Lamotrigine-induced Rash: Can We Stop Worrying?

References

Stevens Johnson Syndrome

Stevens johnson and lamictal

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Stevens-Johnsons Syndrome SJS is an immune-complex-mediated hypersensitivity reaction and has been linked as an adverse side effects to many drugs. Lamotrigine, an anticonvulsive medication and also a commonly used mood stabiliser, stevens johnson and lamictal, can be associated with this adverse reaction. Although this has not been reported very commonlySJS has high mortality and morbidity and requires careful attention as the use of Lamotrigine is increasing in clinical practice.

We present a case where the patient developed Stevens - Johnson Syndrome three weeks after being started on Lamotrigine. The case is discussed for its relevance yasmin and bowel movements the use of Lamotrigine which is currently prescribed very commonly in psychiatric practices. StevensóJohnson Syndrome SJSa dermatological emergency is a rare condition; with a stevens johnson and lamictal incidence of around 2.

The main known cause is hypersensitivity to certain drugs, followed by infections and, rarely, cancers. Although reported as a rare event StevensóJohnson Syndrome SJS has been found to be more common in adults than in children, stevens johnson and lamictal.

Women are affected more often than men, stevens johnson and lamictal, with cases occurring at a two to one 2: SJS and toxic epidermal necrolysis TEN are two forms of this life-threatening skin condition, in which cell death causes the epidermis to separate from the dermis. Clinical features of SJS include significant involvement of skin and oral, nasal, eye, stevens johnson and lamictal, urethral, GI, and lower respiratory tract mucous membranes.

Lesions may continue to erupt in crops for as long as weeks. Skin rash can begin as macules that develop into papules, vesicles, bullae, urticarial plaques or confluent erythema. Bullous lesion can rupture and may lead to further complications. Mucosal involvement includes erythema, oedema, sloughing, blistering, ulceration and necrosis. GI and respiratory involvement may progress to necrosis. SJS is a serious systemic disorder with the potential for severe morbidity and even death.

Drug aetiologies include reaction to drugs including Penicillin, Sulphonamide, Phenytoin, Valproate, Carbamazepine, non-steroidal anti-inflammatory drugs, anti-malarial and allopurinol. Similarly SJS has also been associated with immunisation, e. Anti-epileptics as a group have been shown to cause SJS with variation in its association with individual anti epileptic medications.

Lamotrigine, another commonly used antiepileptic drug and also an emerging treatment for Depression has not been well reported to sudafed and blood pressure medicine together associated with SJS in medical literature although there have been some reports linking Lamotrigine with this syndrome.

We are presenting a case where a patient developed SJS after weeks of use of Lamotrigine. Although she showed significant improvement in her mental stevens johnson and lamictal after the addition of Lamotrigine, her initial response during the first weeks did not show any signs of this syndrome. This 56 years old lady who has been known to the local mental health services for the past 20 years with womens hormones and high heart rate of depression and anxiety was attending follow up appointments on and off.

For her current episode she was in contact with the local team for the last few years and had presented with moderate to severe depression that needed regular follow up and review of stevens johnson and lamictal medication. She also had two inpatient hospital admissions to the psychiatric unit after attempting suicide on two occasions during this episode. During her latest admission, she was treated with different antidepressants and anxiolytics but without any major benefit, stevens johnson and lamictal.

Because of the poor control of symptoms of depression, Lamotrigine was added to her other medications Sertaline and Buspirone which she had been taking for many months. She was started on lamotrigine 25 mg daily which was gradually increased to 50 mg twice daily over the next 2 weeks. Her anxiety and depressive symptoms showed significant improvement on this combination and she started feeling almost back to her normal self.

At her weekly follow up, she continued showing improvement in her mental state and the treating team was very satisfied with her response to treatment. About 16 days following virginia asthma and allergy discharge she developed conjunctivitis and over the next days, stevens johnson and lamictal, developed swelling of the face and lips.

In view of her increasing symptoms, she had to be referred to the general hospital on the 4th day after developing these side effects. She was admitted for further treatment. She had to be treated in the Intensive Care Unit as her physical symptoms deteriorated over the next few days. All her routine blood tests were normal except C-Reactive Protein which was high.

