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Background:
Severe hyponatremia is rare when carbamazepine is used as monotherapy. It is common to encounter this imbalance in the hospital setting, but rare in the ambulatory one. Here, we present a case of hyponatremia secondary to carbamazepine use in an otherwise asymptomatic patient.
Case presentation:
A 44-year-old Guatemalan woman present...
Contexts in source publication
Context 1
... limits (blood pressure of 118/ 64 mmHg; heart rate of 75/minute; respiratory rate of 14 beats/minute; temperature at 98.9 °Fahrenheit). Our pa- tient was on day 12 of her menstrual cycle. A physical examination revealed mild facial edema, multiple port-wine stains on her upper and lower extremities as- sociated with mild hypertrophy of the calves (Fig. 1), more prominent on the right side with mild edema, the rest of the physical examination was non-contributory. Imaging and routine blood studies were requested. Our patient was seen the next day at the office with the labora- tory results (Table ...
Context 2
... 44-year-old Guatemalan woman presented to our out- patient clinic with a chief complaint of left knee pain for the last 6 months. One month prior our patient had consulted with an outside physician, who prescribed her with 300 mg of carbamazepine, 5 mg of prednisone every 24 hours, and ibuprofen every 8 hours as needed. The symptoms did not resolve and our patient increased the dose to 600 mg of carbamazepine and 20 mg of prednisone 7 days before consulting. She suddenly inter- rupted prednisone 3 days before consulting, because she felt this was making her pain worse. At the consultation, our patient complained of left knee pain, fatigue, and bilateral lower limb cramps. No pertinent medical, surgical, allergic, family, and psychosocial history was recorded and her vital signs were within normal limits (blood pressure of 118/ 64 mmHg; heart rate of 75/minute; respiratory rate of 14 beats/minute; temperature at 98.9 °Fahrenheit). Our pa- tient was on day 12 of her menstrual cycle. A physical examination revealed mild facial edema, multiple port-wine stains on her upper and lower extremities as- sociated with mild hypertrophy of the calves (Fig. 1), more prominent on the right side with mild edema, the rest of the physical examination was non-contributory. Imaging and routine blood studies were requested. Our patient was seen the next day at the office with the labora- tory results (Table ...
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Klippel Trenaunay syndrome (KTS) is a complex congenital malformation that may affect the lower or upper extremities or, less commonly, involve the trunk, head, or neck. The three main components of KTS are varicosities and venous malformations (VMs), capillary malformations (port-wine stains), and hypertrophy of the soft tissue and bone. Managemen...
Citations
... Of additional notice, although CBZ is safe and effective in anti-convulsant activities, the unwanted events following CBZ treatment, such as hyponatremia, QT-interval prolongation, hyperprolactinemia, change in pitch perception and idiosyncratic reactions, have gradually emerged [5,[11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28]. The effectiveness of CBZ in inhibiting the activity of ATP-sensitive K + (KATP) channels has also been demonstrated [29,30]. ...
... CBZ has been increasingly demonstrated to cause hyponatremia, which mimics the syndrome of inappropriate antidiuretic hormone secretion [11][12][13][14][15][16][18][19][20][21][22][23][24]27]. Esaxerenone, known to be a nonsteroidal mineralocorticoid receptor blocker, was demonstrated to modify the magnitude and gating of INa [38], while sparsentan, a dual antagonist of endothelial type A receptor and angiotensin II receptor, could suppress INa [41]. ...
