Lamotrigine-induced Stevens-Johnson syndrome

Abstract

SJS was associated with lamotrigine use, despite appropriate dosing and dosage adjustment.

The Association Between Carbamazepine and Valproate and Adverse Cutaneous Drug Reactions in Patients With Bipolar Disorder

“…With the increased use of lamotrigine, for example, in treating patients with bipolar depression, several recent studies have reported an increase in incidence of severe adverse skin reactions. 18,44 The issue of drug-drug interaction emerges due to the increased likelihood of combined drug treatment for patients with bipolar disorder. 30,31,33,45,46 Although we did not analyze the risk of lamotrigine and valproate combination because only 4 patients were exposed to lamotrigine in our study, the findings of a recent study in Taiwan involving increased risk of skin reactions using a combination of these 2 mood stabilizers imply that lamotrigine, like carbamazepine and valproate, may cause ACDR.…”

Intrathecal Lamotrigine Attenuates Mechanical Allodynia and Suppresses Microglial and Astrocytic Activation in a Rat Model of Spinal Nerve Ligation

“…The systemic side effects of lamotrigine include skin rash, Stevens-Johnson syndrome, and toxic epidermal necrolysis 17. Although the reported frequency of serious rash in adults using lamotrigine for adjunct therapy is 0.3%, the mortality rates for Stevens-Johnson syndrome and toxic epidermal necrolysis are 5% or less and 25-30%, respectively 17.…”

“…Although the reported frequency of serious rash in adults using lamotrigine for adjunct therapy is 0.3%, the mortality rates for Stevens-Johnson syndrome and toxic epidermal necrolysis are 5% or less and 25-30%, respectively 17. Intrathecally administered lamotrigine may avoid these systemic side effects.…”

Mood-Stabilizing Agents

“…The incidence of clinically signi fi cant dermatological reactions to lamotrigine among bipolar disorder patients averages approximately 1/100 treated cases, most appearing within the fi rst 8 weeks of treatment [ 303 ] . Much of the dermatological risk can be avoided by very slow increases in doses of lamotrigine, typically starting at 25-50 mg/day unless valproate is also used, in which case, starting doses of 12.5-25 mg/day and maximum doses well below usual target doses of 200-300 mg/day are safer, and typically attained gradually over 2 or 3 weeks [ 165,194,303 ] .…”