Carbamazepine/fluvoxamine
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Reactions 602 - 25 May 1996 Carbamazepine/fluvoxamine Oedema and stroke: case report A 27-year-old man developed oedema and had signs of a stroke during therapy with carbamazepine and fluvoxamine for a psychotic disorder. The patient’s treatment included fluvoxamine at a dosage that was increased to 300 mg/day, carbamazepine 200mg twice daily, zuclopenthixol, temazepam and procyclidine. A few days after he started the full dose of fluvoxamine and several weeks after he started carbamazepine therapy, he developed pitting oedema from his ankle to his mid-calf. In addition, he became acutely breathless after minimal exertion. A few days later, the man developed a left-sided weakness with paraesthesia and drooping of the left side of his face. His serum carbamazepine concentration was elevated at 58 µmol/L (normal 17–42). Further examination revealed that the man had impaired sensation to light touch and pin-prick over the left side of his face and leg. He found it difficult to walk. The patient was treated with aspirin for a possible stroke. All other medications were stopped and he was maintained on a small dose of chlorpromazine for his agitation. The man’s oedema disappeared over the next few days and his symptoms of stroke resolved over the next 2 weeks. Zuclopenthixol was reintroduced in small doses, with no adverse effects, however, the patient’s oedema returned within a day after he restarted fluvoxamine. His oedema resolved when fluvoxamine was discontinued. Author comment: ‘There are three possibilities for the cause of the oedema and stroke: 1) the patient had a vascular episode of some sort due to a cardiac problem, which would also explain the oedema; 2) he experienced a toxic reaction to carbamazepine; or 3) he had an idiosyncratic reaction to fluvoxamine.’ Clark JE, et al. Oedema and signs of stroke in a patient receiving carbamazepine and fluvoxamine. Journal of Drug Development and Clinical Practice 8: 35-38, Apr 1996 - Scotland 800438044 1 Reactions 25 May 1996 No. 602 0114-9954/10/0602-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine/fluvoxamine
Reactions 602 - 25 May 1996
Carbamazepine/fluvoxamine
Oedema and stroke: case reportA 27-year-old man developed oedema and had signs of a
stroke during therapy with carbamazepine and fluvoxamine fora psychotic disorder.
The patient’s treatment included fluvoxamine at a dosagethat was increased to 300 mg/day, carbamazepine 200mgtwice daily, zuclopenthixol, temazepam and procyclidine. Afew days after he started the full dose of fluvoxamine andseveral weeks after he started carbamazepine therapy, hedeveloped pitting oedema from his ankle to his mid-calf. Inaddition, he became acutely breathless after minimal exertion.
A few days later, the man developed a left-sided weaknesswith paraesthesia and drooping of the left side of his face. Hisserum carbamazepine concentration was elevated at 58µmol/L (normal 17–42).
Further examination revealed that the man had impairedsensation to light touch and pin-prick over the left side of hisface and leg. He found it difficult to walk. The patient wastreated with aspirin for a possible stroke. All other medicationswere stopped and he was maintained on a small dose ofchlorpromazine for his agitation.
The man’s oedema disappeared over the next few days andhis symptoms of stroke resolved over the next 2 weeks.Zuclopenthixol was reintroduced in small doses, with noadverse effects, however, the patient’s oedema returnedwithin a day after he restarted fluvoxamine. His oedemaresolved when fluvoxamine was discontinued.
Author comment: ‘There are three possibilities for the causeof the oedema and stroke: 1) the patient had a vascular episodeof some sort due to a cardiac problem, which would alsoexplain the oedema; 2) he experienced a toxic reaction tocarbamazepine; or 3) he had an idiosyncratic reaction tofluvoxamine.’Clark JE, et al. Oedema and signs of stroke in a patient receiving carbamazepineand fluvoxamine. Journal of Drug Development and Clinical Practice 8: 35-38,Apr 1996 - Scotland 800438044
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Reactions 25 May 1996 No. 6020114-9954/10/0602-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
