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NEUROLOGY 1993;43:2696
© 1993 American Academy of Neurology

Carbamazepine toxicity resulting from generic substitution

Jamie T. Gilman, PharmD, Luis A. Alvarez, MD and Michael Duchowny, MD

Comprehensive Epilepsy Center, Department of Neuroscience (Drs. Gilman, Alvarez, and Duchowny), and the Division of Clinical Pharmacology (Dr. Gilman), Miami Children's Hospital; and the Department of Neurology (Drs. Alvarez and Duchowny), University of Miami School of Medicine, Miami, FL.

Generic substitution is practiced widely in both hospital and community settings. There have been several reports of reduced serum concentrations and seizure exacerbation following generic substitution of Tegretol. We describe the first 2 cases of carbamazepine toxicity resulting from the substitution of Tegretol with Epitol. Two 6-year-old children experienced increases in the maximum serum carbamazepine concentration, one of 22% and one of 41%. Both became asymptomatic when their serum concentrations were lowered and had no residual effects.

Address correspondence and reprint requests to Dr. Jamie Gilman, Clinical Pharmacology, Miami Children's Hospital, 6125 SW 31st Street, Miami, FL 33155.

Received April 13, 1993. Accepted for publication in final form May 21, 1993.




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