Reactions 1460, p9 - 13 Jul 2013

SAmoxicillin/clavulanic acid/oxcarbazepine

Liver injury and elevation of liver enzymes: casereport

A 23-year-old woman developed drug-induced liver injurywhile receiving oxcarbazepine, and later a transitory elevationof liver enzymes while receiving amoxicillin/clavulanic acid.

The woman experienced partial complex seizures with oralautomatisms and change in consciousness 1 monthpostpartum. She was diagnosed with localisation-relatedepilepsy, and on 19 April 2007, she started oxcarbazepine300mg twice daily [route not stated] for seizure control. Ofnote, previous baseline investigations had shown borderlineelevated AST and GGT values. Tests on 4 May revealedsignificantly elevated liver enzymes, and 10 days later she washospitalised; at this time, her AST, ALT and GGT upper limits ofnormal values were 5.0, 8.9 and 6.1, respectively. Shereported appetite loss and fatigue. Oxcarbazepine-inducedliver injury was suspected.

On 15 May 2007, oxcarbazepine was withdrawn, and thewoman started gabapentin. Her liver enzyme abnormalitiescontinued for some time, then gradually improved. Testsshowed slight lymphocytosis, and a liver ultrasound revealedhyperechogenic liver parenchyma. She subsequently achievedgood clinical remission. Two years later, she receivedamoxicillin/clavulanic acid [dosage and route not stated] foracute tonsillopharyngitis, and again developed a transitoryelevation of liver enzymes; her AST, ALT and GGT valueswere 1.6, 3.7 and 2.3, respectively [duration of treatment toreaction onset and outcome not stated].

Author comment: "According to the [Council forInternational Organisations of Medical Sciences (CIOMS)]scale, causal relationship between the [oxcarbazepine] intakeand hepatotoxicity would be probable (score 8). Furtherassociation with pregnancy, as one of the risk factors for druginduced liver injury, would increase this causal relationship inour patient to highly probable or definite (score 9)."Planjar-Prvan M, et al. Acute oxcarbazepine-induced hepatotoxicity in a patientsusceptible to developing drug-induced liver injury. Collegium Antropologicum 37:281-4, No. 1, Apr 2013. Available from: URL: http://hrcak.srce.hr/index.php?show=toc&id%5Fbroj=8074 - Croatia 803089738

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Reactions 13 Jul 2013 No. 14600114-9954/13/1460-0001/$14.95 Adis © 2013 Springer International Publishing AG. All rights reserved