The Association Between Carbamazepine and Valproate and Adverse Cutaneous Drug Reactions in Patients With Bipolar Disorder

Abstract

Our study suggests that carbamazepine and valproate as well increase the risk for EM, SJS, or TEN. We should be especially cautious about the combined use of carbamazepine and acetaminophen.

Valproate-Induced Reversible Brain Atrophy and Cognitive Deterioration

“…Four types of valproate-induced encephalopathy are described: 1) Direct toxic encephalopathy; 2) hyperammonemic encephalopathy; 3) hepatic encephalopathy; and 4) encephalopathy with cognitive deterioration and reversible cerebral atrophy. Brain pseudoatrophy and mental regression while taking valproate is reported in a child with a rare mitochondrial DNA mutation [1]. The current and 5 previously reported cases support a role of VPA in triggering a reversible dose-dependent mental deterioration with brain pseudoatrophy in children with epileptic seizures.…”

“…MTHFR may also occur in adults, presenting as hereditary spastic paraplegia. Two unrelated families, each with 2 affected siblings, are reported from Hadassah Medical College, Jerusalem [1]. Treatment aims are normalization of plasma and CSF methionine levels and reduced homocysteinemia.…”

“…Anticonvulsants in addition to phenytoin with increased risk of erythema multiforme, Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) include carbamazepine, oxcarbazepine, valproate, phenobarbital, and lamotrigine. The combination of carbamazepine and acetaminophen further increases the risk of hypersensitivity skin reactions [1]. Erythema multiforme as a synergistic side effect to a combination of phenytoin therapy and cranial radiotherapy is also reported [2].…”

Clinical characteristics and causes of erythema exsudativum multiforme, Stevens-Johnson syndrome and toxic epidermal necrolysis

“…A provokáló gyógyszerek közül a carbamazepin TEN-t (és SJS-t) kiváltó hatását számos korábbi vizsgálat megerôsítette, a kórkép egyik leggyakoribb kiváltó oka, az EuroSCAR tanulmány során is a magas kockázatú csoportba került (23,24). A hatból egy beteg ismert SLE-je, illetve egy betegnek metasztatikus carcinomája volt.…”

“…A hatból egy beteg ismert SLE-je, illetve egy betegnek metasztatikus carcinomája volt. Ezen állapotok ismert hajlamosító tényezôk a TEN kialakulására (2,24).…”