The effect of multidrug exposure on neurological manifestations in carbamazepine intoxication: a nested case-control study
Abstract Background In acute intoxication, carbamazepine concentration above 40 mcg/ml is associated with a risk of severe neurological consequences, including depressed consciousness, respiratory depression, cardiac conduction disorders, seizures, and death. Carbamazepine intoxication is often asso...
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| Format: | Article |
| Language: | English |
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BMC
2020-06-01
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| Series: | BMC Pharmacology and Toxicology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s40360-020-00425-2 |
| _version_ | 1818127596354797568 |
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| author | Ayala Hirsch Maor Wanounou Amichai Perlman Bruria Hirsh-Raccah Mordechai Muszkat |
| author_facet | Ayala Hirsch Maor Wanounou Amichai Perlman Bruria Hirsh-Raccah Mordechai Muszkat |
| author_sort | Ayala Hirsch |
| collection | DOAJ |
| description | Abstract Background In acute intoxication, carbamazepine concentration above 40 mcg/ml is associated with a risk of severe neurological consequences, including depressed consciousness, respiratory depression, cardiac conduction disorders, seizures, and death. Carbamazepine intoxication is often associated with the use of concomitant medications. However, the effect of exposure to other central-nervous-system (CNS) acting medications on the neurological manifestations of carbamazepine toxicity has not been evaluated. Objective To examine the effect of exposure to CNS-acting medications on the neurological effects of carbamazepine toxicity. Methods A retrospective nested case-control study of all patients > 18 years of age, with at least one test of carbamazepine levels > 18 mcg/ml recorded at the Hadassah Hospital Central Laboratory, between the years 2004–2016. Sociodemographic and clinical data were collected from the computerized medical records, and the characteristics of patients with and without severe neurological symptoms of carbamazepine intoxication were compared. Results Eighty patients were identified. In bivariate analyses, the odds of severe neurological symptoms was higher in patients with antidepressants use (odds ratio 8.7, 95% confidence interval: 1.8–41.2, p = 0.007), benzodiazepines use (8.6, 2.0–37.1, p = 0.004), and carbamazepine concentration above 30 mcg/ml (8.1, 1.9–33.3, p = 0.004). Multivariate models demonstrated that antidepressants and benzodiazepines were associated with severe neurological manifestations during carbamazepine intoxication, independently of carbamazepine concentration over 30 mcg/ml. ICU admission was associated in multivariate analysis with antidepressants (but not benzodiazepines) use, and with carbamazepine levels > 30 mcg/ml. Conclusions Among patients with carbamazepine intoxication, severe neurological symptoms are associated with exposure to benzodiazepines or antidepressants and with carbamazepine levels higher than 30 mcg/ml. |
| first_indexed | 2024-12-11T07:19:52Z |
| format | Article |
| id | doaj.art-557f96ab068b4c38b67c8d2f84d3833c |
| institution | Directory Open Access Journal |
| issn | 2050-6511 |
| language | English |
| last_indexed | 2024-12-11T07:19:52Z |
| publishDate | 2020-06-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pharmacology and Toxicology |
| spelling | doaj.art-557f96ab068b4c38b67c8d2f84d3833c2022-12-22T01:16:07ZengBMCBMC Pharmacology and Toxicology2050-65112020-06-012111810.1186/s40360-020-00425-2The effect of multidrug exposure on neurological manifestations in carbamazepine intoxication: a nested case-control studyAyala Hirsch0Maor Wanounou1Amichai Perlman2Bruria Hirsh-Raccah3Mordechai Muszkat4Department of Internal Medicine, Hadassah-Hebrew University Medical SchoolDepartment of Internal Medicine, Hadassah-Hebrew University Medical SchoolDepartment of Internal Medicine, Hadassah-Hebrew University Medical SchoolDepartment of Cardiology, Hadassah-Hebrew University Medical SchoolDepartment of Internal Medicine, Hadassah-Hebrew University Medical SchoolAbstract Background In acute intoxication, carbamazepine concentration above 40 mcg/ml is associated with a risk of severe neurological consequences, including depressed consciousness, respiratory depression, cardiac conduction disorders, seizures, and death. Carbamazepine intoxication is often associated with the use of concomitant medications. However, the effect of exposure to other central-nervous-system (CNS) acting medications on the neurological manifestations of carbamazepine toxicity has not been evaluated. Objective To examine the effect of exposure to CNS-acting medications on the neurological effects of carbamazepine toxicity. Methods A retrospective nested case-control study of all patients > 18 years of age, with at least one test of carbamazepine levels > 18 mcg/ml recorded at the Hadassah Hospital Central Laboratory, between the years 2004–2016. Sociodemographic and clinical data were collected from the computerized medical records, and the characteristics of patients with and without severe neurological symptoms of carbamazepine intoxication were compared. Results Eighty patients were identified. In bivariate analyses, the odds of severe neurological symptoms was higher in patients with antidepressants use (odds ratio 8.7, 95% confidence interval: 1.8–41.2, p = 0.007), benzodiazepines use (8.6, 2.0–37.1, p = 0.004), and carbamazepine concentration above 30 mcg/ml (8.1, 1.9–33.3, p = 0.004). Multivariate models demonstrated that antidepressants and benzodiazepines were associated with severe neurological manifestations during carbamazepine intoxication, independently of carbamazepine concentration over 30 mcg/ml. ICU admission was associated in multivariate analysis with antidepressants (but not benzodiazepines) use, and with carbamazepine levels > 30 mcg/ml. Conclusions Among patients with carbamazepine intoxication, severe neurological symptoms are associated with exposure to benzodiazepines or antidepressants and with carbamazepine levels higher than 30 mcg/ml.http://link.springer.com/article/10.1186/s40360-020-00425-2CarbamazepineIntoxicationConcentration levelConcomitant medicationBenzodiazepines |
| spellingShingle | Ayala Hirsch Maor Wanounou Amichai Perlman Bruria Hirsh-Raccah Mordechai Muszkat The effect of multidrug exposure on neurological manifestations in carbamazepine intoxication: a nested case-control study BMC Pharmacology and Toxicology Carbamazepine Intoxication Concentration level Concomitant medication Benzodiazepines |
| title | The effect of multidrug exposure on neurological manifestations in carbamazepine intoxication: a nested case-control study |
| title_full | The effect of multidrug exposure on neurological manifestations in carbamazepine intoxication: a nested case-control study |
| title_fullStr | The effect of multidrug exposure on neurological manifestations in carbamazepine intoxication: a nested case-control study |
| title_full_unstemmed | The effect of multidrug exposure on neurological manifestations in carbamazepine intoxication: a nested case-control study |
| title_short | The effect of multidrug exposure on neurological manifestations in carbamazepine intoxication: a nested case-control study |
| title_sort | effect of multidrug exposure on neurological manifestations in carbamazepine intoxication a nested case control study |
| topic | Carbamazepine Intoxication Concentration level Concomitant medication Benzodiazepines |
| url | http://link.springer.com/article/10.1186/s40360-020-00425-2 |
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