Identifying the incidence of rash, Stevens-Johnson syndrome and toxic epidermal necrolysis in patients taking lamotrigine: a systematic review of 122 randomized controlled trials

Bloom, Romi; Amber, Kyle T.

doi:10.1590/abd1806-4841.20175070

Cited by 39 publications

(24 citation statements)

References 10 publications

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“…The most concerning of this adverse reactions is SJS/toxic epidermal necrolysis (TEN). The incidence of SJS/TEN is 0.04%, which is the highest frequency in anti-epileptic drugs [16]. But LTG is less teratogenic so that there is a tendency to be prescribed for young women.…”

Section: Discussionmentioning

confidence: 99%

A Japanese Woman with Stevens-Johnson Syndrome without Skin Lesions Induced by an Initial Dosage of Lamotrigine

Sumida¹,

Ishino²,

Saitou³

et al. 2019

AJCEM

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Atypical Stevens-Johnson syndrome (SJS) which is characterized by little or no skin involment, is reported to be triggered by less medications than infection. There are few reports with atypical SJS induced by medications. This is a case report of atypical SJS induced by Lamotrigine (LTG). A 31-year-old Japanese woman, who was bipolar disorder and prescribed an initial dosage of LTG 25mg/day ten days ago, presented with high fever and throat pain for two days. At first she was suspected of pharyngitis and administered antibiotics. She was hospitalized on the first visit day, but she was getting worse and fell into shock over several days. Furthermore she presented with erosions and bleeding of her lips and oral mucosa on day6, and so she was diagnosed with SJS, but her skin lesions were mild even at the extreme of the clinical course. She gradually developed acute pulmonary failure, liver dysfunction, coma and Disseminated Intravascular Coagulation (DIC). But she was treated with intensive care consisting of steroid pulse followed by high dose corticosteroids, and so she gradually recovered from SJS and corticosteroids could be tapered. At last she was discharged on day50 and had no sequelae with SJS. It was extremely difficult to diagnose this case as atypical SJS because of the unremarkable skin lesions and similarity to pharyngitis. It was also characteristic that she was already in severe status when it satisfied the diagnostic criteria for SJS. But physicians should not miss from the perspective of the fatality and social problem. It should be noted that atypical SJS shows mild or little cutaneous lesions.

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Section: Discussionmentioning

confidence: 99%

A Japanese Woman with Stevens-Johnson Syndrome without Skin Lesions Induced by an Initial Dosage of Lamotrigine

Sumida¹,

Ishino²,

Saitou³

et al. 2019

AJCEM

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“…A rash is a common side effect of LTG treatment, occurring in 8.3%, with half of these withdrawing medications as a consequence [34]. This may be an over cautious measure, as separate studies have found that only 0.04% of new users develop SJS/TEN, and less than 0.1% develop DRESS [35]. Many clinicians are aware of appearance or aggravation of acne in those staring lamotrigine, however literature on this is sparse [36].…”

Section: Lamotriginementioning

confidence: 99%

Risks and management of antiepileptic drug induced skin reactions in the adult out-patient setting

Fowler

Bansal

Lozsádi

2019

Seizure

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Adverse cutaneous reactions caused by mostly aromatic antiepileptic drugs (AED) affect 50.000 people a year in the United Kingdom (UK; incidence 75.7/100.000). Optimal management of these cases is often difficult, as the patient may report symptoms to a general practitioner, attend Accident & Emergency or inform a specialist over the telephone or via email. When clinical assessment is limited it is thought safest to withdraw offending medication and inform the patient of a new drug allergy. This may unjustifiably restrict future treatment choices, and increase cost. Most frequent offenders are aromatic AEDs: carbamazepine, oxcarbazepine, eslicarbazepine, phenytoin, lamotrigine, phenobarbitone, primidone (recently licensed lacosamide associated with lower risk) and the sulpha-derivative zonisamide. Our study provides a summary of severe delayed allergic reactions and offers a pragmatic management pathway for patients suffering a suspected drug-induced rash. We include UK pretreatment screening guidelines, step by step clinical assessment of rash and associated symptoms aiding early identification of patients at risk of developing severe allergic reactions. At the same time our manuscript reviews published data informing best choice and titration of alternative medication when allergy confirmed. Finally we summarize current knowledge on genetic predisposition and other personalized risks of AED allergies identifying gaps in our current understanding.

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“…Furthermore, among 122 randomized controlled trial of LTG monotherapy totalizing 18,698 patients, Bloom and Amber found only 8.3% of benign and self‐limited morbiliform rash but 0.04% of Stevens‐Johnson syndrome and Lyell syndrome . Fatal severe cutaneous adverse reactions related to LTG use are extremely rare and estimated at 0.01 per 1000 patient‐year (3.5% of severe cutaneous adverse reactions) and imposes strict compliance with the drug scheduled regimen as well as the immediate cessation of drug intake at first signs suggestive of immunoallergic reactions (eg, high fever, influenza‐like symptoms, conjunctival itching, cutaneous erythema, progressive blistering, mucosal erosions, or hematological abnormalities) .…”

Section: The Safety and Tolerance Of Lamotrigine Appears Among The Himentioning

confidence: 99%

Lamotrigine in the Prevention of Migraine With Aura: A Narrative Review

Buch

Chabriat

2019

Headache

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Background Lamotrigine is not recommended in the prevention of migraine in general but some reports suggest that it might be effective for treating specifically migraine with aura (MA). This review aims to summarize the related data from the literature and to better understand this discrepancy. Methods All reports from the literature related to the use of lamotrigine in migraine with or without aura published prior to February 2019 found using PUBMED and the 2 keywords “migraine” AND “lamotrigine” were reviewed. Original studies, published in full, systematic reviews, and all case reports were synthetized. We also examined the risk profile, pharmacokinetics, and mode of action of lamotrigine in view of the presumed mechanism of MA. Results Lamotrigine was tested in different populations of migraineurs, but previous studies had small sample sizes (n < 35) and might not have been powered enough for detecting a potential benefit of lamotrigine in MA. Accumulating data suggest that the drug can reduce both the frequency and severity of aura symptoms in multiple conditions and is well tolerated. Conclusion Lamotrigine appears promising for treating attacks of MA and related clinical manifestations because of its high potential of efficacy, low‐risk profile, and cost. Additional studies are needed for testing lamotrigine in patients with MA.

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Identifying the incidence of rash, Stevens-Johnson syndrome and toxic epidermal necrolysis in patients taking lamotrigine: a systematic review of 122 randomized controlled trials

Cited by 39 publications

References 10 publications

A Japanese Woman with Stevens-Johnson Syndrome without Skin Lesions Induced by an Initial Dosage of Lamotrigine

A Japanese Woman with Stevens-Johnson Syndrome without Skin Lesions Induced by an Initial Dosage of Lamotrigine

Risks and management of antiepileptic drug induced skin reactions in the adult out-patient setting

Lamotrigine in the Prevention of Migraine With Aura: A Narrative Review

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