title: [Carbamazepine and psychotropic treatment interaction: Two case studies of carbamazepine overdosage].
abstract: Drug interaction is a frequent situation in pediatrics and child psychiatry. Carbamazepine (CBZ) is an antiepileptic drug used as a mood stabilizer in child psychiatry. CBZ is known to be a potent inducer of various CYP isoenzymes of cytochrome P450, which might result in a decrease in the plasma concentration of associated treatments. We describe two cases of CBZ overdosage in adolescent inpatients (14 and 16 years). The patients were treated with risperidone associated with fluoxetine in one and with loxapine in the other case, and CBZ was introduced as a mood stabilizer. Patients presented typical clinical symptoms (fatigue, dizziness, gastrointestinal signs, blurred vision). Overdosage was confirmed by an elevated CBZ plasma concentration (17 and 15.5 mg/L, therapeutic range 4-12 mg/L). We recommend introducing CBZ very progressively in patients treated with psychotropics, particularly when it is associated to several treatments. An intensification of clinical and biological follow-up with early plasma concentration testing should allow for better treatment adjustment.
authors.affiliation: Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France.
authors.forename: A
authors.initials: A
authors.lastname: Fernandez
authors.affiliation: Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France.
authors.forename: E
authors.initials: E
authors.lastname: Dor
authors.affiliation: Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France.
authors.forename: M-L
authors.initials: ML
authors.lastname: Menard
authors.affiliation: Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France.
authors.forename: F
authors.initials: F
authors.lastname: Askenazy
authors.affiliation: Service universitaire de psychiatrie de l'enfant et de l'adolescent, hôpitaux pédiatriques de Nice CHU-Lenval, 57, avenue de la Californie, 06200 Nice, France. Electronic address: thummler.s@pediatrie-chulenval-nice.fr.
authors.forename: S
authors.initials: S
authors.lastname: Thümmler
mesh_terms: D000293:Adolescent; D002220:Carbamazepine / Q000008:administration & dosage / Q000009:adverse effects*; D004305:Dose-Response Relationship, Drug; D004347:Drug Interactions; D062787:Drug Overdose / Q000209:etiology*; D004359:Drug Therapy, Combination; D005260:Female; D005473:Fluoxetine / Q000008:administration & dosage / Q000009:adverse effects*; D006801:Humans; D008152:Loxapine / Q000008:administration & dosage / Q000009:adverse effects*; D001523:Mental Disorders / Q000188:drug therapy*; D018967:Risperidone / Q000008:administration & dosage / Q000009:adverse effects*
chemical_list: D005473:Fluoxetine; D002220:Carbamazepine; D018967:Risperidone; D008152:Loxapine