Question:
Which of the following drugs is known to cause retroperitoneal fibrosis?
Which of the following drugs is known to cause retroperitoneal fibrosis?
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This ergot derivative used for migraine prophylaxis is the classic drug associated with retroperitoneal fibrosis.
Updated On: Jun 23, 2026
- Methysergide
- Metformin
- Amlodipine
- Propranolol
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The Correct Option is A
Solution and Explanation
Step 1: Define retroperitoneal fibrosis (RPF).
RPF is a rare condition characterized by chronic inflammation and fibrosis of the retroperitoneal structures, including the periaortic tissue and ureters. It can lead to hydronephrosis and renal failure due to ureteral obstruction.
Step 2: Drugs causing RPF.
The most classically associated drug is methysergide (an ergot alkaloid derivative used in migraine prophylaxis). Methysergide is the prototype drug causing drug-induced RPF. Other drugs implicated include:
Step 3: Mechanism.
Methysergide is a partial agonist at serotonin receptors. The fibrosis is believed to result from serotonin-mediated activation of fibroblasts in the retroperitoneum. A drug-free period of 1 month after every 6 months of use is recommended to reduce this risk.
Step 4: Other conditions causing RPF.
Idiopathic RPF (most common overall cause), lymphoma, carcinoid tumor, aortic aneurysm (inflammatory), radiotherapy, and other drugs.
Step 5: Eliminate distractors.
Metformin causes GI side effects and B12 deficiency. Amlodipine causes peripheral edema. Propranolol has only a rare, weak association.
Answer: Methysergide
RPF is a rare condition characterized by chronic inflammation and fibrosis of the retroperitoneal structures, including the periaortic tissue and ureters. It can lead to hydronephrosis and renal failure due to ureteral obstruction.
Step 2: Drugs causing RPF.
The most classically associated drug is methysergide (an ergot alkaloid derivative used in migraine prophylaxis). Methysergide is the prototype drug causing drug-induced RPF. Other drugs implicated include:
- Ergotamine (ergot alkaloids as a class)
- Beta-blockers (atenolol, propranolol -- rare association)
- Hydralazine
- Methyldopa
- Pergolide, cabergoline (dopamine agonists)
Step 3: Mechanism.
Methysergide is a partial agonist at serotonin receptors. The fibrosis is believed to result from serotonin-mediated activation of fibroblasts in the retroperitoneum. A drug-free period of 1 month after every 6 months of use is recommended to reduce this risk.
Step 4: Other conditions causing RPF.
Idiopathic RPF (most common overall cause), lymphoma, carcinoid tumor, aortic aneurysm (inflammatory), radiotherapy, and other drugs.
Step 5: Eliminate distractors.
Metformin causes GI side effects and B12 deficiency. Amlodipine causes peripheral edema. Propranolol has only a rare, weak association.
Answer: Methysergide
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