Carbamazepine
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Reactions 1148 - 21 Apr 2007 S Carbamazepine Elevated liver enzymes during benzodiazepine withdrawal in an elderly patient: case report A 70-year-old woman with panic disorder developed elevated liver enzymes whilst receiving carbamazepine during benzodiazepine withdrawal; carbamazepine was subsequently switched to gabapentin leading to normalisation of liver enzymes and successful withdrawal of benzodiazepine. The woman, who had a history of panic attacks, had a recurrence of these attacks in addition to anxiety and sleep disturbances at the age of 61 years following diagnosis of bilateral glaucoma. She started receiving alprazolam but, 4 years later, she experienced the same symptoms. Mirtazapine was added to her regimen. However, her condition deteriorated and she experienced serious panic attacks and she was admitted to a psychiatric ward 3 weeks later. At this time she was taking unknown quantities of alprazolam. She was admitted to a clinic and benzodiazepine withdrawal was initiated with replacement of alprazolam with diazepam. She also started receiving melperon and carbamazepine 500 mg/day. Despite treatment, she developed a state of delirium with panic attacks, tachycardia, high BP (up to 220/100mm Hg), severe unrest, mood swings, irritability and loss of sense of orientation in time. One week later, she had elevated liver enzymes (glutamate pyruvate transaminase 103 U/L and γ-glutamyl transferase 309 U/L). Carbamazepine was stopped and the woman started receiving gabapentin up to 2100 mg/day. The daily dose of diazepam was tapered very slowly so that she spent almost 3 months as an inpatient. She was recommended to discontinue mirtazapine after a few months, with continued gabapentin treatment. At follow-up, 2 months after discharge, she remained abstinent from benzodiazepines. [Patient outcome not clearly stated.] Himmerich H, et al. Gabapentin treatment in a female patient with panic disorder and adverse effects under carbamazepine during benzodiazepine withdrawal. Psychiatrische Praxis 34: 93-94, No. 2, Mar 2007 [German; summarised from a translation] - Germany 801070658 1 Reactions 21 Apr 2007 No. 1148 0114-9954/10/1148-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine
Reactions 1148 - 21 Apr 2007
SCarbamazepine
Elevated liver enzymes during benzodiazepinewithdrawal in an elderly patient: case report
A 70-year-old woman with panic disorder developedelevated liver enzymes whilst receiving carbamazepine duringbenzodiazepine withdrawal; carbamazepine wassubsequently switched to gabapentin leading to normalisationof liver enzymes and successful withdrawal ofbenzodiazepine.
The woman, who had a history of panic attacks, had arecurrence of these attacks in addition to anxiety and sleepdisturbances at the age of 61 years following diagnosis ofbilateral glaucoma. She started receiving alprazolam but,4 years later, she experienced the same symptoms.Mirtazapine was added to her regimen. However, hercondition deteriorated and she experienced serious panicattacks and she was admitted to a psychiatric ward 3 weekslater. At this time she was taking unknown quantities ofalprazolam. She was admitted to a clinic and benzodiazepinewithdrawal was initiated with replacement of alprazolam withdiazepam. She also started receiving melperon andcarbamazepine 500 mg/day. Despite treatment, she developeda state of delirium with panic attacks, tachycardia, high BP (upto 220/100mm Hg), severe unrest, mood swings, irritabilityand loss of sense of orientation in time. One week later, shehad elevated liver enzymes (glutamate pyruvate transaminase103 U/L and γ-glutamyl transferase 309 U/L).
Carbamazepine was stopped and the woman startedreceiving gabapentin up to 2100 mg/day. The daily dose ofdiazepam was tapered very slowly so that she spent almost3 months as an inpatient. She was recommended todiscontinue mirtazapine after a few months, with continuedgabapentin treatment. At follow-up, 2 months after discharge,she remained abstinent from benzodiazepines. [Patientoutcome not clearly stated.]Himmerich H, et al. Gabapentin treatment in a female patient with panic disorderand adverse effects under carbamazepine during benzodiazepine withdrawal.Psychiatrische Praxis 34: 93-94, No. 2, Mar 2007 [German; summarised from atranslation] - Germany 801070658
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Reactions 21 Apr 2007 No. 11480114-9954/10/1148-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
