Phenytoin Toxicity Secondary to an Oxcarbazepine–Phenytoin 2C19 Interaction

Background Polytherapy is common in the management of bipolar disorder, as are the side effects associated with this treatment strategy. Objective The authors review the literature on drug– drug interactions involving oxcarbazepine and identify specific mechanisms that may have clinical importance....

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Bibliographic Details
Published in:Psychosomatics (Washington, D.C.) D.C.), 2010-11, Vol.51 (6), p.532-535
Main Authors: Soskin, David P., M.D, Kane, Ari J., B.A, Stern, Theodore A., M.D
Format: Article
Language:English
Subjects:
Aged
Anticonvulsants - adverse effects
Biological and medical sciences
Bipolar Disorder - drug therapy
Carbamazepine - adverse effects
Carbamazepine - analogs & derivatives
Drug Interactions
Drug toxicity and drugs side effects treatment
Epilepsy - drug therapy
Female
Humans
Internal Medicine
Medical sciences
Miscellaneous (drug allergy, mutagens, teratogens...)
Pharmacology. Drug treatments
Phenytoin - adverse effects
Psychiatry
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Summary:Background Polytherapy is common in the management of bipolar disorder, as are the side effects associated with this treatment strategy. Objective The authors review the literature on drug– drug interactions involving oxcarbazepine and identify specific mechanisms that may have clinical importance. Method The authors provide a case report of a patient who developed phenytoin toxicity associated with an oxcarbazepine–phenytoin interaction. Results Co-administration of phenytoin and oxcarbazepine resulted in toxic levels of phenytoin. Therefore, the patient's daily dosage of oxcarbazepine and phenytoin were reduced. Discussion Although oxcarbazepine is an inducer of the 3A4 isoenzyme, it acts as an inhibitor of the 2C19 isoenzyme, and it can raise levels of other agents, for example, phenytoin, that are also metabolized by this isoenzyme.
ISSN:0033-3182
1545-7206
DOI:10.1016/S0033-3182(10)70749-0