Chronic oxcarbazepine intoxication in a patient with primary antiphospholipid syndrome on maintenance haemodialysis.

Abstract

WHAT IS KNOWN AND OBJECTIVE\nOxcarbazepine (OXC) is an antiepileptic drug. Patients suffering from chronic kidney disease with an estimated glomerular filtration rate below 30\xa0ml/min/1.73\xa0m2 require dose adjustments for OXC.\n\n\nCASE SUMMARY\nA 31-year-old man was admitted with a history of diplopia, ataxia and dizziness attacks that had disappeared after a regular haemodialysis sessions for three months. Medical history was remarkable for primary antiphospholipid syndrome (APS). However, no signs of new-onset APS-related neurological involvement were present. Then, it was revealed that the patient had been using 2400\xa0mg/day of OXC for four months, despite the prescription of half of this dose. Serum OXC level was 50\xa0mcg/ml (reference: 3-35\xa0mcg/ml) before a regular haemodialysis session. All symptoms disappeared in a few days after reducing to 1200\xa0mg/day and never recurred.\n\n\nWHAT IS NEW AND CONCLUSION\nWe reported a chronic OXC intoxication in a patient on maintenance haemodialysis. To the best of our knowledge, it is the first chronic OXC intoxication case in the literature. It could be related to episodic removal of OXC and its metabolites via haemodialysis. Consequently, dose modification of drugs is a pivotal point in haemodialysis patients. Chronic drug intoxications must be kept in mind in haemodialysis patients with unexplained symptoms.