Stevens-Johnson Syndrome in Patients on Phenytoin and Cranial Radiotherapy

Khafaga, Yasser; Jamshed, Arif; Allam, Ayman; Mourad, Walid A.; Eisa, Abdullah Al; Ezzat, Adnan; Gray, Alan; Schultz, Henrik

doi:10.1080/028418699431898

Cited by 46 publications

(25 citation statements)

References 19 publications

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“…Phenytoin induced SJS was reported with 100 mg of Phenytoin thrice daily after 2-3 weeks of therapy. 16 Phenytoin usage also caused oral FDE and lichenoid reaction ( Figure 5). In this regard, Carbamazepine induced SJS has already been recommended by PvPI to Central Drugs Standrd Control Organization (CDSCO) for regulatory interventions for label change (source-PvPI performance report 2014-15).…”

Section: Discussionmentioning

confidence: 99%

Cutaneous drug reactions notified by ADR monitoring centre in a tertiary care hospital of Bihar

Manjhi

Mohan

Dikshit

et al. 2016

Int J Basic Clin Pharmacol

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Background: Cutaneous drug reactions are most frequent drug related adverse events which lead to early treatment discontinuations, high treatment cost and leading cause of morbidity and mortality. The aim of this study is to analyze the clinical patterns and offending drugs as well as their causality, severity and preventive strategies.Methods: All adverse drug reactions (ADRs) forms filled from May 2015 to April 2016 were scrutinized and forms with cutaneous drug reactions were analyzed and assessed for causality, severity and preventability.Results: Out of 300 ADR forms, 160 (53.34%) included cutaneous drug reactions. 68 (42.50%) patients were male and 92 (57.50%) were female. Maculopapular rash 58 (36.25%), fixed drug eruption (FDE) 31 (19.37), pruritus 27 (16.87%) and urticaria 19 (11.87%) were the common clinical patterns of cutaneous drug reactions. Most common offending drug classes included antibiotics, anti-inflammatory and steroidal agents. Causality assessment was done by using Naranjo’s algorithm. The result showed that out of 160 cutaneous drug reactions 141 (88.12%) ADRs were probable, 15 (9.37%) were classified as possible; 2 (1.25) doubtful and 2 (1.25%) were definitely related to the drug.Conclusions: The present study shows cutaneous drug reactions are commonly reported at ADR monitoring centre of this tertiary care hospital. Our study suggests that there is a need of intensive monitoring for ADRs in tertiary care hospital for early detection and to ensure the patient safety.

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Section: Discussionmentioning

confidence: 99%

Cutaneous drug reactions notified by ADR monitoring centre in a tertiary care hospital of Bihar

Manjhi

Mohan

Dikshit

et al. 2016

Int J Basic Clin Pharmacol

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“…It has been observed that the frequency of AED-induced severe cutaneous reactions is greatly increased in patients with brain tumours who undergo cranial irradiation (74) when they are receiving PHT or, less frequently, PB, CBZ or LTG (60,75,76,77). In this population of patients, mild skin rashes are also more frequently induced by aromatic AEDs (60).…”

Section: Brain Tumoursmentioning

confidence: 99%

Neurological comorbidity and epilepsy: implications for treatment

Zaccara¹

2009

Acta Neurologica Scandinavica

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“…The combination of carbamazepine and acetaminophen further increases the risk of hypersensitivity skin reactions [1]. Erythema multiforme as a synergistic side effect to a combination of phenytoin therapy and cranial radiotherapy is also reported [2]. The routine use of postoperative phenytoin as a prophylactic anticonvulsant in the absence of a history of seizures is discouraged [3][4].…”

Section: Pediatric Neurology Briefs 2014 66mentioning

confidence: 99%

Valproate-Induced Reversible Brain Atrophy and Cognitive Deterioration

Millichap¹,

Millichap²

2014

Pediatr Neurol Briefs

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Pediatric Neurology Briefs 2014 66ethosuximide, and gabapentin. Anticonvulsants in addition to phenytoin with increased risk of erythema multiforme, Stevens-Johnson syndrome (SJS), and toxic epidermal necrolysis (TEN) include carbamazepine, oxcarbazepine, valproate, phenobarbital, and lamotrigine. The combination of carbamazepine and acetaminophen further increases the risk of hypersensitivity skin reactions [1]. Erythema multiforme as a synergistic side effect to a combination of phenytoin therapy and cranial radiotherapy is also reported [2]. The routine use of postoperative phenytoin as a prophylactic anticonvulsant in the absence of a history of seizures is discouraged [3][4].The US FDA cautions that phenytoin or fosphenytoin should not be prescribed as an alternative to carbamazepine in patients who carry HLA-B*15.02, although the association with severe cutaneous reactions in Asians is weaker than that found with carbamazepine [5]. Current studies find that the HLA-DRB1*15.01 allele is a risk factor for AED-induced SJS/TEN among Han Chinese, whereas HLA-A*33.03, HLA-B*58.01, and HLA-DRB1*03.01 alleles may be protectors against AED-induced skin reactions, especially CBZ-SJS/TEN [6]. Patients of Han ethnicity living in northeastern China and having EPHX1 c.337T>C polymorphisms also show an increased risk of developing CBZ-SJS/TEN, related to an increased concentration of a CBZ metabolite, CBZ-10,11-epoxide [7]. The discovery of a functional link of genetic variants to the phenytoin, carbamazepine, and other aromatic AED-related hypersensitivity cutaneous reactions might lead to prospective preventive genetic testing.

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Stevens-Johnson Syndrome in Patients on Phenytoin and Cranial Radiotherapy

Cited by 46 publications

References 19 publications

Cutaneous drug reactions notified by ADR monitoring centre in a tertiary care hospital of Bihar

Cutaneous drug reactions notified by ADR monitoring centre in a tertiary care hospital of Bihar

Neurological comorbidity and epilepsy: implications for treatment

Valproate-Induced Reversible Brain Atrophy and Cognitive Deterioration

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