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Edinoff AN, Nguyen LH, Fitz-Gerald MJ, Crane E, Lewis K, Pierre SS, Kaye AD, Kaye AM, Kaye JS, Kaye RJ, Gennuso SA, Varrassi G, Viswanath O, Urits I. Lamotrigine and Stevens-Johnson Syndrome Prevention. PSYCHOPHARMACOLOGY BULLETIN 2021; 51:96-114. [PMID: 34092825 PMCID: PMC8146560] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Stevens-Johnson Syndrome (SJS) is a rare life-threatening condition characterized by severe mucocutaneous epidermal necrolysis and detachment of the epidermis. The condition centers around a delayed-type hypersensitivity reaction with a complex etiology stemming from a variety of causes. The number one cause is medication-related-common ones including sulfonamides, antiepileptics, allopurinol, and nonsteroidal anti-inflammatory drugs. Genetics also play a role as several human leukocyte antigen (HLA) genotypes within certain ethnic groups have been implicated in adverse reactions to specific drugs. HLAB*15:02 has been identified in the Chinese and others of Southeast Asian origin to increase susceptibility to lamotrigine and carbamazepine-induced SJS. Furthermore, patients of Japanese origin with HLAB*31:01 and Koreans with HLA-B*44:03 are also at increased risk of SJS after receiving the same two drugs. Of the antiepileptics, one most commonly associated with SJS is lamotrigine, a pre-synaptic voltage-gated sodium channel inhibitor. Lamotrigine is an antiepileptic drug of the phenyltriazine class that is indicated for the prevention of focal and generalized seizures in epileptic patients as well as monotherapy or adjunctive maintenance treatment for Bipolar disorder. The occurrence of SJS is not a rigid contraindication to lamotrigine reintroduction in the same patient. To facilitate this, manufacturers have developed a strict re-challenge dosing regimen to facilitate successful reintroduction of lamotrigine. In order to prevent the recurrence of SJS during a re-challenge, timing of re-dose and initial rash severity must be considered. Therefore, to prevent SJS recurrence, prime lamotrigine re-challenge patients are those with mild initial rash that has not occurred within the previous 4 weeks. The Federal Food and Drug Administration recommends the testing HLA subtypes for those associated with SJS prior to starting lamotrigine.
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Affiliation(s)
- Amber N Edinoff
- Edinoff, MD, Nguyen, MD, Gerald, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA. Crane, BS, Lewis, BS, St Pierre, BS, Louisiana State University Shreveport School of Medicine, Shreveport, LA. Alan D. Kaye, MD, PhD, Louisiana State University New Orleans, Department of Anesthesiology, New Orleans, LA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Gennuso, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam M. Kaye, PharmD, Jessica S. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Rachel J. Kaye, BA, Medical College of South Carolina, Charleston, SC. Varrassi, MD, PhD, FIPP, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Urits, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Long H Nguyen
- Edinoff, MD, Nguyen, MD, Gerald, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA. Crane, BS, Lewis, BS, St Pierre, BS, Louisiana State University Shreveport School of Medicine, Shreveport, LA. Alan D. Kaye, MD, PhD, Louisiana State University New Orleans, Department of Anesthesiology, New Orleans, LA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Gennuso, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam M. Kaye, PharmD, Jessica S. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Rachel J. Kaye, BA, Medical College of South Carolina, Charleston, SC. Varrassi, MD, PhD, FIPP, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Urits, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Mary Jo Fitz-Gerald
- Edinoff, MD, Nguyen, MD, Gerald, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA. Crane, BS, Lewis, BS, St Pierre, BS, Louisiana State University Shreveport School of Medicine, Shreveport, LA. Alan D. Kaye, MD, PhD, Louisiana State University New Orleans, Department of Anesthesiology, New Orleans, LA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Gennuso, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam M. Kaye, PharmD, Jessica S. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Rachel J. Kaye, BA, Medical College of South Carolina, Charleston, SC. Varrassi, MD, PhD, FIPP, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Urits, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Erin Crane
- Edinoff, MD, Nguyen, MD, Gerald, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA. Crane, BS, Lewis, BS, St Pierre, BS, Louisiana State University Shreveport School of Medicine, Shreveport, LA. Alan D. Kaye, MD, PhD, Louisiana State University New Orleans, Department of Anesthesiology, New Orleans, LA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Gennuso, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam M. Kaye, PharmD, Jessica S. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Rachel J. Kaye, BA, Medical College of South Carolina, Charleston, SC. Varrassi, MD, PhD, FIPP, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Urits, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Kyle Lewis
- Edinoff, MD, Nguyen, MD, Gerald, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA. Crane, BS, Lewis, BS, St Pierre, BS, Louisiana State University Shreveport School of Medicine, Shreveport, LA. Alan D. Kaye, MD, PhD, Louisiana State University New Orleans, Department of Anesthesiology, New Orleans, LA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Gennuso, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam M. Kaye, PharmD, Jessica S. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Rachel J. Kaye, BA, Medical College of South Carolina, Charleston, SC. Varrassi, MD, PhD, FIPP, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Urits, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Samantha St Pierre
