allergic reaction medicine / medication
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Key points include:
- SJS/TEN starts with flu-like symptoms, followed by a painful rash that spreads and blisters.
- The top layer of affected skin dies, sheds, and begins to heal after several days.
- It is usually caused by a skin reaction to medication, with common drug triggers including antibiotics, epilepsy drugs, sulfa drugs, and allopurinol.
- Hospitalization is usually required for treatment.
SJS Stevens Johnson Syndrome
A severe and sometimes fatal form of skin rash caused by lamictal side effect allergic reaction medicine bipolar medication
Therapeutic Drug Monitoring in Psychiatry: Enhancing Treatment Precision and Patient Outcomes
Pharmaceuticals 2024, 17(5), 642; https://doi.org/10.3390/ph17050642
When initiating carbamazepine therapy, patients should be instructed about the risk for skin rashes and the rare Stevens–Johnson syndrome, which are more common during the first weeks [21].
The risk for Stevens–Johnson syndrome seems higher in the population with the HLA-B*1502 allele [75].
Sodium levels should be checked at least annually, while blood pressure, lipid profile, and fasting glucose should be assessed at three and six months from the start of the treatment, and then annually. The BMI should also be checked, especially if the patient is on concomitant atypical antipsychotic therapy. Blood sampling for carbamazepine monitoring should be taken 12 h after the last dose, every six to twelve months [21].
Saliva sampling has also been considered as a valid alternative to standard blood sampling in carbamazepine TDM [28]. A study conducted in Indian patients with epilepsy revealed a good correlation between saliva and serum sampling, although the significance was lost in the case of polytherapy with more than three antiepileptic medications [29]. The validity of this less-invasive method was also more recently confirmed by another group of researchers, who demonstrated a good repeatability of saliva sampling [30].
Other studies have shown the possibility to measure carbamazepine levels in urine samples with good accuracy [31,32]. As for other drugs, the TDM of carbamazepine (and often the other required screening tests) is not performed enough, especially in mental-health settings [76,77], despite being a mandatory assessment.
Epidermal Necrolysis Tied to 34% Mortality in French Study
Edited by Gargi Mukherjee
October 10, 2024
METHODOLOGY:
- Researchers conducted a nationwide cohort study using the French Health System database that included 1221 adult patients (median age, 66 years; women, 56.3%) who were hospitalized with SJS, SJS and TEN overlap, and TEN between January 2013 and December 2022.
- The median length of hospital stay was 17 days.
- The primary outcome was the incidence of epidermal EN per million person-years; secondary outcomes included in hospital mortality and post-discharge mortality within 1 year.
TAKEAWAY:
- The overall incidence of EN was 2.6 cases per million person-years, with SJS at 1.0, SJS/TEN at 0.7, and TEN at 1.0 cases per million person-years.
- The mortality rate at 1 year for EN was 34%. The overall in hospital mortality rate was 19%, and the post-discharge mortality rate up to 1 year was 15%.
- Age, diagnosis of TEN, transfer to an intensive care unit, and comorbidities such as dementia, liver disease, and cancer were associated with higher in hospital mortality. Comorbidities including cancer, liver disease, and dementia and acute kidney injury and sepsis during hospitalization were associated with higher post-discharge mortality.
- Among 987 patients (80.3%) who survived the acute stage, 25% developed at least one new comorbidity within a year, with higher rates of ophthalmologic, mood, and respiratory disorders observed in those with TEN compared with SJS or SJS/TEN.
IN PRACTICE:
"We found that despite EN being a rare condition, it is associated with high in hospital and post-discharge mortality and a high burden of sequelae," the authors wrote. More studies "are warranted to replicate these findings, to compare EN post-discharge mortality with other conditions, and to construct models to estimate long-term outcomes and sequelae in patients with EN," they added.
SOURCE:
The study was led by Thomas Bettuzzi, MD, MPH, Service de Dermatologie, Hôpital Henri Mondor, Assistance Publique-Hôpitaux de Paris, Paris, France, and was published online on October 2 in JAMA Dermatology.
