A 15 year old boy with epilepsy on treatment with combination of valproate and phenytoin has good control of seizures. Levels of both drugs are in the therapeutic range. All of the following adverse effects can be attributed to valproate except :
Answer is D (Lymphadenopathy): Lymphadenopathy 'Pseudolymphoma' is a complication associated with use of phenytoin and is not seen with valproate. Side Effects of Valproate Side effects of phenytoin: 1. Hepatotoxicity : 1. Hyperplasia of gums - asymptomatic rise in serum transaminases is seen-KDT 2. Hyperglycemia - Fulminant hepatitis may be seen 3. Hirsutism 2. Weight gain 4. Hypersensitivity reaction 3. Hyper ammonemia 5. Hydantoin syndrome is foetus : during pregnancy 4. Gastric Irritation : Anorexia, vomiting 6. Megaloblastic anemia 5. Thrombocytopenia 7. Osteomalacia 6. Transient alopecia 8. Lymphadenopathy - (Harrison 15th /2364) 7. Ataxia, tremors and sedation may be seen (Pseudolymphoma) 8. Use during pregnancy may cause neural tube defects 9. Neurological symptoms like dizziness, ataxia, incordination, confusion, diplopia Drugs causing Lymphadenopathy -Harrison PhenytoinQ PrimidoneQ
Weight gain of 5 kg
Serum alanine aminotransaminase 150 IU/L
Rise in serum ammonia level by 201.tg/dL
Lymphadenopathy