- Edinoff, MD, Nguyen, MD, Gerald, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA. Crane, BS, Lewis, BS, St Pierre, BS, Louisiana State University Shreveport School of Medicine, Shreveport, LA. Alan D. Kaye, MD, PhD, Louisiana State University New Orleans, Department of Anesthesiology, New Orleans, LA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Gennuso, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam M. Kaye, PharmD, Jessica S. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Rachel J. Kaye, BA, Medical College of South Carolina, Charleston, SC. Varrassi, MD, PhD, FIPP, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Urits, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Alan D Kaye
- Edinoff, MD, Nguyen, MD, Gerald, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA. Crane, BS, Lewis, BS, St Pierre, BS, Louisiana State University Shreveport School of Medicine, Shreveport, LA. Alan D. Kaye, MD, PhD, Louisiana State University New Orleans, Department of Anesthesiology, New Orleans, LA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Gennuso, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam M. Kaye, PharmD, Jessica S. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Rachel J. Kaye, BA, Medical College of South Carolina, Charleston, SC. Varrassi, MD, PhD, FIPP, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Urits, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Adam M Kaye
- Edinoff, MD, Nguyen, MD, Gerald, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA. Crane, BS, Lewis, BS, St Pierre, BS, Louisiana State University Shreveport School of Medicine, Shreveport, LA. Alan D. Kaye, MD, PhD, Louisiana State University New Orleans, Department of Anesthesiology, New Orleans, LA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Gennuso, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam M. Kaye, PharmD, Jessica S. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Rachel J. Kaye, BA, Medical College of South Carolina, Charleston, SC. Varrassi, MD, PhD, FIPP, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Urits, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Jessica S Kaye
- Edinoff, MD, Nguyen, MD, Gerald, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA. Crane, BS, Lewis, BS, St Pierre, BS, Louisiana State University Shreveport School of Medicine, Shreveport, LA. Alan D. Kaye, MD, PhD, Louisiana State University New Orleans, Department of Anesthesiology, New Orleans, LA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Gennuso, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam M. Kaye, PharmD, Jessica S. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Rachel J. Kaye, BA, Medical College of South Carolina, Charleston, SC. Varrassi, MD, PhD, FIPP, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Urits, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Rachel J Kaye
- Edinoff, MD, Nguyen, MD, Gerald, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA. Crane, BS, Lewis, BS, St Pierre, BS, Louisiana State University Shreveport School of Medicine, Shreveport, LA. Alan D. Kaye, MD, PhD, Louisiana State University New Orleans, Department of Anesthesiology, New Orleans, LA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Gennuso, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam M. Kaye, PharmD, Jessica S. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Rachel J. Kaye, BA, Medical College of South Carolina, Charleston, SC. Varrassi, MD, PhD, FIPP, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Urits, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Sonja A Gennuso
- Edinoff, MD, Nguyen, MD, Gerald, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA. Crane, BS, Lewis, BS, St Pierre, BS, Louisiana State University Shreveport School of Medicine, Shreveport, LA. Alan D. Kaye, MD, PhD, Louisiana State University New Orleans, Department of Anesthesiology, New Orleans, LA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Gennuso, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam M. Kaye, PharmD, Jessica S. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Rachel J. Kaye, BA, Medical College of South Carolina, Charleston, SC. Varrassi, MD, PhD, FIPP, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Urits, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Giustino Varrassi
- Edinoff, MD, Nguyen, MD, Gerald, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA. Crane, BS, Lewis, BS, St Pierre, BS, Louisiana State University Shreveport School of Medicine, Shreveport, LA. Alan D. Kaye, MD, PhD, Louisiana State University New Orleans, Department of Anesthesiology, New Orleans, LA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Gennuso, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam M. Kaye, PharmD, Jessica S. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Rachel J. Kaye, BA, Medical College of South Carolina, Charleston, SC. Varrassi, MD, PhD, FIPP, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Urits, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Omar Viswanath
- Edinoff, MD, Nguyen, MD, Gerald, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA. Crane, BS, Lewis, BS, St Pierre, BS, Louisiana State University Shreveport School of Medicine, Shreveport, LA. Alan D. Kaye, MD, PhD, Louisiana State University New Orleans, Department of Anesthesiology, New Orleans, LA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Gennuso, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam M. Kaye, PharmD, Jessica S. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Rachel J. Kaye, BA, Medical College of South Carolina, Charleston, SC. Varrassi, MD, PhD, FIPP, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Urits, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
| | - Ivan Urits
- Edinoff, MD, Nguyen, MD, Gerald, MD, Louisiana State University Health Science Center Shreveport, Department of Psychiatry and Behavioral Medicine, Shreveport, LA. Crane, BS, Lewis, BS, St Pierre, BS, Louisiana State University Shreveport School of Medicine, