Acute Hypersensitivity Syndrome Caused by Valproic Acid: A Review of the Literature and a Case Report

Bota, Robert G.; Ligasan, Allein P; Najdowski, Tom G; Novac, Andrei

doi:10.7812/tpp/10-140

Cited by 16 publications

(10 citation statements)

References 22 publications

(24 reference statements)

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“…Nevertheless, around 30% of patients with epilepsy remain resistant to both mono- and combinatorial AED therapy [ 9 ] [ 10 ] [ 11 ]. Combinatorial therapy of AEDs is not the first option as it may potentiate the occurrence of adverse side effects due to neurotoxicity and/or hepato-toxicity [ 10 ] [ 12 ] [ 13 ] [ 14 ] [ 15 ]. However, it is important to note that side effects have not only been reported for AED combinatorial therapy but also for monotherapy [ 10 ] [ 11 ] [ 13 ] [ 16 ].…”

Section: Introductionmentioning

confidence: 99%

Insights from Zebrafish and Mouse Models on the Activity and Safety of Ar-Turmerone as a Potential Drug Candidate for the Treatment of Epilepsy

et al. 2013

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In a previous study, we uncovered the anticonvulsant properties of turmeric oil and its sesquiterpenoids (ar-turmerone, α-, β-turmerone and α-atlantone) in both zebrafish and mouse models of chemically-induced seizures using pentylenetetrazole (PTZ). In this follow-up study, we aimed at evaluating the anticonvulsant activity of ar-turmerone further. A more in-depth anticonvulsant evaluation of ar-turmerone was therefore carried out in the i.v. PTZ and 6-Hz mouse models. The potential toxic effects of ar-turmerone were evaluated using the beam walking test to assess mouse motor function and balance. In addition, determination of the concentration-time profile of ar-turmerone was carried out for a more extended evaluation of its bioavailability in the mouse brain. Ar-turmerone displayed anticonvulsant properties in both acute seizure models in mice and modulated the expression patterns of two seizure-related genes (c-fos and brain-derived neurotrophic factor [bdnf]) in zebrafish. Importantly, no effects on motor function and balance were observed in mice after treatment with ar-turmerone even after administering a dose 500-fold higher than the effective dose in the 6-Hz model. In addition, quantification of its concentration in mouse brains revealed rapid absorption after i.p. administration, capacity to cross the BBB and long-term brain residence. Hence, our results provide additional information on the anticonvulsant properties of ar-turmerone and support further evaluation towards elucidating its mechanism of action, bioavailability, toxicity and potential clinical application.

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Section: Introductionmentioning

confidence: 99%

Insights from Zebrafish and Mouse Models on the Activity and Safety of Ar-Turmerone as a Potential Drug Candidate for the Treatment of Epilepsy

et al. 2013

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“…Although VPA is classified as a non-aromatic antiepileptic drug and has fewer risks for developing allergic reactions, 21 some reports have suggested cross-reactivity of VPA and aromatic antiepileptic drugs, including CBZ and lamotrigine. 22 – 24 Thus, the current recommendation, where VPA and benzodiazepines are regarded as safe alternatives for patients with allergic reactions to aromatic anticonvulsants, 25 should be re-examined. The present case is a rare instance of allergic responses to multiple psychotropic drugs.…”

Section: Discussionmentioning

confidence: 99%

Allergy to chlorpromazine and valproic acid following carbamazepine hypersensitivity in a patient with an HLA-B*4601 allele

Sakurada¹,

Kozaru²,

Yamada³

et al. 2018

NDT

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A 73-year-old man, exhibiting psychomotor excitement after traumatic brain injury, developed allergic cutaneous eruptions and hepatic inflammation that did not resolve after the cessation of carbamazepine (CBZ). Fusing maculopapular erythema was observed in the face, neck, presternal region, and bilaterally in the forearms and feet. A drug-induced lymphocyte stimulation test revealed hypersensitivity to chlorpromazine (CPZ) and valproic acid (VPA), as well as to CBZ. The allergic reaction with eosinophilia to CPZ and VPA was suspected to have emerged following CBZ hypersensitivity, since previous treatment with CPZ and VPA prior to the introduction of CBZ had not been associated with adverse reactions earlier in the course of treatment. Recent studies have indicated linkages between severe CBZ hypersensitivity – but not mild CBZ hypersensitivity – and specific leukocyte antigens, HLA-B*1502 and HLA-A*3101, in Asian and European populations. The present case exhibited the HLA-B*4601 allele, which is associated with a high relative risk for the development of CBZ-induced maculopapular eruptions in Japanese and Han Chinese populations. Although cross-hypersensitivity among aromatic compounds, including CBZ and CPZ, is well-established, data regarding CBZ allergy-associated hypersensitivity to VPA are limited. In the present case, a cutaneous allergy to mianserin (a tetracyclic antidepressant) was also observed later in the course of treatment, suggesting additional cross-reactivity exists among aromatic psychotropic drugs. Thus, the association between the HLA-B*4601 allele and allergic reactions to VPA, aromatic psychotropic drugs, and CBZ should be further examined in future studies.

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“…Moreover, Arevalo-Lorido et al described a 36-year-old man with AHS caused by VPA two weeks after initial CBZ, which was discontinued because of severe skin rash [12] . Bota et al discussed the case of a 25-year-old woman with bipolar disorder who experienced DRESS caused by valproic acid one month after withdrawal of LTG because of a nonspecific skin rash [13] . Replacement treatment of VPA with other aromatic ASDs may cause DRESS.…”

Section: Discussionmentioning

confidence: 99%

Drug-induced hypersensitivity syndrome caused by valproic acid as a monotherapy for epilepsy: First case report in Asian population

Hong

Suolang

et al. 2017

Epilepsy & Behavior Case Reports

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Valproic acid (VPA) is a broad-spectrum antiseizure drug used for a variety of clinical conditions, such as epilepsy and mood disorders. Drug-induced hypersensitivity syndrome (DRESS) accompanied by hyponatremia, thrombocytopenia, hypoalbuminemia and elevated aminotransferase has never been reported as an adverse effect of VPA monotherapy during titration for epilepsy in Asian population. Hereby, we present the case of a 73-year-old Chinese male who suffered from DRESS and other complications two weeks after initiating VPA treatment for epilepsy. Understanding the risk associated with VPA-induced DRESS, and taking effective measures to avoid the severe side effects are necessary.

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Acute Hypersensitivity Syndrome Caused by Valproic Acid: A Review of the Literature and a Case Report

Cited by 16 publications

References 22 publications

Insights from Zebrafish and Mouse Models on the Activity and Safety of Ar-Turmerone as a Potential Drug Candidate for the Treatment of Epilepsy

Insights from Zebrafish and Mouse Models on the Activity and Safety of Ar-Turmerone as a Potential Drug Candidate for the Treatment of Epilepsy

Allergy to chlorpromazine and valproic acid following carbamazepine hypersensitivity in a patient with an HLA-B*4601 allele

Drug-induced hypersensitivity syndrome caused by valproic acid as a monotherapy for epilepsy: First case report in Asian population

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