Drug interactions between immune globulin intravenous and mephenytoin
| Results for the following 2 drugs: |
|---|
| immune globulin intravenous |
| mephenytoin |
Interactions between your selected drugs
mephenytoin ↔ immune globulin intravenous
Applies to:mephenytoin and immune globulin intravenous
MONITOR: A possible interaction between phenytoin and intravenous immunoglobulin (IVIG) was suspected in a case of fatal hypersensitivity myocarditis. The mechanism of interaction has not been described. The case patient was a 43-year-old man with a past history of alcohol abuse who had been receiving phenytoin for the treatment of partial epilepsy for eight years. He was given intravenous immunoglobulin 0.4 g/kg for 5 days for suspected Guillain-Barre syndrome. On the second day after the last administration, the patient complained of abdominal pain, aching shoulders, and backache. He subsequently developed hypotension and died after attempts at resuscitation. An autopsy confirmed Guillain-Barre syndrome and revealed signs of a slight hepatitis with eosinophils as well as hypersensitivity (eosinophilic) myocarditis. There were no signs of alcoholic cardiomyopathy. Since phenytoin alone has been associated with hypersensitivity myocarditis, a contributory role for IVIG could not be established. Moreover, IVIG has been used successfully in some cases to treat anticonvulsant hypersensitivity syndrome, including that associated with phenytoin.
MANAGEMENT: Due to the serious nature of the possible interaction, clinicians should consider monitoring hematologic parameters such as eosinophil counts as well as blood pressure and ECG tracings if immunoglobulins are used in patients receiving phenytoin.
See also...
Drug Interaction Classification
The classifications below are a guideline only. The relevance of a particular drug interaction to a specific patient is difficult to determine using this tool alone given the large number of variables that may apply.
| Major | Highly clinically significant. Avoid combinations; the risk of the interaction outweighs the benefit. |
| Moderate | Moderately clinically significant. Usually avoid combinations; use it only under special circumstances. |
| Minor | Minimally clinically significant. Minimize risk; assess risk and consider an alternative drug, take steps to circumvent the interaction risk and/or institute a monitoring plan. |
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