Archive for the ‘Antiepileptics’ Category

Adverse effects of antiepileptics: DESENSITIZATION

Oct 3, 2012 Author: Walter Mcneil | Filed under: Antiepileptics

Desensitization has been attempted following carbamazepine skin rash (Table 2). Because of a risk of a severe reaction, desensitization should only be undertaken in selected cases, where there are no other satisfactory alternatives. Five patients with previous severe skin reactions to carbamazepine were desensitized starting with a dose of 2.5mg/day of carba-mazepineplusan antihistamine. The dose was doubled every three days. If the rash reappeared during the desensitization, the dose was decreased to its previous level for six days before being increased again . It should be noted that concomitant antihistamine use during any desensitization protocol is generally not recommended because symptoms (eg, urticaria) may be masked. buy ampicillin



Slow upwarddosagetitration to the lowest effectivedosageis recommended when a new drug is initiated (Table 1). In addition, whenever possible, monotherapy using the lowest effective dose is advocated to manage dose-related toxicity.

High peak drug concentrations can also be responsible for some of the dose-related adverse effects that are observed. For example, patients taking carbamazepine may experience acute eye movement disturbances 3 to 5 h after an afternoon dose, coinciding with peak carbamazepine concentrations. Separating the doses of carbamazepine by6hor switching the patient to a controlled-release preparation may help to decrease some dose-related adverse effects. buy prednisone


Adverse effects of antiepileptics: LYMPHADENOPATHY

Oct 1, 2012 Author: Walter Mcneil | Filed under: Antiepileptics


Although some clinicians have used the term pseudolymphoma interchangeably with anticonvulsant HSR, pseudolymphoma applies only to patients who have both clinical and histological features suggestive of lymphoma. It is not considered a premalignant state. The syndrome occurs after one week to two years of exposure to the drug . Within seven to 14 days of drug discontinuation, the symptoms generally resolve. Management of drug-induced pseudolymphoma often involves no treatment other than withdrawal of the offending agent. Long term follow-up is necessary to rule out the possibility of pseudopseudolymphoma.


Adverse effects of antiepileptics: PULMONARY ADVERSE EFFECTS

Sep 30, 2012 Author: Walter Mcneil | Filed under: Antiepileptics

Numerous pulmonary effects with phenytoin use have been reported, including acute interstitial pneumonitis, pulmonary fibrosis, abnormal pulmonary function and acute respiratory failure with pulmonary eosinophilia. In the latter case, a patient presented with fever, diffuse bronchial wheezing and both peripheral and sputum eosinophilia. Her course was complicated by acute respiratory failure requiring mechanical ventilation, acute renal failure and hepatic failure. An inadvertent rechallenge exacerbated the symptoms . Pulmonary involvement may also be part of the anticonvulsant HSR associated with phenytoin or carbamazepine. For example, a six-year-old boy developed TEN two weeks after starting phenytoin therapy. Early in the course of his illness, he developed acute respiratory failure, which appeared clinically to be adult respiratory distress syndrome.


Adverse effects of antiepileptics: NEUROLOGICAL DISTURBANCES(4)

Sep 29, 2012 Author: Walter Mcneil | Filed under: Antiepileptics


Psychiatric disturbances, including aggression and psychosis, have been reported in patients treated with vigabatrin. Psychotic symptoms may be more common in patients who experience higher levels of seizure control, who receive higher doses and who have a history of psychiatric illness. Rebound seizures and psychiatric symptoms have also been reported after abrupt discontinuation of vigabatrin . It is recommended that a low starting dosage and a slow dosage escalation be used to minimize the behavioural toxicity of this anticonvulsant . Changes in mood and affect have also been reported in conjunction with gabapentin .


Adverse effects of antiepileptics: NEUROLOGICAL DISTURBANCES(3)

Sep 28, 2012 Author: Walter Mcneil | Filed under: Antiepileptics

Several anticonvulsants have been shown to produce cognitive impairment by affecting specific functions such as attention, concentration, memory and motor speed . In children, this effect can be destructive, leading to impairment of learning abilities. The major offenders are the barbiturates, followed by clonazepam . Adverse cognitive effects of anticonvulsantĀ  canada drugs are dose related. For example, high serum levels of carbamazepine and valproic acid are associated with impairment in adults, although, at therapeutic levels, there is minimal dysfunction . In another study, carba-mazepine, and especially phenytoin, diminished the normal learning effect in various neuropsychological tests and tasks . In contrast, a study done in children who received car-bamazepine monotherapy found a dose-related beneficial effect upon reaction time (ie, children with higher serum levels had faster responses and fewer omission errors) . Etho-suximide was also linked to a decline in higher cognitive function in early reports; however, more recent studies have refuted the earlier reports and found improvement in performance and in higher verbal and full-scale intelligence quotients in children treated with ethosuximide. Choose a perfect online pharmacy to get Purchase Cheap Claritin and treat your health issue.


Adverse effects of antiepileptics: NEUROLOGICAL DISTURBANCES(2)

Sep 27, 2012 Author: Walter Mcneil | Filed under: Antiepileptics

Neurotoxicity is the most common adverse effect associated with the benzodiazepines. Clobazam, a 1,5-benzodiazepine, is associated with less neurotoxicity than the 1,4-benzodiazepines (eg, nitrazepam or clonazepam) . In a study of 115 children, patients who discontinued a 1,4 benzodiazepine and who were started on clobazam showed a significant improvement in alertness. Nonetheless, one trial found that adverse effects were reported by 32% of patients on clobazam, leading to discontinuation in 9%.


Adverse effects of antiepileptics: NEUROLOGICAL DISTURBANCES(1)

Sep 26, 2012 Author: Walter Mcneil | Filed under: Antiepileptics


Headache is a common complaint of patients on anticonvulsant therapy, although some anticonvulsants such as valproic acid and gabapentin are used in migraine prophylaxis. Carbamazepine and ethosuximide are more frequently associated with this side effect than other anticonvulsants.

Dose-related tremor occurs in 10% of adults and 15% of children on valproic acid. This tremor is rhythmic, rapid, symmetrical and most prominent in the upper extremities. Low doses of propranolol may reduce the tremor ; however, dose reduction is the preferred approach.




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