Liver failure under valproic acid

2011 ◽  
Vol 26 (S2) ◽  
pp. 1282-1282
Author(s):  
C. Schönfeldt-Lecuona ◽  
B.J. Connemann ◽  
R.W. Freudenmann ◽  
C. Hiemke ◽  
M.M. Schmid
Keyword(s):  
Valproic Acid ◽  
Side Effects ◽  
Liver Failure ◽  
Liver Enzymes ◽  
Bipolar Affective Disorder ◽  
Hepatic Function ◽  
Good Tolerability ◽  
Medical Products ◽  
Federal Institute

Valproic acid (VPA, 2-propylvaleric acid) is originally an antiepileptic drug, which has been in use for more than 30 years in over 100 countries. The clinical application of VPA has expanded in the last years. Approval has been granted by the FDA for treatment of migraine and cluster headache in 1996, and for treatment of mania and long-term prophylaxis of bipolar affective disorder in 1995. In ongoing studies, VPA has been reported to inhibit growth of several types of cancer cells; in addition, effects on neurodegeneration, and on virus replication in HIV infection have been demonstrated potentially expanding the application of VPA in the future. Despite a good tolerability of the drug, reports of hepatotoxicty even in patients without risk factors become more frequent. We analysed all cases of VPA induced severe hepatic side effects reported to the german Federal Institute for Pharmaceuticals & Medical Products (BfArM) between 1993 and 2009. A special intention was to detect correlations with present co-medication as a crucial factor in the break-down of hepatic function. As frequent co-medications in VPA-induced hepatic side effects benzodiazepines, and antiepileptics, especially carbamazepine, lamotrigine and topiramate were found. In addition, propofol as a co-medication was found in 4 lethal cases. Different pathomechanisms of VPA hepatotoxicity and a therapeutic approach with carnitine are discussed. Current international guidelines for prevention of VPA-induced liver failure are contrasted. Weekly control of liver enzymes in the first treatment weeks might help to detect VPA-induced hepatic side effects earlier.

Oral valproic acid for epilepsy - long-term experience in therapy and side effects

2008 ◽  
Vol 9 (2) ◽  
pp. 285-292 ◽  
Author(s):  
Thorsten Gerstner ◽  
Nellie Bell ◽  
Stephan König
Keyword(s):  
Valproic Acid ◽  
Side Effects ◽  
Long Term Experience

scholarly journals Treatment of Postanoxic Intention Myoclonus with Valproic Acid

1979 ◽  
Vol 6 (1) ◽  
pp. 39-42 ◽  
Author(s):  
J. Bruni ◽  
L.J. Willmore ◽  
B.J. Wilder
Keyword(s):  
Valproic Acid ◽  
Side Effects ◽  
Plasma Levels ◽  
Marked Improvement ◽  
Hepatic Function ◽  
Function Tests ◽  
Therapeutic Doses

SummaryValproic acid in therapeutic doses was used in the treatment of postanoxic intention myoclonus. Disappearance of the myoclonus occurred with marked improvement in the electroencephalogram. No significant side effects were noted. Hepatic function tests were monitored. Determination of valproic acid plasma levels was used to guide therapy. Levels above 55 ßg were generally required. The patient remains free of myoclonus after four and one half months.

Long-Term Follow-up of HCV Infected Stem Cell Transplant Patients and Effects of Antiviral Therapy.

Blood ◽  
2009 ◽  
Vol 114 (22) ◽  
pp. 1141-1141
Author(s):  
Per T. Ljungman ◽  
Anna Locasciulli ◽  
V. Gomez-Garcia de Soria ◽  
Albert N. Bekassy ◽  
Lorentz J. Brinch ◽  
...  
Keyword(s):  
Liver Transplantation ◽  
Stem Cell ◽  
Side Effects ◽  
Liver Failure ◽  
Antiviral Therapy ◽  
Cumulative Incidence ◽  
Severe Liver ◽  
Autologous Hsct

