title: [Convulsions due to an interaction between anti-epileptic drugs and rifampicin].
abstract: BACKGROUND
  Anti-epileptic drugs (AEDs) have a small therapeutic window, so it is important to monitor plasma levels. Inadequate plasma levels may lead to convulsions. Many AEDs are cleared hepatically, and there are many drug interactions that are known to lead to changes in plasma levels.
  
  
  METHODS
  A 54-year-old woman with known epilepsy developed convulsions after using rifampicin and flucloxacillin, despite the use of maintenance treatment in the form of carbamazepine, valproic acid and clonazepam. Since rifampicin is known to induce several cytochrome P450 enzymes and clearance of the anti-epileptic drug used may be affected by this, it can be assumed that the convulsions were caused by rifampicin. This interaction is however not mentioned in the Dutch 'G-standard' database.
  
  
  CONCLUSIONS
  Rifampicin is known to be a strong inducer of various cytochrome P450 enzymes. This case description shows that the use of rifampicin may lead to convulsions. For this reason, these interactions should be included in the Dutch G-standard database.
authors.affiliation: Universiteit van Utrecht, afd. Farmaceutische Wetenschappen, Utrecht.
authors.forename: Maarten A
authors.initials: MA
authors.lastname: Hanrath
authors.forename: Eleonora L
authors.initials: EL
authors.lastname: Swart
mesh_terms: D000927:Anticonvulsants / Q000009:adverse effects* / Q000627:therapeutic use; D002220:Carbamazepine / Q000627:therapeutic use; D002998:Clonazepam / Q000009:adverse effects / Q000627:therapeutic use; D003577:Cytochrome P-450 Enzyme System / Q000187:drug effects* / Q000378:metabolism; D004347:Drug Interactions; D004827:Epilepsy / Q000188:drug therapy; D005260:Female; D005436:Floxacillin / Q000009:adverse effects* / Q000627:therapeutic use; D006801:Humans; D008875:Middle Aged; D012293:Rifampin / Q000009:adverse effects* / Q000627:therapeutic use; D012640:Seizures / Q000139:chemically induced* / Q000188:drug therapy; D014635:Valproic Acid / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D002220:Carbamazepine; D005436:Floxacillin; D002998:Clonazepam; D014635:Valproic Acid; D003577:Cytochrome P-450 Enzyme System; D012293:Rifampin