Carbamazepine
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Carbamazepine Fever and cholestasis Two patients with fever and hepatic complications which resolved on cessation of carbamazepine are described. Case I was a 48-year-old woman on 200mg carbamazepine tid for myoclonic spasms of the right face, when she began to experience daily afternoon rigors 3 weeks later, accompanied by cold, hot and sweating phases and fleeting myalgia. Other symptoms included lumbar backache, and cramping abdominal pains. On admission 7 months later, temperature was 39.2'C, pulse 120/min, with palpable liver and spleen. On her family doctor's advice she was also on amoxycillin, dextropropoxyphene (proPQxyphene) and paracetamol (acetaminophen) all of which were withdrawn on admission, in addition to carbamazepine, and aspirin substituted Laboratory tests disclosed elevated liver enzymes which returned to normal over a period of 4 weeks follOWing drug withdrawal and the afternoon fever declined to normal over 4 days. Subsequent rechallenge with carbamazepine reprecipitated fever. Case 2 was a 59-year-old woman on 200mg bid carbamazepine for temporal lobe epilepsy, when she suffered fever, rigors and headaches after 14 days. Over the next 10 days, swelling of the face, hands and ankles developed with fever of 38·C. On admission serum ALP, GGT and AST were elevated with fever of 37SC, all of which returned to normal 6 days after carbamazepine withdrawal. Circulating immune complexes were detected in Case 2. The mechanism of action is not clear but the presence of immune complexes seems to sugest an immunological mechanism. Up to November 1980 the Adverse Drug Reactions Advisory Committee had received 19 reports of fever associated with carbamazepine. Sheridan. W,P. et at: Australian and New Zealand Journal of Medicine 12: 520 (Oct 1982) 4 Reactions 14 Jan 1983 0157-7271/83/0114-0004/0$01.00/0 ., ADIS PreSS
Transcript of Carbamazepine
Carbamazepine
Fever and cholestasis Two patients with fever and hepatic complications which resolved on cessation of carbamazepine are described. Case I was a 48-year-old woman on 200mg carbamazepine tid for myoclonic spasms of the right face, when she began to experience daily afternoon rigors 3 weeks later, accompanied by cold, hot and sweating phases and fleeting myalgia. Other symptoms included lumbar backache, and cramping abdominal pains. On admission 7 months later, temperature was 39.2'C, pulse 120/min, with palpable liver and spleen. On her family doctor's advice she was also on amoxycillin, dextropropoxyphene (proPQxyphene) and paracetamol (acetaminophen) all of which
were withdrawn on admission, in addition to carbamazepine, and aspirin substituted Laboratory tests disclosed elevated liver enzymes which returned to normal over a period of 4 weeks follOWing drug withdrawal and the afternoon fever declined to normal over 4 days. Subsequent rechallenge with carbamazepine reprecipitated fever. Case 2 was a 59-year-old woman on 200mg bid carbamazepine for temporal lobe epilepsy, when she suffered fever, rigors and headaches after 14 days. Over the next 10 days, swelling of the face, hands and ankles developed with fever of 38·C. On admission serum ALP, GGT and AST were elevated with fever of 37SC, all of which returned to normal 6 days after carbamazepine withdrawal. Circulating immune complexes were detected in Case 2. The mechanism of action is not clear but the presence of immune complexes seems to sugest an immunological mechanism. Up to November 1980 the Adverse Drug Reactions Advisory Committee had received 19 reports of fever associated with carbamazepine. Sheridan. W,P. et at: Australian and New Zealand Journal of Medicine 12: 520 (Oct 1982)
4 Reactions 14 Jan 1983 0157-7271/83/0114-0004/0$01.00/0 ., ADIS PreSS
