Carbamazepine
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Reactions 972 - 11 Oct 2003 S Carbamazepine Hypertension and transient neurologic deficits in an elderly patient: case report A 68-year-old man developed severe uncontrolled hypertension and experienced two episodes of transient neurologic deficits while receiving carbamazepine for complex partial seizures. The man, who had a 6-year history of hypertension controlled with atenolol and irbesartan, had previously received long-term treatment with phenytoin for seizure control but had developed decreased coordination and cognitive decline. He started receiving carbamazepine 200mg twice daily with a concomitant decrease in his phenytoin dosage. Prior to starting carbamazepine his BP had been 147/82mm Hg. After 4 days of carbamazepine treatment his BP had increased to 187/95mm Hg, and he had a carbamazepine level of 0.4 µg/mL and a phenytoin level of 11.2 µg/mL. Following adjustment of his antihypertensive medications carbamazepine was titrated to a maximum dose of 1600 mg/day, and his blood levels ranged from 9.3–9.8 µg/mL. He experienced two 5-minute episodes of dysarthria, vertigo and loss of balance during this time; each episode occurred ≥ 6 hours after a carbamazepine dose, with BP readings of 210/104 and 204/122mm Hg. Clonidine, felodipine and doxazosin were added to the man’s antihypertensive treatment and carbamazepine was discontinued. He received several other antiepileptic drugs, but these were not as effective as carbamazepine and it was restarted. With each increase in carbamazepine dosage there was an increase in his BP. Tiagabine with carbamazepine 200 mg/day subsequently provided effective seizure control and his BP was eventually maintained within the normal range with atenolol, irbesartan, felodipine and ramipril. Author comment: "Hypertension developed with a carbamazepine blood level of only 0.4 µg/mL, and the dose- related increase in blood pressure required two additional antihypertensive medications. Thus, these findings suggest a causal relationship between carbamazepine and hypertension." Marini AM, et al. Transient neurologic deficits associated with carbamazepine- induced hypertension. Clinical Neuropharmacology 26: 174-176, No. 4, Jul-Aug 2003 - USA 800952650 1 Reactions 11 Oct 2003 No. 972 0114-9954/10/0972-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
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Transcript of Carbamazepine
Reactions 972 - 11 Oct 2003
SCarbamazepine
Hypertension and transient neurologic deficits in anelderly patient: case report
A 68-year-old man developed severe uncontrolledhypertension and experienced two episodes of transientneurologic deficits while receiving carbamazepine for complexpartial seizures.
The man, who had a 6-year history of hypertensioncontrolled with atenolol and irbesartan, had previouslyreceived long-term treatment with phenytoin for seizurecontrol but had developed decreased coordination andcognitive decline. He started receiving carbamazepine 200mgtwice daily with a concomitant decrease in his phenytoindosage. Prior to starting carbamazepine his BP had been147/82mm Hg. After 4 days of carbamazepine treatment hisBP had increased to 187/95mm Hg, and he had acarbamazepine level of 0.4 µg/mL and a phenytoin level of11.2 µg/mL. Following adjustment of his antihypertensivemedications carbamazepine was titrated to a maximum doseof 1600 mg/day, and his blood levels ranged from9.3–9.8 µg/mL. He experienced two 5-minute episodes ofdysarthria, vertigo and loss of balance during this time; eachepisode occurred ≥ 6 hours after a carbamazepine dose, withBP readings of 210/104 and 204/122mm Hg.
Clonidine, felodipine and doxazosin were added to theman’s antihypertensive treatment and carbamazepine wasdiscontinued. He received several other antiepileptic drugs,but these were not as effective as carbamazepine and it wasrestarted. With each increase in carbamazepine dosage therewas an increase in his BP. Tiagabine with carbamazepine200 mg/day subsequently provided effective seizure controland his BP was eventually maintained within the normal rangewith atenolol, irbesartan, felodipine and ramipril.
Author comment: "Hypertension developed with acarbamazepine blood level of only 0.4 µg/mL, and the dose-related increase in blood pressure required two additionalantihypertensive medications. Thus, these findings suggest acausal relationship between carbamazepine andhypertension."Marini AM, et al. Transient neurologic deficits associated with carbamazepine-induced hypertension. Clinical Neuropharmacology 26: 174-176, No. 4, Jul-Aug2003 - USA 800952650
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Reactions 11 Oct 2003 No. 9720114-9954/10/0972-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
