Carbamazepine
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Reactions 726 - 7 Nov 1998 Carbamazepine Skin rash, leucopenia and thrombocytopenia in elderly patients: 2 case reports Two patients experienced carbamazepine-induced skin rash and blood dyscrasias during treatment with this agent for bipolar disorder. The first patient, a 66-year-old man, experienced no adverse effects after his dosage of carbamazepine was slowly titrated to 500 mg/day (plasma carbamazepine concentration of 4.1 µg/ml). On treatment day 35, his carbamazepine dosage was increased to 300mg twice daily, and the following day he developed a generalised rash with pruritus and erythema. Since 1 of his concomitant medications, furosemide, was considered to be the cause of the rash, this was stopped. However, the man’s rash worsened. On treatment day 39 it was noted that his WBC count had decreased from a baseline level of 5.3 × 10 3 /mm 3 to 2.8 × 10 3 /mm 3 . Two days later, carbamazepine was discontinued and the patient’s rash improved markedly over the next few days. Two weeks later, his WBC count had returned to the baseline level. The second patient, a 69-year-old woman, was treated with carbamazepine 200mg twice daily, resulting in a plasma concentration of 5 µg/ml. On treatment day 46, she noted a mild rash on her arms and legs and by day 65, this had developed into a generalised macular rash with pruritus and erythema. Eight days later, the patient’s carbamazepine dosage was increased to 200mg 3 times daily, with a resultant plasma concentration of 7.4 µg/ml. Six days later, a routine laboratory test showed that her WBC count had decreased from a baseline level of 6.8 × 10 3 /mm 3 with 68% granulocytes to 2 × 10 3 /mm 3 with 23% granulocytes. Her platelet count had decreased from 218 ×10 3 /mm 3 to 36 × 10 3 /mm 3 . Carbamazepine was stopped. When the patient was discharged 41 days later, her rash had resolved, her WBC count had returned to the baseline level and her platelet count had improved, but had not returned to the baseline level. Author comment: ‘Further study is required to establish whether carbamazepine-induced concomitant rashes and blood dyscrasias are truly meaningful associations insofar as monitoring is concerned.’ Cates M, et al. Concomitant rash and blood dyscrasias in geriatric psychiatry patients treated with carbamazepine. Annals of Pharmacotherapy 32: 884-887, Sep 1998 - USA 800711535 1 Reactions 7 Nov 1998 No. 726 0114-9954/10/0726-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine
Reactions 726 - 7 Nov 1998
Carbamazepine
Skin rash, leucopenia and thrombocytopenia inelderly patients: 2 case reports
Two patients experienced carbamazepine-induced skin rashand blood dyscrasias during treatment with this agent forbipolar disorder.
The first patient, a 66-year-old man, experienced no adverseeffects after his dosage of carbamazepine was slowly titratedto 500 mg/day (plasma carbamazepine concentration of 4.1µg/ml). On treatment day 35, his carbamazepine dosage wasincreased to 300mg twice daily, and the following day hedeveloped a generalised rash with pruritus and erythema.
Since 1 of his concomitant medications, furosemide, wasconsidered to be the cause of the rash, this was stopped.However, the man’s rash worsened. On treatment day 39 itwas noted that his WBC count had decreased from a baselinelevel of 5.3 × 103/mm3 to 2.8 × 103/mm3. Two days later,carbamazepine was discontinued and the patient’s rashimproved markedly over the next few days. Two weeks later,his WBC count had returned to the baseline level.
The second patient, a 69-year-old woman, was treated withcarbamazepine 200mg twice daily, resulting in a plasmaconcentration of 5 µg/ml. On treatment day 46, she noted amild rash on her arms and legs and by day 65, this haddeveloped into a generalised macular rash with pruritus anderythema.
Eight days later, the patient’s carbamazepine dosage wasincreased to 200mg 3 times daily, with a resultant plasmaconcentration of 7.4 µg/ml. Six days later, a routine laboratorytest showed that her WBC count had decreased from abaseline level of 6.8 × 103/mm3 with 68% granulocytes to 2 ×103/mm3 with 23% granulocytes. Her platelet count haddecreased from 218 ×103/mm3 to 36 × 103/mm3.Carbamazepine was stopped.
When the patient was discharged 41 days later, her rash hadresolved, her WBC count had returned to the baseline leveland her platelet count had improved, but had not returned tothe baseline level.
Author comment: ‘Further study is required to establishwhether carbamazepine-induced concomitant rashes andblood dyscrasias are truly meaningful associations insofar asmonitoring is concerned.’Cates M, et al. Concomitant rash and blood dyscrasias in geriatric psychiatrypatients treated with carbamazepine. Annals of Pharmacotherapy 32: 884-887, Sep1998 - USA 800711535
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Reactions 7 Nov 1998 No. 7260114-9954/10/0726-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
