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Published Online, 10 May 2005, www.theannals.com, DOI 10.1345/aph.1E557.
 The Annals of Pharmacotherapy: Vol. 39, No. 6, pp. 1128-1130. DOI 10.1345/aph.1E557
© 2005 Harvey Whitney Books Company.
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Phenazopyridine-Induced Sulfhemoglobinemia

Anuradha S Gopalachar, MD

Internal Medicine Residency Program Director, Veterans Affairs Medical Center, Amarillo, TX; Clinical Assistant Professor, Texas Tech University Health Sciences Center, Amarillo

Venita L Bowie, PharmD

Assistant Professor of Pharmacy Practice, School of Pharmacy, Texas Tech Health Sciences Center, Amarillo; Clinical Pharmacist, Veterans Affairs Medical Center, Amarillo

Parag Bharadwaj, MD

Fellow, Internal Medicine/Inpatient Care Center, San Diego Hospice & Palliative Care, San Diego, CA

Reprints: Dr. Gopalachar, Amarillo Veterans Affairs Medical Center, 6010 W. Amarillo Blvd., Amarillo, TX 79106-1991, fax 806/468-1863, Anuradha.gopalachar{at}med.va.gov

OBJECTIVE: To report a case of sulfhemoglobinemia in a patient receiving phenazopyridine for a urinary tract infection.

CASE SUMMARY: A 63-year-old white woman presented to the emergency department with complaints of fatigue and bluish discoloration of her body that had gradually progressed over the previous 6–8 weeks. About 4 months prior to presenting to the emergency department, she had started taking phenazopyridine, an over-the-counter medication for symptoms of dysuria. Because the cyanosis did not improve after the patient received oxygen and methylene blue, sulfhemoglobinemia was suspected and confirmed by spectrophotometer analysis.

DISCUSSION: Sulfhemoglobin is a green-pigmented molecule containing a sulfur atom in one or more of the porphyrin rings. It is a rare cause of cyanosis, which is usually drug induced. Sulfhemoglobinemia is suspected when a cyanotic patient has normal to near-normal oxygen tension, laboratory reports of elevated methemoglobin, and does not respond to methylene blue therapy. Sulfhemoglobinemia is relatively rare, despite the widespread use of drugs that have been reported to cause it. Predisposing factors, such as chronic constipation, present in our patient, have been suggested as a source of hydrogen sulfide.

CONCLUSIONS: This case of sulfhemoglobinemia, which occurred after the patient took phenazopyridine, is considered a probable adverse event according to the Naranjo probability scale.

Key Words: phenazopyridine, sulfhemoglobinemia, urinary tract infection

Published Online, May 10, 2005. www.theannals.com, DOI 10.1345/aph.1E557




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