Abstract
We would like to add a case in which phytotherapy, namely avocado leaf, caused a recurrence of epileptic seizures in a male patient who had been seizure free for the last 5 years with antiepileptic treatment. He was using sodium valproate and had a serum level of approximately 60 μg/mL, but the level dramatically dropped to 30 μg/mL after continous use of avocado leaf extract. The side effect of Avocado (epileptic seizure) disappeared. After stopping the use of the phytotherapy, the serum valproate level increased to normal levels, and he became seizure free again. Avocado improves the functioning of cytochrome P450 enzymes. Therefore serum level of valproate decreases. After stopping avocado, the serum valproate level increased to normal levels.
Although there are some studies in which avocado capsules are proposed as a dietary supplement for prevention of stone formation, there is no proof of melting the urinary stones by avocado capsules. 3 –5 The theory of prevention for recurrent urolithiasis in rats is that extract of avocado leaves with ethanol extraction is an efficient agent to inhibit formation of calcium oxalate crystal in the rat kidney. Therefore, the extract of avocado leaves is a potential natural antioxidant and anti-inflammation compound that is able to prevent formation of calcium oxalate crystal by interfering with the process of epithelial cell damage.
Many tropical fruits, including avocado, contain alpha-pinene. 6 There is induction of cytochrome P450 enzyme by alpha-pinene, especially in the liver. Our patient had been using sodium valproate for simple partial epileptic seizures. Both the sodium valproate and alpha-pinene initiate induction of cytochrome P450 enzyme in the liver. 7 Therefore, the serum level of sodium valproate decreases. As in this case, by decreasing the serum level of sodium valproate, the patient had a simple partial epileptic seizure after 5 years without epileptic seizure. The patient's serum sodium valproate level had been followed regularly, and this level was about 60 μg/mL before the use of avocado capsules. After the patient used avocado capsules, the level of sodium valproate was 30 μg/mL. The effective serum levels of sodium valproate should be in the range of 50 to 120 μg/mL to reduce epileptic seizures. 8
In light of this case, urologists should be aware of drug interactions while using terpene compound drugs as medical expulsive therapy for ureterolithiasis. Dietary intervention, however, may be an integral component of prevention of kidney stones. 1 We should remember that all tropical fruits include alpha-pinene, which initiates cytochrome P450 enzyme induction, before suggesting avocado use as well as other terpene compound drugs. 9 –11 More comprehensive studies should be performed to investigate the efficiency and also complications of phytotherapy in urolithiasis.