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    This serious condition may develop within a short period of treatment, even within viagra from india safe 5–11 weeks of α-methyldopa therapy. Fatty change, increased collagen deposition, impaired drug metabolism, and decreased cytochrome P500 and lowered glutathione concentrations contribute to hepatic dysfunction and eventual chronic liver damage by α-methyldopa. Acute liver necrosis is an unusual complication of α-methyldopa therapy. The large functional reserve for drug metabolism by the liver may account for the delay of symptoms or lesions development over prolonged periods (224). Isolated instances of submassive necrosis appear to have repaired after withdrawal from the drug.

    The most remarkable histological feature during the acute reaction phase was extensive periportal necrosis. Rechallenge with α-methyldopa resulted in increased serum transaminases within 5 days and fatal submassive hepatic necrosis (249). The protracted effects of the drug after discontinuation of therapy have been studied, and liver scans 6–7 months after treatment was stopped revealed generalized mottling and hypertrophic left lobe.

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