Wednesday, April 8, 2015

Hematological ADR to Antiepileptics


  • Most common antiepileptic causing neutropenia and/or agranulocytosis are : Carbamazepine (boxed warning), phenytoin, Phenobarbital, Valproate
  • Other agents are such as below:
Carbamazepine
Agranulocytosis, leukopenia, thrombocytopenia, pancytopenia, leukocytosis
Phenytoin
Agranulocytosis, leukopenia, thrombocytopenia, pancytopenia, granulocytopenia
Phenobarbitone
Agranulocytosis, megaloblastic anaemia, thrombocytopenia
Valproate
Thrombocytopenia (1-24%)
<1% leukopenia, pancytopenia, leukocytosis
Lamotrignine
<1%  aplastic anemia,  leukopenia, neutropenia, pancytopenia, thrombocytopenia
Levetiracetam
8% eosinophilia (4-16 years)
3% decreased WBC count
<1% pancytopenia (bone marrow suppression)

Management:
  • Monitor for blood dyscrasias (routine lab investigations and/or inform patient to watch for fever, sore throat, rash, etc)
  • Intense monitoring for high risk patients during the first 3 months of treatment
  • Frequency depends on the results of each lab values
  • discontinuation of therapy is usually not indicated unless symptoms are severe, persistent, or accompanied by infection.
  • Leukopenia often reverses, even if carbamazepine treatment is continued.
  • A severe risk of infection exists when the patient's neutrophil count falls below 500 mm
References:
  1. www.lexicomp.com
  2. Careful Monitoring for Agranulocytosis During Carbamazepine Treatment. http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1764526/

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