She stevens johnson and lamictal kept under the care of a medical specialist, ophthalmologist and dermatologist who agreed with the clinical diagnosis of Stevens - Johnson Syndrome, stevens johnson and lamictal.

Lamotrigine, along with her other antidepressant medications was stopped. After a few days she started feeling better, made a full recovery in 2 weeks time and was discharged home. Her ophthalmic symptoms needed a few more weeks for full recovery. Lamotrigine is an anti epileptic medication which is also used as a mood stabilizer. SJS, on the other hand, has been reported from concomitant use of Valproic Acid and Lamotrigine 1314 and it is thought that Valproic Acid interferes with the metabolism of Lamotrigine by inhibiting glucuronide causing increased Lamotrigine blood levels, stevens johnson and lamictal.

In our case, the patient was on Sertraline and Buspirone for many months and did not show any side effects suggestive of a drug reaction.

There is also no evidence in the literature that either Sertraline or Buspirone can cause SJS or concomitant use of these medications with Lamotrigine increases the risk of SJS. All her symptoms developed after about two week of being on Lamotrigine 50 mg twice daily dose. We are reporting this case, since there is increasing use of Lamotrigine in psychiatry especially as a mood stabilizer and because of the rarity of StevensóJohnson Syndrome SJS as an adverse effect of Lamotrigine.

Mechanisms for Lamotrigine-induced SJS are less well understood but recent evidence suggests that antiepileptic drug-related hypersensitivity may be a consequence of chemotoxic and immunologically mediated injury; however, the pathogenesis of this reaction may vary somewhat among different antiepileptic drugs. The risk of developing SJS with Lamotrigine is rare and relatively predictable during the first few weeks of its use; clinicians prescribing this medication should however be aware of this high risk condition.

Stevens johnson and lamictal Center for Biotechnology Informationstevens johnson and lamictal, U. Pak J Med Sci. Shama Parveen 1 and M. Shama Parveen 1 Dr. Find articles by Shama Parveen. Afzal Javed 2 Dr. Find articles by M. Abstract Stevens-Johnsons Syndrome SJS is an immune-complex-mediated hypersensitivity reaction and has been linked as an adverse side effects to many drugs. Stevens-Johnsons syndrome, Hypersensitivity reaction, Lamotrigine.

CASE REPORT This 56 years old lady who has been known to the local mental health services for the past 20 years with symptoms of depression and anxiety was attending follow up appointments on and off. The current understanding of Stevens-Johnson syndrome and toxic epidermal necrolysis.

Expert Rev Clin Immunol. A new eruptive fever associated with stomatitis and ophthalmia; report of two cases in children. Am J Dis Child. Mockenhaupt M, Schopf E. Epidemiology of drug-induced severe skin reactions.

Semion Cutan Med Surg. Severe adverse skin reactions to nonsteroidal anti inflammatory drugs: A review of the literature. Am Stevens johnson and lamictal Health Syst Pharm. Toxic epidermal necrolysis and Stevens Johnson syndrome: Treatment of severe drug reactions: Stevens-Johnson syndrome, toxic epidermal necrolysis and hypersensitivity syndrome. Frittsch PO, Sidoroff A. Am J Clin Dermatol. Risk of StevensóJohnson syndrome and toxic epidermal necrolysis in new users of antiepileptics.

Diagnosis, classification, and management of erythema multiforme and Stevens-Johnson syndrome. Stevens-Johnson syndrome and antiepileptics. Anticonvulsants and antiepileptics in the treatment of bipolar disease. Risk of Stevens-Johnson syndrome and toxic epidermal necrolysis during first weeks of antiepileptic therapy: Safety review of adult clinical trial experience with lamotrigine.

Yalcin B, Karaduman A. Stevens Johnson Syndrome associated with concomitant use of lamotrigine and valproic acid. J Am Acad Dermatol, stevens johnson and lamictal. Suspected Lamotrigine induced toxic epidermal necrolysis. Rechallenge with lamotrigine after initial rash. Phenytoin like hypersensitivity associated with lamotrigine. Characterization of drug-specific T cells in lamotrigine hypersensitivity. J Allergy Clin Immunol. Support Center Support Center. Please review our privacy policy.

 

Stevens johnson and lamictal

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