without consulting physician.
1%)
Canadian drug name; 
Prototype drug