Carbamazepine toxicity with concomitant levetiracetam therapy in patients with epilepsy.
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| Title: | Carbamazepine toxicity with concomitant levetiracetam therapy in patients with epilepsy. |
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| Authors: | Mishra, Archana (AUTHOR), Mishra, Biswa Ranjan (AUTHOR), Mohapatra, Debadatta (AUTHOR), Srinivasan, Anand (AUTHOR), Maiti, Rituparna (AUTHOR), Hota, Debasish (AUTHOR) |
| Source: | International Journal of Neuroscience. Feb2026, Vol. 136 Issue 2, p251-257. 7p. |
| Subjects: | Carbamazepine, Levetiracetam, Patient safety, Drug interactions, Poisons, Dose-effect relationship in pharmacology, Epilepsy, Case-control method |
| Abstract: | Aim: Drug interactions are crucial in understanding the efficacy and safety of co-administered antiepileptic drugs. This study aims to investigate drug interactions between carbamazepine (CBZ) and levetiracetam (LEV) and the factors associated with CBZ toxicity. Methods: The present record-based case-control study analyzed data from 158 patients. A univariate analysis was done to identify the association of various factors with toxic trough CBZ concentrations. Frequentist disproportionality analysis was done to determine a signal for the association between concomitant LEV administration and CBZ toxicity. Receiver operating characteristic (ROC) analysis was done to identify the LEV:CBZ dose ratio to differentiate between toxic and non-toxic CBZ concentrations. Results: The odds of developing manifestations of CBZ toxicity in CBZ + LEV versus CBZ group were 16.65 (95% confidence interval [CI]: 3.52–78.70; p < 0.001). The univariate analysis showed no association between CBZ dose and toxic trough CBZ levels, while an association between LEV administration and toxic trough CBZ levels was evident. A reporting odds ratio (ROR) of 2.25 (95% CI: 1.07–4.72; p = 0.030) and proportional reporting ratio (PRR) of 1.77(95% CI: 1.07–2.94) was observed for toxic levels of CBZ with co-administration of LEV. A LEV: CBZ dose ratio of 1.86 was identified as a threshold for differentiating between toxic and non-toxic serum concentrations with an accuracy of 72.9%. Conclusions: There is a temporal association between LEV administration and toxic blood levels and toxic symptoms of CBZ, the chances of which significantly higher when the dose ratio of LEV:CBZ is 1.86. [ABSTRACT FROM AUTHOR] |
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| Database: | Psychology and Behavioral Sciences Collection |
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| Abstract: | Aim: Drug interactions are crucial in understanding the efficacy and safety of co-administered antiepileptic drugs. This study aims to investigate drug interactions between carbamazepine (CBZ) and levetiracetam (LEV) and the factors associated with CBZ toxicity. Methods: The present record-based case-control study analyzed data from 158 patients. A univariate analysis was done to identify the association of various factors with toxic trough CBZ concentrations. Frequentist disproportionality analysis was done to determine a signal for the association between concomitant LEV administration and CBZ toxicity. Receiver operating characteristic (ROC) analysis was done to identify the LEV:CBZ dose ratio to differentiate between toxic and non-toxic CBZ concentrations. Results: The odds of developing manifestations of CBZ toxicity in CBZ + LEV versus CBZ group were 16.65 (95% confidence interval [CI]: 3.52–78.70; p < 0.001). The univariate analysis showed no association between CBZ dose and toxic trough CBZ levels, while an association between LEV administration and toxic trough CBZ levels was evident. A reporting odds ratio (ROR) of 2.25 (95% CI: 1.07–4.72; p = 0.030) and proportional reporting ratio (PRR) of 1.77(95% CI: 1.07–2.94) was observed for toxic levels of CBZ with co-administration of LEV. A LEV: CBZ dose ratio of 1.86 was identified as a threshold for differentiating between toxic and non-toxic serum concentrations with an accuracy of 72.9%. Conclusions: There is a temporal association between LEV administration and toxic blood levels and toxic symptoms of CBZ, the chances of which significantly higher when the dose ratio of LEV:CBZ is 1.86. [ABSTRACT FROM AUTHOR] |
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| ISSN: | 00207454 |
| DOI: | 10.1080/00207454.2025.2489701 |
