Other Issues

Haematological concerns are an important adverse effect. Valproic acid, carbamazepine, phenytoin and felbamate are associated with a reduction in white blood cell count and/or platelet function. Nephrolithiasis can occur with topiramate and zonisamide. Patients at risk have either a prior history of nephrolithiasis or a positive first-degree relative.

Tremor and/or parkinsonian symptoms can be seen with valproic acid use. Lastly, hyponatraemia occurs with either carbamazepine or oxcarbazepine. Therefore, patients who are sodium depleted, have fluid/electrolyte abnormalities or are receiving diuretics should be careful when utilizing these agents. The elderly are at increased risk of hyponatraemia with these agents (up to 6-7%), and their electrolytes should be monitored on a routine basis.

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