Stevens Johnson Syndrome
Stevens-Johnson Syndrome: The Connection to Pharmaceutical Drugs Medicine
Treatment of bipolar depression: clinical practice vs. adherence to guidelines—data from a Bavarian drug surveillance project
- Department of Psychiatry and Psychotherapy, kbo-Lech-Mangfall-Klinik Garmisch-Partenkirchen, Garmisch-Partenkirchen, Germany
- 2Department of Psychiatry and Psychotherapy, kbo-Isar-Amper-Klinikum, Haar, Germany
- 3Department of Psychiatry and Psychotherapy, Ludwig-Maximilians-University, Munich, Germany
- 4Bavarian Institute for Data, Analysis and Quality Assurance, Munich, Germany
Of the patients, 14% were prescribed lamotrigine, which has a level 0 recommendation for the treatment of acute BPD and a level B recommendation for prophylaxis of depressive episodes in BD, though drug approval in Germany is limited to the latter.
The weak level 0 recommendation is based on only two controlled studies in outpatients, one in patients with bipolar I compared to placebo (42) and the other in patients with bipolar II compared to lithium (43). Of all drugs that were found to be superior to placebo in the network meta-analysis by Yildiz et al. (29), lamotrigine had the smallest effect size.
Additionally, the use of lamotrigine in the treatment of acute BPD is limited by the necessity of slow dose titration, due to the risk of Stevens–Johnson syndrome.
Nevertheless, considering the generally favorable side effect profile (44), the efficacy in the prophylaxis of depressive episodes, and the positive results for lamotrigine as adjunctive treatment to lithium or quetiapine in the acute episode (45–47), it is surprising that it is not prescribed more often.
Burns
. 2020 Jun;46(4):959-969. doi: 10.1016/j.burns.2019.10.008. Epub 2019 Dec 30.
Retrospective study of 213 cases of Stevens-Johnson syndrome and toxic epidermal necrolysis from China
Abstract
Background: Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but severe adverse drug reactions with high mortality. The use of corticosteroids and the management of complications (e.g. infection) in SJS/TEN remains controversial.
Methods: A retrospective study was performed among 213 patients with SJS/TEN who were hospitalized in our department between 2008 and 2018, to investigate the causative agents, clinical characteristics, complications, and prognoses of SJS/TEN mainly treated by systemic corticosteroids combined with intravenous immunoglobulin (IVIG).
Results: The causative drugs of SJS/TEN in these patients mainly consisted of antibiotics (61/213, 28.6%), anticonvulsants (52/213, 24.4%), and nonsteroidal anti-inflammation drugs (24/213, 11.3%), among which carbamazepine was the most frequently administered drug (39/213, 18.3%). There were significant differences in the maximum dosage, time to corticosteroid tapering, and the total dosage of corticosteroid between the SJS group and the TEN group, as well as among the three groups (P = 0.000), whereas in the initial dose of corticosteroid was not statistically significant among the three groups (P = 0.277). In a series of 213 cases, 18.4 cases (8.6%) were expected to die based on the score for the toxic epidermal necrolysis (SCORTEN) system, whereas eight deaths (3.8%) were observed; the difference was not statistically significant (P = 0.067; SMR = 0.43, 95% CI: 0.06, 0.48). The most common complications were electrolyte disturbance (174/213, 81.7%), drug-induced liver injury (64/213, 30.0%), infection (53/213, 24.9%), and fasting blood sugar above 10 mmol/L (33/213, 15.5%). Respiratory system (22/213, 10.3%) and wound (11/213, 5.2%) were the most common sites of infection. Multivariate logistic regression analysis indicated that the maximum blood sugar (≥10 mmol/L), the time to corticosteroid tapering (≥12 d), the maximum dosage of corticosteroid (≥1.5 mg/kg/d), and the total body surface area (TBSA) (≥10%) were defined as the most relevant factors of the infection.
Conclusion: The mortality of patients in this study was lower than that predicted by SCORTEN, although there was no significant difference between them. Hyperglycemia, high-dose corticosteroid, and the TBSA were closely related to the infections of patients with SJS/TEN.
Did Lamictal cause Stevens Johnson Syndrome?
Suspect an anticonvulsants: Lamotrigine, carbamazepine, phenytoin, phenobarbital, Sulfonamides: Cotrimoxazole and sulfasalazine caused Stevens Johnson Syndrome?
SJS Research Consortium, Inc
