Similar Hypersensitivity Reactions Risk for Both Anticonvulsant Drugs and Tricyclic Antidepressants
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Seizures or convulsion can generally be classified as either "simple" (no change in level of consciousness) or "complex" (change in level of consciousness). Seizures may also be classified as generalized (whole body affected) or focal (only one part or side of the body is affected).Most people think of a seizure as shaking all over and losing control of your body. But there are different kinds of seizures, and all of them are caused by abnormal electrical activity in the brain. Your brain uses electrical signals and if those signals go a little haywire, a person can have a seizure.
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Some people may have only one seizure in their whole life or seizures may recur as part of a condition called epilepsy. People with epilepsy usually need medicine to control their seizures.Epilepsy is a chronic disorder with recurrent seizures.More than half of children with epilepsy whose seizures are controlled by medications can eventually stop their medications and live a seizure-free life. Many adults also can discontinue medication after two or more years without seizures.
Finding the right medication and dosage can be complex. It might take more than one drug, or trying several different drugs until the right one is found. Anti-seizure (anticonvulsant) medications include: phenytoin (Dilantin, Phenytek), carbamazepine (Carbatrol, Tegretol), valproic acid (Depakene), divalproex (Depakote), levetiracetam (Keppra), gabapentin (Neurontin), phenobarbital, ethosuximide (Zarontin), clonazepam (Klonopin), primidone (Mysoline), oxcarbazepine (Trileptal), lamotrigine (Lamictal), topiramate (Topamax), felbamate (Felbatol), tiagabine (Gabitril) and zonisamide (Zonegran).
All of these medications have some side effects, which may include mild fatigue, dizziness and weight gain. More severe side effects include depression, skin rashes, loss of coordination, speech problems and extreme fatigue.
Anticonvulsant hypersensitivity syndrome is an acute, life-threatening, idiosyncratic drug reaction seen with the aromatic antiepileptic drugs, phenytoin, carbamazepine, phenobarbital, and primidone, with frequent cross sensitivity. It usually occurs 2–8 weeks after initiation of therapy and the hallmark clinical features are fever, rash, and lymphadenopathy. Hematologic abnormalities such as eosinophilia, atypical lymphocytes, and internal organ involvement also occur with varying severity. A case of hypersensitivity syndrome due to carbamazepine with cross sensitivity to phenytoin is reported. It is emphasized that this serious drug reaction with diverse clinical presentations should be recognized and treated promptly.
Anticonvulsants can cause a characteristic hypersensitivity reaction. This multisystem reaction typically presents as fever, mucocutaneous eruptions, lymphadenopathy and hepatitis. There is cross-reactivity between different anticonvulsants, which complicates subsequent therapy. We report three cases to illustrate both the typical features, and less common complications, of this under-recognized and life-threatening syndrome.
"Anticonvulsant hypersensitivity syndrome," as doctors call it, is a rare side effect of anti-seizure therapy resulting in fever, rash, hepatitis, and swollen lymph nodes, the authors explain. Other drugs have also been implicated in this syndrome.
Patients who are hypersensitive to anticonvulsant drugs can show similar adverse reactions to older types of antidepressant medications called tricyclic antidepressants, according to a report in the Annals of Allergy, Asthma & Immunology.
In their report, Dr. Axel Trautmann and colleagues from University of Wuerzburg, Germany describe 36 patients with hypersensitivity reactions to the anti-seizure drugs carbamazepine and phenytoin.
Five patients with carbamazepine-induced anticonvulsant hypersensitivity developed similar harmful reactions after taking tricyclic antidepressants, the authors report.
Four experienced moderate hypersensitivity symptoms and one developed severe symptoms.
"We suggest that patients with a history of anticonvulsant hypersensitivity syndrome due to anticonvulsant agents should not receive tricyclic antidepressants," the authors conclude.
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