A case with Stevens Johnson syndrome triggered by combination of clobazam, lamotrigine, and valproic acid treatment

Ertam, İlgen; Sezgin, Aycan Özden; Ünal, İdil

doi:10.1111/j.1365-4632.2009.03865.x

Cited by 16 publications

(12 citation statements)

References 11 publications

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“…SJS or TEN associated with other benzodiazepines have been scarcely reported in the literature, i.e., 2 TEN episodes under treatment with flurazepam [35] and clobazam [36], respectively, and 3 SJS episodes, i.e., 1 after chlordiazepoxide overdose [37] and 2 under treatment with clobazam [38] and nitrazepam [39], respectively, both in combination with anticonvulsant drugs. In spite of these communications of cases to pharmacovigilance registers and publications, and the high use of benzodiazepines in Western countries [40], a formal study estimating the risk of SJS/TEN associated with these drugs is lacking in the literature.…”

Section: Discussionmentioning

confidence: 99%

Risk of toxic epidermal necrolysis and Stevens-Johnson syndrome associated with benzodiazepines: a population-based cohort study

Martín-Merino

Abajo

Gil

2015

Eur J Clin Pharmacol

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Section: Discussionmentioning

confidence: 99%

Risk of toxic epidermal necrolysis and Stevens-Johnson syndrome associated with benzodiazepines: a population-based cohort study

Martín-Merino

Abajo

Gil

2015

Eur J Clin Pharmacol

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“…In all of the included studies, immediate discontinuation of VPA and concomitant drug LTG was done as a primary measure except in cases reported by Ertam et al . and Famularo et al . However, VPA was not stopped in one case as it is the safer option among AEDs in that patient …”

Section: Resultsmentioning

confidence: 95%

“…This allele is found only in 10–15% of the populations who belong to China, South Asia, and South‐east Asia. An inborn error of metabolism is another risk factor for idiosyncratic severe reactions caused by VPA …”

Section: Introductionmentioning

confidence: 99%

“…An inborn error of metabolism is another risk factor for idiosyncratic severe reactions caused by VPA. 5 International Journal of Dermatology 2019, 58, 1014-1022 ª 2019 The International Society of Dermatology Management of this fatal condition is challenging. The suspected drug should be stopped, and treatment should be started immediately with certain therapy like wound care and topical treatment, immunosuppressive therapy (especially corticosteroids, which decrease the immune and inflammatory response), and other drugs like antihistamines, antibiotics, supportive therapeutic measures, fluid/electrolytic maintenance, nutritional support, analgesia, and other symptomatic management.…”

Section: Introductionmentioning

confidence: 99%

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Valproic acid and Stevens‐Johnson syndrome: a systematic review of descriptive studies

Rashid¹,

Kashyap

Undela

2019

Int J Dermatology

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Valproic acid (VPA) is a commonly used antiepileptic drug (AED). Stevens‐Johnson syndrome (SJS) and toxic epidermal necrolysis are the rare but fatal cutaneous adverse drug reactions for VPA. We aimed to identify and critically evaluate all the literature of SJS in association with VPA and to describe the clinical features of the condition. A literature search was conducted in MEDLINE/PubMed from inception to December 2017 and updated in July 2018 without any restrictions, and the references of included studies were also searched. The descriptive studies discussing any patients who experienced SJS followed by the use of VPA alone or along with any other AED for its main indication were included. Two authors were independently involved in the study selection and data extraction. Disagreements were resolved by consensus or by the discussion with a third reviewer. A total of 19 studies including 17 case reports and two case series of 98 were included in the review. In all studies, the dose of VPA ranged from 100 mg/day to a maximum dose of 1,000 mg/day and was administered for indications including epilepsy, seizures, schizophrenic affective disorders, and bipolar disorder. The mortality seen with severe cutaneous adverse drug reactions can be decreased by immediate withdrawal of opposing medications, providing symptomatic relief, and offering supportive care, all of which are the mainstay of controlling the condition. It is essential for healthcare professionals to be aware of the importance of monitoring SJS or any other cutaneous reactions followed by the use of valproic acid even though the incidence is low, but it is injurious to the patient.

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“…It is known that the association of valproate and lamotrigine may increase the risk of SJS, a life‐threatening disorder (Schlienger et al., 1998; Ertam et al., 2009). Indeed, we had to withdraw a 9‐year‐old boy because of SJS upon initiation of the AED combination we implemented, highlighting the importance of close surveillance of patients receiving this AED combination.…”

Section: Discussionmentioning

confidence: 99%

Long-term control of epileptic drop attacks with the combination of valproate, lamotrigine, and a benzodiazepine: A ‘proof of concept,’ open label study

et al. 2011

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and xThe Brain Institute (InsCer), PUCRS, Porto Alegre, Brazil SUMMARY Purpose: Long-term medical management of epileptic drop attacks is usually unsatisfactory and more effective antiepileptic drug (AED) regimens are needed. The present study aimed at providing proof of concept that previously refractory epileptic drop attacks could be significantly and safely controlled by the specific combination of valproate, lamotrigine, and a benzodiazepine.Methods: An open label trial providing class IV evidence of efficacy, including 32 patients with cryptogenic/symptomatic, generalized or multifocal epilepsies, and refractory drop attacks. Following baseline, the combination under study was introduced and patients followed for 12 months. Frequency of drop attacks was compared at 3-month intervals with that during baseline and correlated with clinical, electroencephalography (EEG), and imaging variables. A list of putative side effects was read to patients and caregivers at each visit. Key Findings: Four patients were excluded, one due to a Stevens-Johnson syndrome (SJS). Median number of drop attacks decreased 96% between baseline and the fourth trimester of the study (from 50 to 2; p < 0,001). Intentionto-treat (ITT) analysis showed that 15 patients (47%) had complete control, 7 (21%) had a 75% and 5 (15%) had a 50-74% reduction in the frequency of falls in the fourth trimester. Twenty-two patients (68%) had side effects, but except for the three excluded because of early rash, caregivers did not consider discontinuation. Mean final dose of valproate was 35.9 mg/kg/day and that of lamotrigine 4.9 mg/kg/day. Twenty patients used clobazam, eight nitrazepam, and the other four clonazepam as the elected benzodiazepine. Outcome did not correlate with clinical, EEG, and imaging variables.Significance: This open label study suggests that the combination of valproate, lamotrigine, and a benzodiazepine can markedly reduce the frequency of epileptic drop attacks in patients with generalized or multifocal epilepsies. Careful clinical monitoring for early signs of SJS is needed.

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A case with Stevens Johnson syndrome triggered by combination of clobazam, lamotrigine, and valproic acid treatment

Cited by 16 publications

References 11 publications

Risk of toxic epidermal necrolysis and Stevens-Johnson syndrome associated with benzodiazepines: a population-based cohort study

Risk of toxic epidermal necrolysis and Stevens-Johnson syndrome associated with benzodiazepines: a population-based cohort study

Valproic acid and Stevens‐Johnson syndrome: a systematic review of descriptive studies

Long-term control of epileptic drop attacks with the combination of valproate, lamotrigine, and a benzodiazepine: A ‘proof of concept,’ open label study

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