Comparison and predictors of rash associated with 15 antiepileptic drugs

Arif, Hiba; Buchsbaum, Richard; Weintraub, David; Koyfman, Shlomo A.; Salas-Humara, Caroline; Bazil, Carl W.; Resor, Stanley R.; Hirsch, Lawrence J.

doi:10.1212/01.wnl.0000261917.83337.db

Cited by 230 publications

(203 citation statements)

References 28 publications

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“…AEDs infrequently associated with allergic reactions are levetiracetam, topiramate, gabapentin, and divalproex. 15 Many patients, particularly the elderly, are sensitive to CNS-related medication side effects, such as dizziness, somnolence, and imbalance. 16 They often tolerate and respond to treatment with standard AEDs if AEDs are titrated very slowly to low doses.…”

Section: Why Is It Important To Recognize Medically Resistant Epilepsy?mentioning

confidence: 99%

Treating patients with medically resistant epilepsy

Krauss

Sperling

2011

Neur Clin Pract

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Section: Why Is It Important To Recognize Medically Resistant Epilepsy?mentioning

confidence: 99%

Treating patients with medically resistant epilepsy

Krauss

Sperling

2011

Neur Clin Pract

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“…It appears that patients tend to be given phenobarbital much more frequently than primidone, from its higher numbers of exposure across all retrospective studies, and those patients with previous rash to phenobarbital are unlikely to be given primidone subsequently; this would result in a low-risk group of patients being given primidone, as proposed by Arif and coworkers (27). Primidone is a BDDCS class 2 drug and therefore shares reactive properties that we hypothesize would cause a drug hypersensitivity event, as observed in the American retrospective study (Fig.…”

Section: Discussionmentioning

confidence: 97%

Use of the Biopharmaceutics Drug Disposition Classification System (BDDCS) to Help Predict the Occurrence of Idiosyncratic Cutaneous Adverse Drug Reactions Associated with Antiepileptic Drug Usage

Chan

Wei

Chen

et al. 2016

AAPS J

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Abstract. Cutaneous adverse reactions (CARs) from antiepileptic drugs (AEDs) are common, ranging from mild to life-threatening, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). The identification of subjects carrying the HLA-B*15:02, an inherited allelic variant of the HLA-B gene, and the avoidance of carbamazepine (CBZ) therapy in these subjects are strongly associated with a decrease in the incidence of carbamazepine-induced SJS/TEN. In spite of the strong genetic associations, the initiation of hypersensitivity for AEDs is still not very well characterized. Predicting the potential for other AEDs to cause adverse reactions will be undoubtedly beneficial to avoid CARs, which is the focus of this report. Here, we explore the use of the Biopharmaceutics Drug Disposition Classification System (BDDCS) to distinguish AEDs associated with and without CARs by examining the binding relationship of AEDs to HLA-B*15:02 and data from extensive reviews of medical records. We also evaluate the lack of benefit from a Hong Kong population policy on the effects of screening for HLA-B*15:02 and previous incorrect structure-activity hypotheses. Our analysis concludes that BDDCS class 2 AEDs are more prone to cause adverse cutaneous reactions than certain BDDCS class 1 AEDs and that BDDCS Class 3 drugs have the lowest levels of cutaneous adverse reactions. We propose that BDDCS Class 3 AEDs should be preferentially used for patients with Asian backgrounds (i.e., Han Chinese, Thai, and Malaysian populations) if possible and in patients predisposed to skin rashes.

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“…7,8 Arif et al emphasized that the only non-drug predictor of antiepileptic drug (AED) related rash was rash to another AED, with an odds ratio of 3.1. 4 This patient had a hematologic malignancy which at least in partly may have contributed to the development of rash via immune mechanisms. As a precaution, pregabalin treatment was started with lower doses (150 mg) and increased to recommended dose (300 mg).…”

Section: Discussionmentioning

confidence: 98%

Rash associated with Pregabalin: A case report

Alkan²,

Göker³

et al. 2013

J Clin Exp Invest

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ÖZETKırksekiz yaşında ve 2 aydır nöropati tedavisi için 300 mg/gün oral yolla pregabalin kullanan erkek hasta, ekstremiteler ve lomber bölgesinde eritematöz, makülopapü-ler döküntü şikayeti ile başvurdu. Naranjo olasılık skalası döküntü ve pregabalin kullanımı arasında muhtemel bir ilişkiyi gösterdi. Pregabalin tedavisi kesilerek, antihistaminik tedavi, oral metilprednizolon ve topical steroidli krem başlandı. Tedavinin kesilmesinden 1 hafta sonra döküntü neredeyse tamamen düzeldi. Pregabalin ilişkili döküntü faz 3 klinik çalışmalarda nadiren rapor edilmiştir. Pregabalin kullanımına eşlik eden döküntü daha önce yalnızca bir vaka raporunda sunulmuştur. Pregabalin ilişkili dökün-tünün mekanizması tam olarak anlaşılamamıştır. Düşük dozlarda pregabalin tedavisine başlamak ve doz artımını yavaş yapmak yan etki insidansını azaltabilir. Anahtar kelimeler: pregabalin, döküntü, multipl myelom ABSTRACTA 48-year-old man with erythematous, maculopapular rash localized to his extremities and lumbar region that he had been receiving oral pregabalin 300 mg per day for 2 months to treat his neuropathy was applied. The Naranjo probability scale indicates a probable relationship between the development of rash and use of pregabalin by our patient. Pregabalin was discontinued and antihistaminic treatment, oral methyprednisolone and topical steroid cream were given to treat the rash. The rash almost completely resolved one week after pregabalin was discontinued. Pregabalin-induced rash was rarely reported in Phase 3 clinical trials, and there is currently only one available report on the development of a rash coinciding with the use of pregabalin. No clear mechanisms reported for rash associated with pregabalin. It is usually recommended to start pregabalin with low doses and slow increases might prevent the incidence of side effects. J Clin Exp Invest 2013; 4 (1): 107-109

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Comparison and predictors of rash associated with 15 antiepileptic drugs

Abstract: The rate of an antiepileptic drug (AED) rash is approximately five times greater in patients with another AED rash (8.8%) vs those without (1.7%). Rash rates were highest with phenytoin, lamotrigine, and carbamazepine and low (<1%) with several AEDs.

Cited by 230 publications

References 28 publications

Treating patients with medically resistant epilepsy

Treating patients with medically resistant epilepsy

Use of the Biopharmaceutics Drug Disposition Classification System (BDDCS) to Help Predict the Occurrence of Idiosyncratic Cutaneous Adverse Drug Reactions Associated with Antiepileptic Drug Usage

Rash associated with Pregabalin: A case report

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