Respiratory Disease in Patients with Epilepsy on Single-Drug Therapy with Carbamazepine or Phenobarbital

Gilhus, Nils Erik; Strandjord, R. E.; Aarli, Johan A.

doi:10.1159/000115493

Cited by 11 publications

(5 citation statements)

References 4 publications

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“…The clinical significance oflowered immunoglobulin A, M and G levels is uncertain, although there is some evidence that intake of phenytoin, but not of carbamazepine or phenobarbitone (Gilhus et al 1982), may be associated with an increased risk of recurrent respiratory infections (Aarli & Gilhus 1983). Phenytoin and ethosuximide intake have both been associated with the presence of circulating antinuclear 328 antibodies in occasional patients (Beernink & Miller 1973).…”

Section: Haematological Effectsmentioning

confidence: 99%

The Risk-Benefit Ratio of Anticonvulsant Drugs

Eadie

1987

Medical Toxicology

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The concepts underlying the notion of a risk-benefit ratio for anticonvulsant therapy have determined the development of the drug treatment of epilepsy over many years. The risk element in the ratio arises from the various possible physical and psychological adverse effects of anticonvulsant therapy; the benefit is derived from the capacity of therapy to prevent seizures and thus reduce the disadvantages which result from having epilepsy. The physical adverse effects of anticonvulsant therapy may involve many tissues and organs. The drugs tend to depress cerebral, cerebellar and brain stem function, and may slow peripheral nerve conduction. Prolonged intake may cause hypocalcaemia and osteoporosis, folate depletion, various haematological and immunological abnormalities, and overgrowth of subcutaneous and gingival tissues. Idiopathic reactions may involve the skin, lymph nodes, liver, pancreas, kidney and thyroid, and cause electrolyte disturbances, while maternal anticonvulsant intake during pregnancy may be associated with an increased incidence of fetal malformations. Local reactions may occur at drug administration sites, and anticonvulsants may interact pharmacokinetically and pharmacodynamically with co-administered drugs. The taking of anticonvulsants sometimes has undesirable psychological effects on both the patient and his or her family. Epilepsy itself often results in adverse psychological consequences which emanate from the uncertainty and insecurity that is imposed by the unpredictable occurrence of seizures, from the limitations epilepsy sets on the patient's lifestyle and employment prospects, and from unfavourable community attitudes towards the disorder. Contemporary anticonvulsant therapy is not fully effective in all patients, but to the extent that it can control seizures it may help alleviate these emotional burdens that are a result of epilepsy. The consensus of present day medical opinion is that, in the great majority of clinical situations, the benefits of anticonvulsant therapy outweigh the disadvantages. However, to provide optimal management for individual patients, the risk-benefit ratio of therapy must be repeatedly assessed at all stages of a patient's treatment, and therapeutic decisions taken in the light of the ratio as it applies to the individual.

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Section: Haematological Effectsmentioning

confidence: 99%

The Risk-Benefit Ratio of Anticonvulsant Drugs

Eadie

1987

Medical Toxicology

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“…Individuals with low IgG2 levels have been shown to be at a greater risk of developing infections with several encapsulated bacteria (Siber et al, 1980;Schur, 1987;Plebani et al, 1985). However, even though CBZ reduces IgG2 and other immunoglobulin concentrations in serum, epileptic patients receiving CBZ monotherapy do not have more frequent respiratory tract infections than controls (Gilhus et al, 1982b). This may indicate that the CBZ-induced changes of humoral immune factors are of no major significance for the patient.…”

Section: Discussionmentioning

confidence: 99%

Carbamazepine: Effect on IgG Subclasses in Epileptic Patients

Gilhus

Lea

1988

Epilepsia

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IgG subclass concentrations were determined in sera from 20 epileptic patients before carbamazepine therapy and after 6 weeks of treatment. Subclass-specific monoclonal antibodies were used in an ELISA technique. Carbamazepine reduced the IgG2 concentration in 13 patients, and the mean value fell from 3.21 to 2.47 g/L during the carbamazepine treatment (p less than 0.01). This IgG2 decrease was maintained after 4 and 12 months of carbamazepine therapy. IgG1, IgG3, and IgG4 concentrations did not change. IgG2 deficiency was not seen. The reduction in IgG2 was not related to the carbamazepine serum concentration within the therapeutic range, to the type of epilepsy, or to the age of the patient. The carbamazepine-induced reduction of IgG2 in serum may indicate an altered immune response to certain antigens, preferentially to carbohydrates.

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“…Second, current use of carbamazepine was additionally treated as a reference category for mitigating confounding by indication bias. We chose carbamazepine because it is used as an adjunctive therapy for schizophrenia 34 and an alternative therapy for bipolar disorder, 35 and the drug use at usual dose is not linked with ARF 36 . We did not specify the use of carbamazepine for epilepsy because the drug was mainly used as off‐label, such as agitation 37 .…”

Section: Methodsmentioning

confidence: 99%

“…We chose carbamazepine because it is used as an adjunctive therapy for schizophrenia 34 and an alternative therapy for bipolar disorder, 35 and the drug use at usual dose is not linked with ARF. 36 We did not specify the use of carbamazepine for epilepsy because the drug was mainly used as offlabel, such as agitation. 37 Third, we performed stratified analyses by presence or absence of COPD, asthma and heart failure.…”

Section: Additional Analysesmentioning

confidence: 99%

Use of antipsychotics and the risk of acute respiratory failure among adults: A disease risk score‐matched nested case–control study

Wang

Chen

Tsai

et al. 2020

Brit J Clinical Pharma

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Evidence on acute respiratory failure (ARF) from antipsychotics is scant, and only 1 population-based study examined this drug safety issue in chronic obstructive pulmonary disease patients. Antipsychotics have been frequently prescribed off-label in adults, but whether antipsychotic use carries an increased ARF risk among adult patients is uncertain. Methods: We adopted a nested case-control study analysing 716 493 adults aged ≥20 years, identified from the Taiwan nationwide healthcare claims records between January 2000 and December 2013. Among the study cohort, 7084 adults with ARF and 12,785 disease risk scored-matched randomly selected controls were analysed. Multivariable logistic regression models were employed to estimate odds ratios of ARF with antipsychotic usages. Results: Current, recent, and recent past use of antipsychotics was associated with a 2.33-fold (95% confidence interval [CI] = 2.06-2.64), 1.79-fold (95% CI = 1.43-2.25) and 1.41-fold (95% CI = 1.20-1.66) increased risk of ARF, respectively, compared with nonuse, while antipsychotics discontinued >90 days carried no risk. A dosedependent association was observed with current therapy of antipsychotics (test for trend, P < .001), in which antipsychotic use at >1 defined daily dose yielded the highest risk of 6.53-fold (95% CI = 3.33-12.79). The findings were robust to using carbamazepine as an active comparator. Conclusion: Antipsychotic use was associated with an increased risk of ARF in adult patients. The risk was dose-dependent and markedly higher with current use of antipsychotic agents at doses of 1 defined daily dose and above, <10% of this cohort. Physicians should be vigilant about any respiratory symptoms in patients currently receiving antipsychotics at such dose.

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Respiratory Disease in Patients with Epilepsy on Single-Drug Therapy with Carbamazepine or Phenobarbital

Cited by 11 publications

References 4 publications

The Risk-Benefit Ratio of Anticonvulsant Drugs

The Risk-Benefit Ratio of Anticonvulsant Drugs

Carbamazepine: Effect on IgG Subclasses in Epileptic Patients

Use of antipsychotics and the risk of acute respiratory failure among adults: A disease risk score‐matched nested case–control study

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