The first reported rare case of carbamazepine induced malignant hypertension from Nepal: a case report

Abstract

Introduction and Importance: Malignant hypertension is the most severe form of hypertension that may cause life threatening manifestations. Carbamazepine is an antiepileptic drug primarily used for seizure disorders and trigeminal neuralgia. One of the rarely triggered adverse side effects of carbamazepine is drug induced malignant hypertension. Here, we intend to present the first case report of carbamazepine induced malignant hypertension from Nepal. Presentation of Case: Here, we aim to present a case report of a 26-year-old female with a history of generalized tonic-clonic seizure who had developed de-novo hypertension after initiation of carbamazepine with no decrease in blood pressure (BP) to normal level despite several anti-hypertensive administrations which eventually resolved on the discontinuation of drug carbamazepine. The patient was subsequently managed at our institution where levetiracetam was used as an alternative. The patient was in close follow up monitoring BP charting. Clinical Discussion: Although rare, a variety of cardiovascular side effects including hypertension led by the drug carbamazepine have been reported. Carbamazepine acts by inducing cytochrome P450 that facilitates an early metabolism and clearance of several anti-hypertensive medications causing a decrease in their role in hypertension. The exact etiology is still debatable. However, removal of the drug carbamazepine may result in a remission of hypertension as illustrated in several literatures. Conclusion: Malignant hypertension is caused in the rare due to the use of the drug carbamazepine. The hypertension can undergo remission by subsequent discontinuation of the carbamazepine therapy. Regular blood pressure monitoring and charting are crucial in such case.