Abstract
Case description: A 4-year-old boy presented with tuberous sclerosis and symptomatic partial epilepsy of the upper right extremity. Topiramate was prescribed for the treatment of epilepsy, and seizure behavior was well controlled. However, the patient experienced a significantly increased seizure frequency immediately after the administration of clarithromycin and pranlukast treatment during topiramate treatment. Topiramate is metabolized by CYP3A4, which is inhibited by clarithromycin and pranlukast. Thus, pharmacokinetic interactions may have occurred. This is the first report of a possible drug interaction between topiramate, clarithromycin, and pranlukast.
Highlights
Case description: A 4-year-old boy presented with tuberous sclerosis and symptomatic partial epilepsy of the upper right extremity
Clarithromycin, topiramate and pranlukast are primarily metabolized by CYP3A4
The Drug Interaction Probability Scale (DIPS) was designed to assess the probability of a causal relationship between a potential drug interaction and an observed adverse drug reaction
Summary
Case description: A 4-year-old boy presented with tuberous sclerosis and symptomatic partial epilepsy of the upper right extremity. Following a worsening of status epilepticus, the patient was transferred and admitted to the Department of Pediatrics, Ehime University Hospital, where he had been receiving treatment for seizures. The patient had been taking lamotrigine and vigabatrin for seizure control, and topiramate (5 mg) twice daily was added to the existing treatment. When topiramate was increased to 10 mg twice daily, the patient’s mother reported that he became drowsy, and that this was improved by a dose reduction to 7.5 mg twice daily.
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