Stevens-Johnson syndrome induced by a combination of lamotrigine and valproic acid

Abstract

Lamotrigine and valproic acid are well-tolerated anticonvulsants, but frequently associated with severe cutaneous reactions, such as the Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis, when used in combination. We report a case of SJS likely induced by the use of a lamotrigine and valproic acid regimen and as a dental surgeon it is important to identify such lesion and report to pharmacovigilance.

Adverse Effects of Antiepileptic Drug Lamotrigine and Oral Implications: Case Report

“…The interaction between lamotrigine and valproate is well documented, and it is recommended that the two drugs not be combined( 4 , 5 , 7 , 8 ).Kavitha et al ( 5 ) reported on the case of a patient with painful ulcers in the mouth, bleeding lips, rashes throughout the body, and high fever (39°C) induced by a combination of lamotrigine and valproic acid (Stevens–Johnson syndrome).This is however not the case with sertraline which was prescribed to our patient. It is generally accepted that combined therapy of lamotrigine with sertraline should not increase the risk of toxic reactions to lamitrigine.…”

“…This happens because lamotrigine is, along with other antiepileptic drugs, used in the treatment of bipolar disorderand neurologic disorders ( 2 ).The use of lamotrigine increases the risk of some mucocutaneous disorders in the population of patients recieving lamotrigine therapy. Among adverse reactions, maculopapular rashes are relativelly common (3-15%), and the most serious adverse effect of lamotrigine is development of potentially fatal Stevens–Johnson syndrome andtoxicepidermalnecrolysis ( 2 - 5 ).Adverse reactions are more common during the first two months of treatment with lamotrigine, if the dosage is increased too rapidly, and if valproate is co-administered ( 4 , 6 ).…”

Lamotrigine-induced Stevens-Johnson syndrome in a 25 year old lady

“…17 SJS has been reported from concomitant use of valproic acid and lamotrigine but reports of Lamotrigine alone causing SJS are relatively rare. 18,19 Lamotrigine is a potential anti-epileptic drug which is also used as a mood stabilizer. 3 Though our patient was concomitantly on haloperidol since four months before the addition of lamotrigine to her drug regimen, it is unlikely that Haloperidol was the cause of her SJS because symptoms of SJS were seen 5 weeks after being on lamotrigine add-on therapy.…”

“…6 Though there has been a few reported cased of lamotrigine-induced SJS in Indian patients with epilepsy in combination with valproic acid, we can find no report of SJS in Indian patients of mood disorders on lamotrigine therapy without concomitant use of valproic acid. 7 Here we report a rare case of lamotrigine-induced SJS in a 25 year old Indian patient suffering from Schizoaffective disorder. Use of the Naranjo algorithm scale indicated a probable relationship of causality with a score of 6.…”

Management of stevens-johnson syndrome-toxic epidermal necrolysis: Looking beyond guidelines!

“…High-risk drugs for the development of SJS-TEN include phenobarbital, phenytoin, carbamazepine, lamotrigine, nevirapine, nonsteroidal anti-inflammatory drugs, allopurinol, cotrimoxazole, homeopathic medicines, and fluconazole. [ 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 ]…”