Carbamazepine
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Reactions 878 - 17 Nov 2001 S Carbamazepine Non-alcoholic steatohepatitis in a patient with undiagnosed porphyria: case report Non-alcoholic steatohepatitis developed in a 42-year-old woman with undiagnosed variegate porphyria during treatment with carbamazepine for presumed epilepsy. The woman had received carbamazepine 300 mg/day for 3 months when she presented with a 2-week history of oedema and diffuse bullous lesions on her hands and feet. Carbamazepine was discontinued and she was admitted to hospital. Laboratory tests revealed the following elevated levels: AST 70 IU/L (normal 7–45), ALT 92 IU/L (7–45), alkaline phosphatase 406 IU/L (98–279), γ-glutamyl transferase 58 IU/L (7–45), serum albumin 27 g/L and total cholesterol 11.97 mmol/L. Her erythrocyte sedimentation rate was 67 mm/h. A liver biopsy showed evidence of drug-induced cholestatic hepatitis. Histological examination of a skin lesion revealed subepidermal bullosis. Total urinary coproporphyrin and uroporphyrin levels were markedly elevated. Her initial diagnosis of epilepsy was excluded after further investigations. A final diagnosis of variegate porphyria with neurological and skin involvement was made, and her liver disorders were attributed to an adverse effect of carbamazepine. The woman’s skin lesions gradually resolved, and her liver function tests normalised. She was discharged taking ursodeoxycholic acid. Two months later, she was in good health. Author comment: Carbamazepine may have decreased hepatic microsomal P450-dependent activity. ‘Since these enzymes are partially responsible for the metabolism of haem, the damage would have had additional negative effects on the already abnormal production of porphyrin intermediates. Thus porphyria should always be excluded before prescribing carbamazepine.’ Grieco A, et al. Non-alcoholic steatohepatitis induced by carbamazepine and variegate porphyria. European Journal of Gastroenterology and Hepatology 13: 973-975, Aug 2001 - Italy 800877801 1 Reactions 17 Nov 2001 No. 878 0114-9954/10/0878-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine
Reactions 878 - 17 Nov 2001
SCarbamazepine
Non-alcoholic steatohepatitis in a patient withundiagnosed porphyria: case report
Non-alcoholic steatohepatitis developed in a 42-year-oldwoman with undiagnosed variegate porphyria duringtreatment with carbamazepine for presumed epilepsy.
The woman had received carbamazepine 300 mg/day for 3months when she presented with a 2-week history of oedemaand diffuse bullous lesions on her hands and feet.Carbamazepine was discontinued and she was admitted tohospital. Laboratory tests revealed the following elevatedlevels: AST 70 IU/L (normal 7–45), ALT 92 IU/L (7–45), alkalinephosphatase 406 IU/L (98–279), γ-glutamyl transferase 58 IU/L(7–45), serum albumin 27 g/L and total cholesterol 11.97mmol/L. Her erythrocyte sedimentation rate was 67 mm/h. Aliver biopsy showed evidence of drug-induced cholestatichepatitis. Histological examination of a skin lesion revealedsubepidermal bullosis. Total urinary coproporphyrin anduroporphyrin levels were markedly elevated. Her initialdiagnosis of epilepsy was excluded after further investigations.A final diagnosis of variegate porphyria with neurological andskin involvement was made, and her liver disorders wereattributed to an adverse effect of carbamazepine.
The woman’s skin lesions gradually resolved, and her liverfunction tests normalised. She was discharged takingursodeoxycholic acid. Two months later, she was in goodhealth.
Author comment: Carbamazepine may have decreasedhepatic microsomal P450-dependent activity. ‘Since theseenzymes are partially responsible for the metabolism of haem,the damage would have had additional negative effects on thealready abnormal production of porphyrin intermediates. Thusporphyria should always be excluded before prescribingcarbamazepine.’Grieco A, et al. Non-alcoholic steatohepatitis induced by carbamazepine andvariegate porphyria. European Journal of Gastroenterology and Hepatology 13:973-975, Aug 2001 - Italy 800877801
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Reactions 17 Nov 2001 No. 8780114-9954/10/0878-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