Carbamazepine (CBZ, Tegretol®) is an anticonvulsant used in the treatment of epilepsy and neuropathic pain; however, several unwanted effects of this drug have been noticed. Therefore, the regulatory actions of CBZ on ionic currents in electrically excitable cells need to be reappraised, although its efficacy in suppressing voltage-gated Na+ current (INa) has been disclosed. This study was undertaken to explore the modifications produced by CBZ on ionic currents (e.g., INa and erg-mediated K+ current [IK(erg)]) measured from Neuro-2a (N2a) cells. In these cells, we found that this drug differentially suppressed the peak (transient, INa(T)) and sustained (late, INa(L)) components of INa in a concentration-dependent manner with effective IC50 of 56 and 18 μM, respectively. The overall current–voltage relationship of INa(T) with or without the addition of CBZ remained unchanged; however, the strength (i.e., ∆area) in the window component of INa (INa(W)) evoked by the short ascending ramp pulse (Vramp) was overly lessened in the CBZ presence. Tefluthrin (Tef), a synthetic pyrethroid, known to stimulate INa, augmented the strength of the voltage-dependent hysteresis (Hys(V)) of persistent INa (INa(P)) in response to the isosceles-triangular Vramp; moreover, further application of CBZ attenuated Tef-mediated accentuation of INa(P)’s Hys(V). With a two-step voltage protocol, the recovery of INa(T) inactivation seen in Neuro-2a cells became progressively slowed by adding CBZ; however, the cumulative inhibition of INa(T) evoked by pulse train stimulation was enhanced during exposure to this drug. Neuro-2a-cell exposure to CBZ (100 μM), the magnitude of erg-mediated K+ current measured throughout the entire voltage-clamp steps applied was mildly inhibited. The docking results regarding the interaction of CBZ and voltage-gate Na+ (NaV) channel predicted the ability of CBZ to bind to some amino-acid residues in NaV due to the existence of a hydrogen bond or hydrophobic contact. It is conceivable from the current investigations that the INa (INa(T), INa(L), INa(W), and INa(P)) residing in Neuro-2a cells are susceptible to being suppressed by CBZ, and that its block on INa(L) is larger than that on INa(T). Collectively, the magnitude and gating of NaV channels produced by the CBZ presence might have an impact on its anticonvulsant and analgesic effects occurring in vivo.
... However, in addition to gender and weight, we also demonstrated that co-medication with carbamazepine determines the Vd/F. We suggest that hyponatremia, a well-known adverse effect of carbamazepine [54][55][56][57][58][59], may be involved in this drug-drug interaction. Briefly, the increased secretion of the antidiuretic hormone due to carbamazepine stimulation may lead to the syndrome of inappropriate antidiuretic hormone secretion. ...
Levetiracetam is a second-generation antiepileptic drug, widely used in the treatment of focal and generalized epilepsy due to its pharmacokinetic and safety profiles. Its pharmacokinetic monitoring is ascribed as useful to personalize its dosing regimen. The aim of the present study was to describe, for the first time, the pharmacokinetics of levetiracetam in Portuguese refractory epileptic patients. Therefore, a retrospective study was carried out on 65 Portuguese refractory epileptic patients (pharmacokinetic study: 48; validation study: 17) admitted to the Refractory Epilepsy Centre of the Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal. The pharmacokinetic parameters of levetiracetam were estimated by applying a one-compartment model with first-order absorption and elimination analysis. Male patients showed higher distribution volume (Vd/F) and oral clearance (CL/F) than female patients (median Vd/F: 52.40 L in males and 38.60 L in females, p = 0.011; median CL/F: 4.71 L/h in males and 3.91 L/h in females, p = 0.028). Higher values of Vd/F (p = 0.026) and CL/F (p = 0.003) were also found in overweight patients relative to normal weight and obese patients. Carbamazepine was the co-administered antiepileptic drug that mostly affected the pharmacokinetics of levetiracetam, increasing both Vd/F (61.30 L with carbamazepine and 39.10 L without carbamazepine, p = 0.007) and CL/F (6.71 L/h with carbamazepine and 3.91 L/h without carbamazepine, p < 0.001). The pharmacokinetics of levetiracetam was affected by gender, body mass index, and co-administration of carbamazepine. This study highlights the impact of several factors on the CL/ and Vd/F of levetiracetam when administered to refractory epileptic patients. The importance of its pharmacokinetic monitoring in clinical pharmacy stands out, thereby enabling the optimization of antiepileptic drug therapy.
Side Effects of Drugs Annual is an annual publication including the most recently published adverse effects and toxicities associated with antiepileptic medications. The series supplements the contents of Meyler's Side Effects of Drugs: The International Encyclopedia of Adverse Drug Reactions and Interactions. This is a review of current literature published between January 2018 and December 2018 including any publications regarding antiepileptic agents, specifically focusing on the following medications: clobazam, clonazepam, clorazepate, diazepam, lorazepam, phenobarbital, primidone, tiagabine, vigabatrin, gabapentin, pregabalin, valproic acid, carbamazepine, oxcarbazepine, eslicarbazepine acetate, lacosamide, zonisamide, lamotrigine, phenytoin, topiramate, felbamate, perampanel, ezogabine, levetiracetam, brivaracetam, ethosuximide, and rufinamide. There is an additional special review on studies that included multiple anticonvulsant agents.