Abstract Abstract 1141 Poster Board I-163 Hepatitis C virus (HCV) infection has been reported to be an important cause for serious liver disease including cirrhosis and liver failure after hematopoietic stem cell transplantation (HSCT). This study was initiated by the EBMT in 1993 and recruited patients to 1996 with the aims to prospectively follow a cohort of HCV infected patients and study late effects and responses to antiviral therapy. The requirements for participation were for a center to report all HCV infected HSCT patients having survived for at least 6 months and to be willing to report baseline and follow-up data approximately every five years. Initially, 236 patients were registered. However, no follow-up information was reported on 41 patients. Thus, 195 patients from 12 centers were included in this analysis. The diagnosis, clinical follow-up, and antiviral therapy were made according to each center's routines. Kaplan-Meier curves were calculated for overall survival. Cumulative incidences were calculated for death from liver failure with death from other causes as the competing risk and for development of severe liver complications including death from liver failure, liver transplantation, and biopsy verified cirrhosis with death occurring without the diagnosis of severe liver complication as the competing event. Uni- and multivariable logistic regression was performed with the aim to determine risk factors for severe liver complications. 134 patients had undergone allogeneic and 61 autologous HSCT. The median follow-up from HSCT is currently 16.3 years and the maximum 27.1 years. 33 of 195 patients have died of which seven died from liver complications. The survival probability at 20 years after HSCT was 81.4% and the cumulative incidence for death in liver complications was 4.1% (3.3% in allogeneic and 6.5% in autologous HSCT recipients). 120/195 patients had a least one liver biopsy performed during follow-up. The cumulative incidence of severe liver complications (death from liver failure, liver transplantation, cirrhosis) was 7.6% at 15 years and 11.3% at 20 years after HSCT. 85 patients have been treated with interferon based therapy; 43 in combination with ribavirin. 16 patients have been treated more than once. At last follow-up, 42 patients had become PCR negative of whom seven had relapsed, 25 did not respond, two were not yet evaluated, and for 16 the PCR status was unknown. The sustained virological response rate among all treated patients was 40%. The rates of severe side effects were comparable to other patient populations and no patient developed exacerbations of GVHD. Patients who received antiviral therapy had a trend towards a decreased risk of severe liver complications (p=.058). HCV infection is associated with morbidity and mortality in long-term survivors after HSCT. Antiviral therapy might reduce the risk for severe complications and can be given safely with similar rates of side effects and antiviral response as in non-HSCT patients. Disclosures No relevant conflicts of interest to declare.

scholarly journals Comparison of monotherapy effect of phenytoin, carbamazapine and valproic acid in pediatric general tonic clonic and partial epilepsy

2008 ◽  
Vol 48 (1) ◽  
pp. 37
Author(s):  
Muchamad Budi Nugroho ◽  
E. S. Herini ◽  
Sunartini Sunartini
Keyword(s):  
Valproic Acid ◽  
Cohort Study ◽  
Survival Analysis ◽  
Side Effects ◽  
Treatment Time ◽  
Partial Epilepsy ◽  
Historical Cohort ◽  
Drug Regimens ◽  
Secondary Outcomes

Background Problems on epilepsy do not only depend on thedisease itself but also on management and drug regimens. Drugselection is very important to yield optimal treatment effect andto prevent side effects due to long-term therapy.Objective To determine whether there are any different effectsof monotherapy of phenytoin, carbamazapine, and valproic acidon pediatric general tonic clonic and partial epilepsy.Methods We conducted a historical cohort study on one monthuntil 18-years old children diagnosed as general tonic clonic orparsial epilepsy treated with phenytoin, carbamazapine, or valproicacid routinely for more than two years in Sardjito Hospital fromJanuary 2000 until May 2007. The sample size of each group was41. The main outcome was the time of 12-month remission,whereas the secondary outcomes were withdrawal from treatment,time to remission, side effects and cure rates.Results Valproic acid increased the possibility to achieve 12-monthremission (RR 2.66; 95%CI 1.06;6.65) compared to phenytoin,whereas carbamazapine did not (RR 1.47; 95%CI 0.66;3.28).Survival analysis showed that valproic acid was better thancarbamazapine (P=0.042) and phenytoin (P=0.007). There wereno significant differences among groups in the result of withdrawalfrom treatment, time to remission, and cure variables. The sideeffects of valproic acid seemed less than those of others.Conclusions Valproic acid increases the possibility of 12-monthremission compared to carbamazapine and phenytoin asmonotherapy in pediatric general tonic clonic and partial epilepsywithout increasing side effects. Carbamazapine has similar effectsof therapy to phenytoin.

