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Asterixis and toxic encephalopathy induced by gabapentin
GianPietro Sechi1, Bastianino Murgia, GianFranco Sau
1Neurological Clinic, University of Sassari, Viale San Pietro, 10, 07100 Sassari, Italy. gpsechi@ssmain.uniss.it
Progress in Neuro-Psychopharmacology & Biological Psychiatry
|December 23, 2003
Summary
High doses of gabapentin (GBT) can cause reversible encephalopathy and asterixis in elderly patients. Lower doses combined with oxcarbazepine may also induce disabling asterixis due to drug interaction.
Area of Science:
- Neurology
- Clinical Pharmacology
Background:
- Gabapentin (GBT) is an anticonvulsant medication.
- Limited data exists on GBT-induced asterixis, especially in elderly patients with encephalopathy.
Observation:
- Two elderly patients developed asterixis and encephalopathy during GBT therapy.
- One patient experienced asterixis after GBT rechallenge.
- Subclinical asterixis was detected via EMG in a patient also receiving oxcarbazepine (OXCBZ).
Findings:
- Discontinuation or dose reduction of GBT resolved asterixis and encephalopathy in both patients.
- High GBT doses were linked to reversible toxic encephalopathy.
- Low GBT doses combined with OXCBZ induced disabling asterixis, suggesting a synergistic effect.
Implications:
- High-dose GBT may induce reversible encephalopathy and asterixis in the elderly.
- Concomitant use of GBT and OXCBZ requires careful monitoring due to potential synergistic interactions causing asterixis.