Acharya Ashish, Bhattarai Kritika, Timilsina Sarika, Adhikari Jenish
Nepal Medical College and Teaching Hospital, Kathmandu University.
Department of Internal Medicine, Nepal Medical College and Teaching Hospital, Kathmandu University, Kathmandu, Nepal.
Ann Med Surg (Lond). 2024 Jul 8;86(9):5535-5540. doi: 10.1097/MS9.0000000000002359. eCollection 2024 Sep.
Malignant hypertension is the most severe form of hypertension that may cause life-threatening manifestations. Carbamazepine is an antiepileptic drug primarily used for seizure disorders and trigeminal neuralgia. One of the rarely triggered adverse side effects of carbamazepine is drug-induced malignant hypertension. Here, we intend to present the first case report of carbamazepine-induced malignant hypertension from Nepal.
Here, we aim to present a case report of a 26-year-old female with a history of generalized tonic-clonic seizure who had developed de-novo hypertension after initiation of carbamazepine with no decrease in blood pressure to normal levels despite several antihypertensive administrations which eventually resolved on the discontinuation of drug carbamazepine. The patient was subsequently managed at our institution, where levetiracetam was used as an alternative. The patient was in close follow-up monitoring blood pressure charting.
Although rare, a variety of cardiovascular side effects, including hypertension led by the drug carbamazepine, have been reported. Carbamazepine acts by inducing cytochrome P450, which facilitates an early metabolism and clearance of several antihypertensive medications, causing a decrease in their role in hypertension. The exact etiology is still debatable. However, the removal of the drug carbamazepine may result in a remission of hypertension, as illustrated in several literatures.
Malignant hypertension is caused in rare cases to the use of the drug carbamazepine. The hypertension can undergo remission by subsequent discontinuation of the carbamazepine therapy. Regular blood pressure monitoring and charting are crucial in such cases.
恶性高血压是高血压最严重的形式，可能导致危及生命的表现。卡马西平是一种抗癫痫药物，主要用于治疗癫痫发作和三叉神经痛。卡马西平极少引发的不良反应之一是药物性恶性高血压。在此，我们打算呈现尼泊尔首例卡马西平诱发恶性高血压的病例报告。
在此，我们旨在报告一例26岁女性病例，该女性有全身强直阵挛发作病史，在开始使用卡马西平后出现新发高血压，尽管多次给予抗高血压药物治疗，但血压仍未降至正常水平，最终在停用卡马西平后血压恢复正常。该患者随后在我们机构接受治疗，使用左乙拉西坦作为替代药物。患者接受密切随访并监测血压。
尽管罕见，但已报道卡马西平会引发包括高血压在内的多种心血管副作用。卡马西平通过诱导细胞色素P450起作用，这会促进几种抗高血压药物的早期代谢和清除，导致它们在控制高血压方面的作用减弱。确切病因仍存在争议。然而，如多篇文献所示，停用卡马西平可能会使高血压缓解。
罕见情况下，卡马西平的使用会导致恶性高血压。后续停用卡马西平治疗后，高血压可能会缓解。在此类病例中，定期监测和记录血压至关重要。
