Carbamazepine/oxcarbazepine/phenytoin
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Reactions 990 - 28 Feb 2004 Carbamazepine/oxcarbazepine/ phenytoin Hypersensitivity in a child: case report Hypersensitivity to phenytoin, carbamazepine and oxcarbazepine occurred in an 8-year-old boy during treatment of partial seizures. Fifteen days after starting carbamazepine 100mg three times daily, the boy developed generalised pruritus and a maculopapular rash on his trunk, face, limbs, palms and soles. Carbamazepine was discontinued and his rash began to resolve. Two days after stopping carbamazepine, he began anticonvulsant therapy with phenytoin 100 mg/day. Twelve days later, he developed a low-grade fever (37.5°C) and painful bilateral cervical and axillary lymphadenopathy 5–10mm in size. He also had gaze-evoked nystagmus. Fine needle aspiration of the right cervical lymph node showed reactive hyperplasia. At this time, his serum phenytoin level was 22.4 µg/L. Phenytoin was discontinued and the boy began sodium valproate. His fever resolved within 1 week and his lymphadenopathy resolved 15 days later. One month after starting sodium valproate, he experienced a recurrence of partial seizures, so began concomitant oxcarbazepine 75mg twice daily. Four days later, he developed multiple oral mucocutaneous ulcerations. Oxcarbazepine was discontinued and he began gabapentin. His seizures remained well controlled during an 8-month follow-up period and he did not experience any further adverse effects. Author comment: Phenytoin, carbamazepine and oxcarbazepine are all aromatic anticonvulsants. If an anticonvulsant-induced adverse effect occurs, other drugs from the same group should be avoided. Seizures in patients with hypersensitivity to aromatic anticonvulsants are best managed by valproate, benzodiazepines or newer anticonvulsants. Misra UK, et al. Phenytoin and carbamazepine cross reactivity: report of a case and review of literature. Postgraduate Medical Journal 79: 703-704, No. 938, Dec 2003 - India 800970960 1 Reactions 28 Feb 2004 No. 990 0114-9954/10/0990-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
Transcript of Carbamazepine/oxcarbazepine/phenytoin
Reactions 990 - 28 Feb 2004
Carbamazepine/oxcarbazepine/phenytoin
Hypersensitivity in a child: case reportHypersensitivity to phenytoin, carbamazepine and
oxcarbazepine occurred in an 8-year-old boy during treatmentof partial seizures.
Fifteen days after starting carbamazepine 100mg three timesdaily, the boy developed generalised pruritus and amaculopapular rash on his trunk, face, limbs, palms and soles.Carbamazepine was discontinued and his rash began toresolve. Two days after stopping carbamazepine, he begananticonvulsant therapy with phenytoin 100 mg/day. Twelvedays later, he developed a low-grade fever (37.5°C) and painfulbilateral cervical and axillary lymphadenopathy 5–10mm insize. He also had gaze-evoked nystagmus. Fine needleaspiration of the right cervical lymph node showed reactivehyperplasia. At this time, his serum phenytoin level was22.4 µg/L.
Phenytoin was discontinued and the boy began sodiumvalproate. His fever resolved within 1 week and hislymphadenopathy resolved 15 days later. One month afterstarting sodium valproate, he experienced a recurrence ofpartial seizures, so began concomitant oxcarbazepine 75mgtwice daily. Four days later, he developed multiple oralmucocutaneous ulcerations. Oxcarbazepine was discontinuedand he began gabapentin. His seizures remained wellcontrolled during an 8-month follow-up period and he did notexperience any further adverse effects.
Author comment: Phenytoin, carbamazepine andoxcarbazepine are all aromatic anticonvulsants. If ananticonvulsant-induced adverse effect occurs, other drugs fromthe same group should be avoided. Seizures in patients withhypersensitivity to aromatic anticonvulsants are best managedby valproate, benzodiazepines or newer anticonvulsants.Misra UK, et al. Phenytoin and carbamazepine cross reactivity: report of a caseand review of literature. Postgraduate Medical Journal 79: 703-704, No. 938, Dec2003 - India 800970960
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Reactions 28 Feb 2004 No. 9900114-9954/10/0990-0001/$14.95 Adis © 2010 Springer International Publishing AG. All rights reserved
