Liver injury caused by oxcarbazepine

Abstract

A 30-year-old male patient received oral oxcarbazepine (300 mg in the morning and 600 mg at night) for epilepsy recurrence after drug withdrawal. The patient′s liver function was normal before taking oxcarbazepine [alanine aminotransferase (ALT) 24 U/L, aspartate aminotransferase (AST) 22 U/L, alkaline phosphatase (ALP) 61 U/L, gamma-glutamyltransferase (γ-GT) 55 U/L, total bilirubin (TBil) 8.7 μmol/L, and direct bilirubin (DBil) 5.2 μmol/L]. After 12 days of treatment, the patient developed mild liver injury (ALT 70 U/L). Tiopronin was given and oxcarbazepine was continued. However, the liver injury gradually worsened and the patient developed anorexia and yellow urine after 23 days of oxcarbazepine treatment. On day 30 of treatment. Laboratory tests showed ALT 2 763 U/L, AST 1 291 U/L, ALP 115 U/L, γ-GT 365 U/L, TBil 65.9 μmol/L, and DBil 41.4 μmol/L. Drug-induced liver injury was considered. Oxcarbazepine and tiopronin were stopped, topiramate 50 mg once daily was given orally (changed to 50 mg twice daily 1 week later), and the liver-protective treatments such as diammonium glycyrrhizinate and reduced glutathione were given. The liver function of the patient gradually improved. After 20 days, his liver function basically returned to normal (ALT 38 U/L, AST 30 U/L, ALP 71 U/L, γ-GT 84 U/L, TBil 13.4 μmol/L, and DBil 5.5 μmol/L). Long-term use of topiramate orally was advised by doctor. At 3 months of follow-up, the patient had no seizures and his liver function stayed normal. Key words: Chemical and drug induced liver injury; Oxcarbazepine; Anticonvulsants