Indications for DEMSER:
Treatment of pheochromocytoma for: preoperative preparation for surgery; or management when surgery is contraindicated. Chronic treatment in malignant pheochromocytoma.
Initially 250mg 4 times daily; may increase by 250–500mg daily up to max 4g/day in divided doses. Usual dose: 2–3g/day; monitor. If hypertensive, titrate dose to normalize BP and control symptoms; if normotensive, titrate dose to reduce urinary metanephrines and/or vanillylmandelic acid by ≥50%. Add an α-blocker (eg, phenoxybenzamine) if patients not adequately controlled. Pre-op prep: treat for at least 5–7 days.
Renal or hepatic impairment. Maintain adequate hydration; if crystalluria occurs, increase more fluids; if crystalluria persists, reduce dose or discontinue. Pre-op use: maintain adequate intravascular volume intra- and postoperatively. Pregnancy (Cat.C). Nursing mothers.
Tyrosine hydroxylase inhibitor.
Increased CNS effects with alcohol, other CNS depressants (eg, hypnotics, sedatives, tranquilizers). Potentiates extrapyramidal effects of phenothiazines, haloperidol.
Sedation, diarrhea, extrapyramidal effects, anxiety, CNS disturbances, crystalluria; rare: hematological disorders.