Anticonvulsant hypersensitivity syndrome to lamotrigine confirmed by lymphocyte stimulation in vitro

Karande, Sunil; Gogtay, Nithya J; Kanchan, Sandeep; Kshirsagar, Nilima A

doi:10.4103/0019-5359.19914

Cited by 13 publications

(10 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…It is a type of drug hypersensitivity reaction and is more likely to occur with anticonvulsants. Carbamazepine, oxcarbazepine, valproate, and LTG are some of the medications implicated and cross-reactivity is about 50-80 % (Karande et al, 2006;Kaur et al, 2002). It is more common in anticonvulsants that have an aromatic benzene ring (e.g.…”

Section: Anticonvulsant Hypersensitivity Syndromementioning

confidence: 99%

Lamotrigine-associated rash: to rechallenge or not to rechallenge?

Lorberg

Youssef

Bhagwagar

2008

Int. J. Neuropsychopharm.

View full text Add to dashboard Cite

The major burden of illness in bipolar disorder (BD) is in the depressive pole. Lamotrigine has been shown to be useful in the long-term prophylaxis of depressive episodes in BD. Current guidelines recommend discontinuing lamotrigine in patients who develop rash. Our objective in this paper is to review literature to identify possible predictors of serious vs. benign rash that might help guide clinical decision-making and recommend titration strategy for re-introduction of lamotrigine, if indicated. We performed a search of the literature between 1966 and July 2008 to investigate the phenomenon of lamotrigine-induced rash and rechallenge procedures. The search identified six reports, and we were able to identify another case series from reviewing the bibliography of all of the above papers. We reviewed all the papers of lamotrigine rash rechallenge that resulted from the literature search. These papers describe 44 cases of lamotrigine rechallenge. Currently, there are 39 reported cases in the literature of successful lamotrigine rechallenge after a rash and five cases with rash recurrence. There are some characteristics of the rash that can help identify serious cases from benign ones. In addition, very slow titration of lamotrigine is crucial to the reduction of rash recurrence rate. Several cases that develop benign rash on lamotrigine can be rechallenged without adverse consequences. We believe that lamotrigine rechallenge in bipolar depression is an under-utilized option in our clinical armamentarium, and further studies are needed to guide us in this area.

show abstract

Section: Anticonvulsant Hypersensitivity Syndromementioning

confidence: 99%

Lamotrigine-associated rash: to rechallenge or not to rechallenge?

Lorberg

Youssef

Bhagwagar

2008

Int. J. Neuropsychopharm.

View full text Add to dashboard Cite

show abstract

“…[1][2][3][4][5][6][7] AHS has been reported with nonaromatic anticonvulsant such as valproic acid (VPA) and lamotrigine (LTG), through rare. [8][9][10] Incidence of AHS is 1/1000-1/10,000 exposures [1,2] with a mortality rate of about 10%. We report a case of severe AHS secondary to injudicious combination of carbamazepine, LTG and VPA.…”

Section: A Nticonvulsant Hypersensitivity Syndrome (Ahs)mentioning

confidence: 99%

Injudicious use of anticonvulsants leading to life-threatening event

Sharma¹,

Saikia²,

Sharma³

et al. 2014

Indian J Paediatr Dermatol

View full text Add to dashboard Cite

83seizures persisted. MRI brain revealed left temporal and occipital gliosis. Electroencephalography show epileptiform discharges from the left temporal region.Child was subsequently started on VPA (17 mg/kg/day), LTG (6 mg/kg/day) by neurologist and phenytoin was gradually stopped. Seizures frequency decreased and Carbamazepine was also added after 10 days (11.8 mg/kg/day). Thereafter, child remained seizure free for next 4 months.At present, child had fever and cough, treated with paracetamol, amoxycilin and clavulanic acid. Within 24 h she developed rash and was hospitalized. LTG, carbamazepine and amoxicillin were stopped. VPA was continued and rash continued to increase. Subsequently VPA was stopped and phenobarbitone was added. Child was referred to us in view of worsening of rash and hepatic involvement.At admission, child was hemodynamically stable. Extensive vesicobullous lesions with nikolsky sign positivity were present. 30% of body surface area had cutaneous detachment. Mucosal surfaces, bilateral conjunctiva were also involved. Cornea was spared. ABSTRACTEpilepsy is common childhood problem and advent of newer anticonvulsant drugs has led to injudicious uses. Anticonvulsant hypersensitivity syndrome (AHS) has been previously described developing secondary to aromatic anticonvulsants such as phenytoin and carbamazepine. AHS developing secondary to non-aromatic anticonvulsant agents such as lamotrigine (LTG) and valproic acid (VPA) is rare. We present a case of an 11-year-old girl with known epilepsy on VPA, LTG and carbamazepine therapy that developed fever with the clinical pattern of Steven-Johnson syndrome/toxic epidermal necrolysis requiring pediatric intensive care. Judicious use of anticonvulsant should be done in appropriate dose especially in pediatric population and when used in combination to prevent AHS like life-threatening event.

show abstract

“…Less frequent are erythema multiforme and the life-threatening syndromes of drug hypersensitivity syndrome, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). [50,[102][103][104] The total number of lamotrigine-related deaths from rash was reported at ten in 1999, with an estimated worldwide exposure of >950 000 at that time. [102] In 1999, data pooled from 1233 children revealed that 13% developed rash, with 1% considered serious.…”

Section: Skinmentioning

confidence: 99%

The Safety and Tolerability of Newer Antiepileptic Drugs in Children and Adolescents

Sarco

Bourgeois

2010

CNS Drugs

View full text Add to dashboard Cite

The newer antiepileptic drugs (AEDs) provide more therapeutic options and overall improved safety and tolerability for patients. To provide the best care, physicians must be familiar with the latest tolerability and safety data. This is particularly true in children, given there are relatively fewer studies examining the effects of AEDs in children compared with adults. Since we now have significant paediatric literature on each of these agents, we provide a comprehensive and current literature review of the newer AEDs, focusing on safety and tolerability data in children and adolescents. Because the safety profiles in children differ from those in adults, familiarity with this literature is important for child neurologists and other paediatric caregivers. We have organized the data by organ system for each AED for easier reference.

show abstract

Anticonvulsant hypersensitivity syndrome to lamotrigine confirmed by lymphocyte stimulation in vitro

Cited by 13 publications

References 12 publications

Lamotrigine-associated rash: to rechallenge or not to rechallenge?

Lamotrigine-associated rash: to rechallenge or not to rechallenge?

Injudicious use of anticonvulsants leading to life-threatening event

The Safety and Tolerability of Newer Antiepileptic Drugs in Children and Adolescents

Contact Info

Product

Resources

About