Megaloblastic Anaemia in Patients Treated with Diphenylhydantoin and Primidone

Gydell, Karl

doi:10.1159/000205202

Cited by 30 publications

(7 citation statements)

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“…Since this time most authors have supported this possibility, with a majority opinion favouring an intracellular site for the block. In addition, several references in the literature suggest the possibility of competitive inhibition in the absorptive system (Druskin et alii, 1962;Lees, 1961 ;Gydell, 1957 reports on folic acid absorption, or reports on small groups of subjects, have not completely justified the tendency to dismiss the possibility of limited inhibition by anticonvulsants on folate absorption.…”

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confidence: 99%

Studies on Deficiency and Absorption of Folates in Patients on Anticonvulsant Drugs

1967

Australasian Annals of Medicine

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Summary The incidence of macrocytosis and low serum folate levels has been estimated in 115 mental hospital patients on anticonvulsant drug therapy and in 48 mental hospital control patients. Low serum folate levels were found in 36·1% of the patients treated with anticonvulsants. Of the patients on anticonvulsants, 14·6% had red cell macrocytosis, and the incidence of macrocytosis was significantly higher in female than in male patients. The mental hospital patients not on anticonvulsants who were used as controls had mean serum folate values significantly below that of the normal, non‐hospitalized controls. Attention is drawn to the influence of the diet on normal folate ranges, which must be taken into account during their assessment. The fact that a combination of factors is probably necessary to produce a frank megaloblastic change in anticonvulsant‐drug‐treated patients could account for the relative infrequency of megaloblastosis among these patients. It is believed that, in case of anticonvulsant drug therapy, a borderline folate diet often interacts with the mild drug folate inhibition. Folic acid absorption tests, carried out on 19 patients on anticonvulsant therapy with subnormal folate levels, showed slightly decreased absorption values at two hours after the oral test dose but no difference at three hours. The significance of these findings is discussed, and attention is drawn to possible mechanisms of mild malabsorption of folates in patients on anticonvulsant drugs.

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confidence: 99%

Studies on Deficiency and Absorption of Folates in Patients on Anticonvulsant Drugs

1967

Australasian Annals of Medicine

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“…Lindquist (36) demonstrated a positive LE phenomenon following treatment with 5-ethyl-3-methyl-5-phenyl-hydantoin (mesantoin). Chalmers and Boheimer (10) and Gydell (26) found the patient's erythrocytes sensitized by incomplete antibodies (positive direct Coombs test) in two patients with megaloblastic anaemia. Both patients were using phenobarbital and diphenylhydantoin.…”

Section: Haematological Changes Of Allergic Originmentioning

confidence: 99%

Haematological Aspects during Treatment with Anticonvulsant Drugs

Vries

1965

Epilepsia

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SUMMARY The literature comprises many reports on haematological complications during anticonvulsant medication. Systematic haematological surveillance of epileptic patients is considered necessary to prevent these complications. This paper discusses ways and means to ensure maximum efficacy of this surveillance in clinics without a specialized haematological laboratory. A description is also given of methods suitable for supplementing and extending the routine examinations. RÉSUMÉ La littérature comporte de nombreuses observations de complications hématologiques au cours des traitements anticonvulsivants. La surveillance hématologique des épileptiques est done nécessaire pour prévenir ces complications. Ce travail discute les moyens qui assurent une efficacité maximum à pareille surveillance dans les cliniques qui ne comportent pas un laboratoire spécialisé en hématologic Il fournit également une description des méthodes convenables pour compléter et élargir les examens de routine.

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“…Anticonvulsive drugs, specially diphenylhydantoin but even barbiturates, are known to induce megaloblastic anemia (3,9,12). It has been suggested that these drugs interfere with the utilization of folic acid (2, 4, 13).…”

Section: Comments On the Hematological Findingsmentioning

confidence: 99%