Carbamazepine
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Carbamazepine Cardiac conduction disturbances Three of carbamazepine-induced cardiac conduction disturbances are described. Case I: Two days after beginning carbamazepine 600 mg/daily for pain secondary to polyneuropathy, an 82-year- old woman experienced a syncope during which no peripheral pulse could be felt. No cardiac or chest abnormalities had been detected on admission to hospital. Continuous cardiac monitoring revealed intermitlent total sino-atrial (SA) block with junctional escape rhythm and intermittent asystole. Episodes of total SA block persisted despite reduction of the dose of carbamazepine to 200mg daily and insertion of a demand pacemaker, but disappeared when carbamazepine was stopped. Two days after a provocation test with carbamazepine 600mg daily, cardiac symptoms recurred and the drug was withdrawn. Case 2: A 72-year-old woman with baseline right bundle branch block and left-anterior hemiblock received carbamazepine 200mg daily initially increased to 400 mg/day 3 days later. On day 5 of treatment she experienced a syncope during which there was no detectable pulse. Intermittent total atrioventricular (A V) block with junctional escape rhythm and intermittent asystole were seen on continuous ECG monitoring. Two days after stopping carbamazepine + insertion of a temporary pacemaker, normal sinus rhythm returned. The diagnosis of carbamazepine intoxication was confirmed by a positive provocation test. Carbamazepine was then withdrawn and no more A V-block episodes occurred. The pacemaker was subsequently removed. Case 3: An 86-year-old woman with no previous cardiac complaints and a 5-year history of trigeminal neuralgia treated with carbamazepine 400 mg/day, was admitted to hospital with dizziness. She had experienced a single syncope 2 months before admission. Continuous ECG monitoring showed intermittent SA block with junctional escape rhythm only. Withdrawal of carbamazepine resulted in the disappearance of SA block and dininess. Over the next year there were no recurrences of dizziness or syncope. It is therefore recommended that cardiac function be evaluated in patients (especially the elderly) beginning carbamazepine therapy. Roesen. F. <I al.: Acta Neurologica &andln.vial 68: 49 (lui 1983) 0157-7271/83/1125-0003/0$01.00/0 "ADIS Press Reactions 25 Nov 1983 3
Transcript of Carbamazepine
Carbamazepine
Cardiac conduction disturbances Three ca~es of carbamazepine-induced cardiac conduction disturbances are described. Case I: Two days after beginning carbamazepine 600 mg/daily for pain secondary to polyneuropathy, an 82-yearold woman experienced a syncope during which no peripheral pulse could be felt. No cardiac or chest abnormalities had been detected on admission to hospital. Continuous cardiac monitoring revealed intermitlent total sino-atrial (SA) block with junctional escape rhythm and intermittent asystole. Episodes of total SA block persisted despite reduction of the dose of carbamazepine to 200mg daily and insertion of a demand pacemaker, but disappeared when carbamazepine was stopped. Two days after a provocation test with carbamazepine 600mg daily, cardiac symptoms recurred and the drug was withdrawn. Case 2: A 72-year-old woman with baseline right bundle branch block and left-anterior hemiblock received carbamazepine 200mg daily initially increased to 400 mg/day 3 days later. On day 5 of treatment she experienced a syncope during which there was no detectable pulse. Intermittent total atrioventricular (A V) block with junctional escape rhythm and intermittent asystole were seen on continuous ECG monitoring. Two days after stopping carbamazepine + insertion of a temporary pacemaker, normal sinus rhythm returned. The diagnosis of carbamazepine intoxication was confirmed by a positive provocation test. Carbamazepine was then withdrawn and no more A V-block episodes occurred. The pacemaker was subsequently removed. Case 3: An 86-year-old woman with no previous cardiac complaints and a 5-year history of trigeminal neuralgia treated with carbamazepine 400 mg/day, was admitted to hospital with dizziness. She had experienced a single syncope 2 months before admission. Continuous ECG monitoring showed intermittent SA block with junctional escape rhythm only. Withdrawal of carbamazepine resulted in the disappearance of SA block and dininess. Over the next year there were no recurrences of dizziness or syncope. It is therefore recommended that cardiac function be evaluated in patients (especially the elderly) beginning carbamazepine therapy. Roesen. F. <I al.: Acta Neurologica &andln.vial 68: 49 (lui 1983)
0157-7271/83/1125-0003/0$01.00/0 "ADIS Press Reactions 25 Nov 1983 3
