Danazol-induced cholestasis

A 39-yr-old female on high-dose Danazol presented with jaundice and pruritus. Danazol-induced cholestasis was suspected, and the drug was discontinued. A liver biopsy revealed panlobular cholestasis with portal and periportal inflammation. The cholestasis resolved completely in 8 wk. This is a rare case of Danazol-induced cholestasis and should be considered in the differential diagnosis of drug-induced liver injury.

Pseudotumor cerebri induced by danazol

Intracranial hypertension with papilledema occurred in two patients receiving danazol therapy for either cyclic neutropenia or immune hemolytic anemia. Results of clinical, laboratory, and neuroradiologic studies showed no apparent cause for the condition in Case 1 and the papilledema resolved one month after discontinuing danazol. Carotid angiography in Case 2 demonstrated cerebral venous sinus thrombosis; the papilledema showed gradual improvement after cessation of danazol. An additional seven cases of pseudotumor cerebri presumed secondary to danazol therapy have been reported to the Food and Drug Administration. The papilledema resolved in all seven cases soon after discontinuing danazol. A drug-induced complication should be suspected, and alternative therapy sought, in patients who develop intracranial hypertension associated with administration of danazol.

Danazol and internal carotid artery thrombosis

The case of a 47-year-old woman suffering from a CT-assessed ischemic right hemisphere stroke, which occurred after a 2-month treatment with danazol (a synthetic androgen), is reported. The patient's thrombocytosis in association with danazol treatment and its possible correlations with the thrombotic event are discussed.

Ischemic colitis in a 33-year-old woman on danazol treatment for endometriosis

A 33-yr-old Japanese woman, married, no parity, was treated for endometriosis. Danazol 400 mg a day was initiated on September 25, 1986, for 21 consecutive days. She became severely constipated and had left lower abdominal colic pain. Five days later, she had to be admitted to the hospital, because she had had no bowel movements for 12 days and the abdominal pain was severe. On the day after admission, she had frequent painful bowel movements. The stool was blood-tinged, but pathogenic bacteria were nil. Ischemic colitis of the stricture type was identified. She was treated with hyperalimentation and anticholinergic agents. At 3 months and 5 days after discharge from hospital, danazol 400 mg per day was readministered, and 11 days later, the patient again became constipated and complained of the same pain in the left flank. We consider that danazol-induced constipation played a role in the onset of the ischemic colitis.

Serum bile acid concentrations as an indicator of liver dysfunction induced during danazol therapy

The effects of danazol therapy (600 mg/day) on the liver function of 16 women with endometriosis were investigated. The primary bile acids (cholic acid [CA] and chenodeoxycholic acid [CDCA]) were analyzed with radioimmunoassays in the fasting state and after a test meal. Also, the conventional liver function tests were performed. Ultrasonography was used to detect any possible changes in the gallbladder function. The fasting concentrations of CA increased (P less than 0.05) during therapy, while those of CDCA did not change. The ratio of CA/CDCA also increased (P less than 0.001). The maximal response of CA after the test meal increased (P less than 0.01) during the trial. As regards the other liver function tests, only the transaminases significantly increased (P less than 0.01) after 1 month of therapy but showed a tendency to decrease later during the trial. The gallbladder's volume and function did not change. All the parameters studied normalized within 1 month of cessation of danazol therapy. Danazol seems to have a rather mild effect on liver function. The analyzed parameters indicate transient cell wall injury and slight disturbances in liver cell uptake and secretion mechanism and also of synthesis activity.

Hepatocellular carcinoma after danazol therapy

Danazol, an inhibitor of pituitary gonadotropin, has been proposed in the treatment of systemic lupus erythematosus (SLE). We report the case of a female patient with SLE in whom a hepatocellular carcinoma was discovered after 4 years of treatment with danazol. Except for 3 days of hypochondrium pain, there were neither clinical signs of liver tumor nor biological abnormalities. An ultrasonography showed 2 tumors of the liver. At histological examination after surgery, one of the tumors was found to be a benign adenoma, while the other was a well differentiated hepatocellular carcinoma. When longterm danazol therapy is required, ultrasonography may be useful for early tumor detection.

[Effects of danazol therapy in endometriosis on the blood picture and blood coagulation]

Over a six-month period, 62 endometriosis patients were given 600 mg per day of the ethisterone derivative danazol. Blood count and coagulation status were checked before and during treatment. There was a significant increase (p less than 0.05) in hemoglobin and hematocrit. There were no changes in RBC, leukocyte count, or thrombocyte count; the mean cellular erythrocyte volume, thrombin time, thromboplastin time, and partial thromboplastin time also remained unchanged, as did factors VII, VIII, X, XII, and alpha-1-antitrypsin. Antithrombin III levels increased, while alpha-2-macroglobulin values decreased. Only the drop in fibrinogen, to pathologic values, and the increase in plasminogen reached significant levels (p less than 0.01). These in part contradictory changes suggest that hypocoagulability occurs under danazol medication; however, its clinical relevance is unclear.

Intra-articular rimexolone in the rheumatoid knee: a placebo-controlled, double-blind, multicentre trial of three doses

One-hundred and thirty-seven patients with classical or definite rheumatoid arthritis, involving at least one knee joint, were randomly allocated to a single intra-articular injection of 10, 20 or 40 mg of rimexolone (Org 6216) or placebo. The follow-up period was 84 days, during which clinical and laboratory assessments were done. Clinical improvement of the treated knee joint was measured by the following variables: pain, tenderness, morning stiffness, swelling, range of movement and walking ability. Placebo response was considerable. However, clinical improvement with rimexolone at 20 mg and 40 mg was significantly superior to placebo for most of the variables, whilst with the 10 mg dose only reduction of tenderness was significantly superior. The duration of improvement was longest with 40 mg of rimexolone. One single, intra-articular injection of this dose into the affected knee joint provided significant reduction in pain, tenderness and stiffness and improved the range of movement and walking ability for a period of 8 to 12 weeks.

Clinically significant danazol-carbamazepine interaction

In six patients with epilepsy and fibrocystic breast disease the concentration in serum of antiepileptic drugs was obtained before, during, and after danazol therapy. Carbamazepine serum levels increased almost twofold in the presence of danazol. Thus, interaction between carbamazepine and danazol producing acute carbamazepine toxicity is clinically significant. If these drugs are administered concurrently, an awareness of the potential for this drug-drug interaction along with monitoring of carbamazepine levels is required for optimal patient care.

Endocrine consequences of danazol treatment in menorrhagia

In order to study the endocrine side-effects of danazol, 15 patients with severe, benign menorrhagias, were individually treated with this drug to stop bleeding. LH, FSH, testosterone, free testosterone, DES-S, androstenedione, prolactin, estradiol and cortisol serum concentrations were measured before and after the 3 month treatment period. Danazol was found to be effective in reducing the amount of bleeding in patients with benign, severe menorrhagias; however, the weight gain of patients was significant during the 3 month period. LH and estradiol concentrations decreased; testosterone, free testosterone and dehydroepiandrosterone sulfate increased; prolactin, FSH, androstenedione and cortisol serum concentrations did not change, and SHBG disappeared from the serum, during the treatment period. We are of the opinion that danazol is an effective drug in menorrhagias with side-effects. In our view the hyperandrogenicity is the most important side-effect of this substance, which might be the result of some metabolites, but which might be the effect of a peripheral action of the drug as well.