Reactions 1704, p82 - 2 Jun 2018 O X S Carbamazepine/grapefruit juice interaction Various toxicities: case report A 23-year-old man developed impaired consciousness, restlessness, hypo-peristalsis and inability to defecate secondary to carbamazepine overdose. Additionally, he concomitantly ingested grapefruit juice, which resulted in an increased blood concentration of carbamazepine leading to its toxicity [duration of treatment to reactions onsets not stated]. The man was transported to the emergency department 2 hours following the ingestion of 100 tablets of carbamazepine 100mg (10g total carbamazepine) along with 1L of 100% grapefruit juice. He had a history of epilepsy, for which he was receiving carbamazepine 200 mg/day. On arrival, he showed signs of restlessness and his Glasgow Coma Scale score was 9. His blood carbamazepine level was 41.5 mg/L. His pulse rate was 113 bpm, BP was 117/82mm Hg, temperature was 35.7°C and RR was 20 breaths/min. Hypo-peristalsis was observed on abdominal examination, while auscultation showed normal respiratory and heart sounds. A gastric tube inserted in the man’s stomach showed approximately 600 mL grapefruit juice-like gastric fluid with white tablet residue. Following tracheal intubation, 6L gastric lavage was performed. Mechanical ventilation was initiated and he received propofol infusion. Magnesium citrate and charcoal were administered through the gastric tube, followed by magnesium citrate and activate charcoal administration every 2 hours. However, he was unable to defecate after three doses and metallic sounds were noted in the abdomen. Consequently, charcoal treatment was ceased. He underwent enema, after which he defecated and the metallic sounds subsided. His blood carbamazepine levels remained elevated 12 hours after the ingestion. Therefore, charcoal haemoperfusion was performed for 4 hours. Heparin anticoagulation was administered. His carbamazepine levels decreased to 17.3 mg/L after the haemoperfusion (21 hours after the ingestion). Moreover, 36 hours after the ingestion his carbamazepine levels further decreased to 9.8 mg/L. Treatment with propofol was withdrawn. Tracheal tube was extubated after he regained consciousness. On day 4, his regular oral carbamazepine 200 mg/day was re-initiated. He was discharged on day 9 after a psychiatric consultation, without any sequelae. Author comment: "We report a case with concurrent ingestion of carbamazepine overdose and grapefruit juice." "Grapefruit juice has been reported to increase blood [carbamazepine] concentrations". "[T]he patient had ingested 10 g (167 mg/kg) [carbamazepine] and showed impaired consciousness during his admission." "On arrival,. . .he showed signs of restlessness." "[A]bdominal examination revealed hypoperistalsis." Mochizuki K, et al. Successful treatment of a case with concurrent ingestion of carbamazepine overdose and grapefruit juice. Acute Medicine and Surgery 3: 36-38, No. 1, Jan 2016. Available from: URL: http://doi.org/10.1002/ams2.117 - Japan 803322922 0114-9954/18/1704-0001/$14.95 Adis © 2018 Springer International Publishing AG. All rights reserved Reactions 2 Jun 2018 No. 1704
Reactions Weekly – Springer Journals
Published: Jun 2, 2018
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