PubMed · 8177113
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1994-05-16. Anticonvulsant hypersensitivity.. https://pubmed.ncbi.nlm.nih.gov/8177113/
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In this issue (see pages 561 to 566 two case reports by Lorne J. Brandes and Linda A. Friesen illustrate a temporal relation between the discontinuation or initiation of therapy with certain non-antineoplastic agents (lithium, carbamazepine and an H1-antihistamine) and the clinical course of cancer. Only an accumulation of similar case reports and the results of epidemiologic and controlled clinical studies will show whether the temporal relation observed in these cases is also a causal one. In the absence of strong, let alone conclusive, evidence that antidepressants or antihistamines promote the growth of tumours in human beings, a recommendation to stop using these medications would be premature. The news about these case reports and about animal studies on the tumour-promoting potential of some antidepressants and antihistamines is likely to spread through the media. The realistic and responsible option for physicians and clinical investigators is to help patients and prospective participants in clinical trials to interpret this information in a balanced and reasonable fashion.
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This review summarizes the studies on the cognitive side-effects of two important antiepileptic drugs: phenytoin and carbamazepine. A large literature database was compiled through the DIMDI computer database and the inspection of recent reviews. Only scientific articles published in peer-reviewed journals during the last 25 years were selected. Of the 358 potentially relevant papers on cognitive effects of AEDs, a total of 16 studies have been found that have studied both carbamazepine and phenytoin. After excluding studies with designs that do not permit valid inferences regarding the cognitive effects of AEDs, only five studies remained. The evaluation of these studies reveal that our current knowledge allows us to draw conclusions about the cognitive side-effects of phenytoin and carbamazepine only with great caution. The claim in reviews that 'both drugs have an impact on cognitive function, PHT to a larger degree than CBZ' is simply not supported by valid 'high quality' data. The same is true for the overall conclusion in more recent reviews that 'drug-induced cognitive effects of these AEDs on cognitive function are probably mild or even negligible'. Apparently, the only information that we have is that the differential impact of PHT and CBZ on cognitive function is not extremely different. No conclusive and reconfirmed data are available on the absolute effects of CBZ and PHT (differences between the two drugs and a no-treatment condition). Our review summarizes some recommendations for future studies.