CARBAMAZEPNE HYPERSENSITIVITY
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At this moment our colleagues from internal medicine have a patient with a
full-blown "carbamazepine hypersensitivity syndrome".
The drug was stopped a week ago, but despite 100 mg prednisolon his
condition is getting worse.

I am looking for a therapeutic suggestion for this impressive syndrome.
Is plasmapheresis an option? (even after one week)

Roland Koopman
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If there is good renal function and no contraindications, and if there are
features suggestive of erythema multiforme then I'd certainly give Sandimmune
Neoral cyclosporine, about 5 mg / kg as soon as possible. In my experience
with erythema multiforme, the faster you give cyclosporine the better it
works, and the required duration of treatment is less. I've never treated a
reaction to carbamazepine (Tegretol).

Kevin C. Smith MD FRCPC
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Most likely represents an inherited deficiency or decrease in epoxide
hydrolase which detoxifies arene oxides, intermediates in the metabolism
of all aromatic anticonvulsants.  These intermediates are immunogenic
and destructive via free-radical pathways, etc.  Enough of the theory.
Pulse prednisone 500mg-1000mg daily X 5 then large doses of daily
prednisone for months.  Might also consider cyclosporine as a steroid
sparing agent, or vice versa.

Patrick R. Carrington
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It is bothersome that patient is not responding to 100mg of prednisone. Is
patient on any other drugs? If not then it may be worthwhile to try same
dose but use methyprednisolone(Medrol) or higher dose pulse therapy. If no
response then consider cyclosporine. Good luck!

Thomas F. Downham II, M.D.
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