Folic acid supplementation reduces the development of some blood cell abnormalities in children receiving carbamazepine.
BACKGROUND
Carbamazepine is a commonly used anticonvulsant agent; however, it has been linked with various blood cell abnormalities. This study evaluated the effect of low-dose folic acid supplementation on the prevention of carbamazepine-induced hematological derangements in children.


METHODS
This randomized clinical trial was conducted in children with epilepsy who received carbamazepine monotherapy. Group 1 received carbamazepine alone, and group 2 received carbamazepine plus folic acid. The two groups were age- and sex-matched. Each group comprised 41 children with epilepsy. Complete blood counts were obtained before starting medication (baseline) and then serially. The patients were followed for at least 1 year.


RESULTS
In group 1, 31.4% of the patients developed leukopenia and 17.1% neutropenia, but in group 2, these figures were 14.6 and 9.8% (P = 0.067 and P = 0.331, respectively). At the end of the first year of follow up, white blood cell and polymorphonuclear cell counts were significantly higher in group 2 (P = 0.007 and P = 0.001, respectively). Hemoglobin concentration dropped in group 1, but rose slightly in group 2; these changes were significant. Platelet, lymphocyte, and monocyte counts and changes in serial blood tests did not differ significantly between the two groups.


CONCLUSIONS
Folic acid is a safe drug that can reduce the development of some blood cell abnormalities linked to carbamazepine. It has a favorable effect on preventing the leukopenia and drop in hemoglobin observed in patients receiving carbamazepine, but its exact effect and the optimal dose required to enhance its benefits require further investigation.
Asadi-Pooya
Ali Akbar
AA
Shiraz University of Medical Sciences, Shiraz, Iran. asadipoa@sums.ac.ir
Ghetmiri
Ehsan
E
D000293:Adolescent; D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D002220:Carbamazepine / Q000009:adverse effects* / Q000627:therapeutic use; D002648:Child; D019587:Dietary Supplements; D005260:Female; D005492:Folic Acid / Q000627:therapeutic use*; D006397:Hematinics / Q000627:therapeutic use*; D006801:Humans; D007958:Leukocyte Count; D007970:Leukopenia / Q000139:chemically induced / Q000517:prevention & control*; D008297:Male; D009503:Neutropenia / Q000139:chemically induced / Q000517:prevention & control*; D011446:Prospective Studies
D000927:Anticonvulsants; D006397:Hematinics; D002220:Carbamazepine; D005492:Folic Acid