Stevens-Johnson Syndrome following Failure of Genetic Screening prior to Carbamazepine Prescription

Nasir, Suraya Ahmad; Tan, Huann Lan; Tan, Hui Jan; Hussaini, Haizal Mohd; Ramli, Roszalina

doi:10.1155/2017/4201357

Cited by 6 publications

(6 citation statements)

References 21 publications

(24 reference statements)

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“…condition involving mucous membrane and skin [1] . CBZ is extensively used in all over the world in the management of epilepsy, trigeminal neuralgia and bipolar disorder [2] .…”

mentioning

confidence: 99%

Measurement and Comparison of Carbamazepine Plasma Levels for Assessment of Compliance, Safety and Toxicity

Shaikh¹,

Guo²

2017

pharmaceutical-sciences

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Shaikh and Guo: Measurement of Carbamazepine plasma levelsCarbamazepine is one of the most frequently prescribed antiepileptic drugs and influence of genetic differences, sex, age and race on the plasma levels of carbamazepine and its metabolites is well known. The objective of this study was to assess and compare the compliance, safety and toxicity in different age and gender groups of Chinese epileptic patients on the basis of therapeutic drug monitoring results of carbamazepine, since Han-Chinese are at higher risk of developing serious and fatal adverse effects when exposed to carbamazepine. The therapeutic drug monitoring results of carbamazepine in epileptic patients, obtained with validated methods were complied, evaluated and compared for compliance, safety and toxicity in different age and gender groups of Chinese epileptic patients. The therapeutic drug monitoring results of males and females were separately compiled and thereafter each gender group was further divided into children, adults and elderly as different age group. All age groups in both gender groups were evaluated for therapeutic, sub-therapeutic and toxic ranges. It was found that 45 % of samples of total samples had sub-therapeutic levels and 55 % of all samples had carbamazepine levels in therapeutic range, and none of gender and age group found in toxic range. Compared to males, female samples were more in number of sub-therapeutic levels. Populations of children males and children females were having more samples in sub-therapeutic levels as compared to adult and elderly males and females, respectively. However, it needs further evaluation. The findings of present study revealed that majority of patients were in sub-therapeutic levels. It is suggested that regularly therapeutic drug monitoring of carbamazepine should be performed and dose of carbamazepine in epileptic patients should be adjusted only after therapeutic drug monitoring results in order to assess the compliance, optimize the efficacy, safety and minimize the toxicity.

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“…condition involving mucous membrane and skin [1] . CBZ is extensively used in all over the world in the management of epilepsy, trigeminal neuralgia and bipolar disorder [2] .…”

mentioning

confidence: 99%

Measurement and Comparison of Carbamazepine Plasma Levels for Assessment of Compliance, Safety and Toxicity

Shaikh¹,

Guo²

2017

pharmaceutical-sciences

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“…e most significant is HLA-B * 15 : 02 with carbamazepine-induced SJS among the Asian population. Genetic screening for HLA-B * 15 : 02 can be performed prior to the prescription of carbamazepine, especially in Southeast Asia, where the prevalence of this allele is high [3]. Unfortunately, in our case, we cannot confirm that the allele is the cause for TEN as a genetic test was not performed.…”

Section: Discussionmentioning

confidence: 83%

“…Both conditions are characterized by full-thickness epidermal necrosis and severe mucous membrane in ammation leading to mucocutaneous sloughing and denudation [3].…”

Section: Introductionmentioning

confidence: 99%

Carbamazepine Induced Stevens-Johnson Syndrome That Developed into Toxic Epidermal Necrolysis: Review of the Literature

Abuzneid

Alzeerelhouseini

Rabi

et al. 2022

Case Reports in Dermatological Medicine

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Background. Stevens-Johnson syndrome and toxic epidermal necrolysis are both skin diseases believed to be following the pattern of a type IV hypersensitivity mechanism, which can be triggered by infectious agents or administration of a variety of drugs as part of the spectrum of severe cutaneous adverse reactions (SCARs). Fever and blisters, that peel forming painful raw areas, are early symptoms of this condition, and complications such as dehydration, sepsis, pneumonia, and multiple organ failure are typically seen during the course of the disease. Case Presentation. We present a case of a 23-year-old female patient referred to our hospital after taking carbamazepine and developing high-grade fever and ulcers that appeared initially in her mouth and face but then progressed despite treatment, extending all over her body and involving about 90% of her BSA. Conclusion. The use of IVIG and plasmapheresis was a good management for our case, helping in our patient’s well-being and recovery. Even if there is no stipulated guideline treatment for cases of SJS and TEN, we think that further investigations about IVIG and plasmapheresis should be investigated as a possible way to treat both conditions.

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“…This could also apply to dentists for trigeminal neuralgia treatment with carbamazepine. 15 In 21 years, there were 99 reported cases involving children with carbamazepine-induced SCARs. The proportion of SCARs for children treated with carbamazepine was slightly higher, as compared to adults.…”

Section: Discussionmentioning

confidence: 99%

“…Nevertheless, physicians treating patients with carbamazepine should be vigilant, with high clinical suspicion of SCARs, especially during the first 2 weeks of initiation of carbamazepine up to a month for any SCARs. This could also apply to dentists for trigeminal neuralgia treatment with carbamazepine 15 …”

Section: Discussionmentioning

confidence: 99%

Carbamazepine‐Induced Severe Cutaneous Adverse Drug Reactions: A 21‐Year Comparison Between Children and Adults in Malaysia

Hariraj

Lee

et al. 2023

The Journal of Clinical Pharma

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Severe cutaneous adverse drug reactions (SCARs) are a life‐threatening condition. We aimed to identify all carbamazepine‐induced SCARs voluntarily reported to the Malaysian pharmacovigilance database and to compare between children and adults. Adverse drug reaction reports for carbamazepine were extracted from 2000 to 2020, and divided into 2 groups, that is, children (aged 0–17 years) and adults (aged 18 years and above). Age, sex, race, and carbamazepine dose were analyzed using multiple logistic regression. Of 1102 carbamazepine adverse drug reaction reports, 416 reports were SCARs (99 children, 317 adults). Stevens–Johnson syndrome and toxic epidermal necrolysis were the main SCAR types for both age groups. Median time‐to‐onset for any type of SCAR was 13 days, regardless of age. In children, Malay individuals were 3.6 times more likely to report SCARs (95% confidence interval, 1.356–9.546; P = .010) compared to the Chinese population. In adults, carbamazepine‐induced SCARs were reported as 3.6 times higher in those with a daily dose of 200 mg or less as compared to a daily dose of 400 mg or more. (95% confidence interval, 2.257–5.758; P < .001) Carbamazepine‐induced SCARs reported in Malaysia were predominantly Stevens–Johnson syndrome or toxic epidermal necrolysis, with the majority in Malay individuals. Initiation therapy needs close monitoring between 2 weeks and 1 month.

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Stevens-Johnson Syndrome following Failure of Genetic Screening prior to Carbamazepine Prescription

Cited by 6 publications

References 21 publications

Measurement and Comparison of Carbamazepine Plasma Levels for Assessment of Compliance, Safety and Toxicity

Measurement and Comparison of Carbamazepine Plasma Levels for Assessment of Compliance, Safety and Toxicity

Carbamazepine Induced Stevens-Johnson Syndrome That Developed into Toxic Epidermal Necrolysis: Review of the Literature

Carbamazepine‐Induced Severe Cutaneous Adverse Drug Reactions: A 21‐Year Comparison Between Children and Adults in Malaysia

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