Side Effects and Toxicity of Interferon in the Treatment of Recurrent Respiratory Papillomatosis

1987 ◽  
Vol 96 (5) ◽  
pp. 601-607 ◽  
Author(s):  
Dennis M. Crockett ◽  
Rodney P. Lusk ◽  
Brian F. McCabe ◽  
Janis Horne Mixon
Keyword(s):  
Side Effects ◽  
Liver Enzymes ◽  
Recurrent Respiratory Papillomatosis ◽  
Short Term ◽  
University Of Iowa ◽  
Show Evidence ◽  
Grand Mal ◽  
Experimental Protocols ◽  
The University

Twenty-six patients with recurrent respiratory papillomatosis have received interferon administered according to one or more of five experimental protocols currently ongoing or completed at the University of Iowa. Short-term side effects following interferon administration were common and included fever, headache, chills, fatigue, myalgias, and nausea. Two patients experienced neurotoxicity manifested as somnolence, confusion, or petit mal type or grand mal type seizures. Preliminary data show evidence for some growth retardation in patients receiving long-term interferon therapy. Laboratory evidence of toxicity in the form of decreased WBC, RBC, and platelet counts occurred in five patients, and increased liver enzymes occurred in 16 patients. Neither cardiovascular nor renal toxicity was noted.

Cutaneous ulcers following hydroxyurea therapy

Phlebologie ◽  
2004 ◽  
Vol 33 (06) ◽  
pp. 202-205 ◽  
Author(s):  
K. Hartmann ◽  
S. Nagel ◽  
T. Erichsen ◽  
E. Rabe ◽  
K. H. Grips ◽  
...  
Keyword(s):  
Side Effects ◽  
Side Effect ◽  
Antineoplastic Agent ◽  
Limited Time ◽  
Myeloproliferative Diseases ◽  
Dermatological Side Effects ◽  
Chronic Myeloproliferative Diseases ◽  
Hydroxyurea Therapy

SummaryHydroxyurea (HU) is usually a well tolerated antineoplastic agent and is commonly used in the treatment of chronic myeloproliferative diseases. Dermatological side effects are frequently seen in patients receiving longterm HU therapy. Cutaneous ulcers have been reported occasionally.We report on four patients with cutaneous ulcers whilst on long-term hydroxyurea therapy for myeloproliferative diseases. In all patients we were able to reduce the dose, or stop HU altogether and their ulcers markedly improved. Our observations suggest that cutaneous ulcers should be considered as possible side effect of long-term HU therapy and healing of the ulcers can be achieved not only by cessation of the HU treatment, but also by reducing the dose of hydroxyurea for a limited time.

Long-term side effects following pneumonectomy: A case report and review of the literature

2019 ◽  
Author(s):  
BA Högerle ◽  
EL Bulut ◽  
L Klotz ◽  
F Eichhorn ◽  
M Eichhorn ◽  
...  
Keyword(s):  
Case Report ◽  
Side Effects ◽  
Review Of The Literature

Long-Term Follow-Up of Early Cochlear Implant Device Activation

2021 ◽  
pp. 1-11
Author(s):  
Stefanie Bruschke ◽  
Uwe Baumann ◽  
Timo Stöver
Keyword(s):  
Speech Recognition ◽  
Side Effects ◽  
Cochlear Implant ◽  
Surgical Techniques ◽  
Control Group ◽  
First Year ◽  
Safe Procedure ◽  
Sound Processor

Background: The cochlear implant (CI) is a standard procedure for the treatment of patients with severe to profound hearing loss. In the past, a standard healing period of 3–6 weeks occurred after CI surgery before the sound processor was initially activated. Advancements of surgical techniques and instruments allow an earlier initial activation of the processor within 14 days after surgery. Objective: Evaluation of the early CI device activation after CI surgery within 14 days, comparison to the first activation after 4–6 weeks, and assessment of the feasibility and safety of the early fitting over a 12 month observation period were the objectives of this study. Method: In a prospective study, 127 patients scheduled for CI surgery were divided into early fitting group (EF, n = 67) and control group (CG, n = 60). Individual questionnaires were used to evaluate medical and technical outcomes of the EF. Medical side effects, speech recognition, and follow-up effort were compared with the CG within the first year after CI surgery. Results: The early fitting was feasible in 97% of the EF patients. In the EF, the processor was activated 25 days earlier than in the CG. No major complications were observed in either group. At the follow-up appointments, side effects such as pain and balance problems occurred with comparable frequency in both groups. At initial fitting, the EF showed a significantly higher incidence of medical minor complications (p < 0.05). When developing speech recognition within the first year of CI use, no difference was observed. Furthermore, the follow-up effort within the first year after CI surgery was comparable in both groups. Conclusions: Early fitting of the sound processor is a feasible and safe procedure with comparable follow-up effort. Although more early minor complications were observed in the EF, there were no long-term wound healing problems caused by the early fitting. Regular inspection of the magnet strength is recommended as part of the CI follow-up since postoperative wound swelling must be expected. The early fitting procedure enabled a clear reduction in the waiting time between CI surgery and initial sound processor activation.

Sign in / Sign up

Export Citation Format

Share Document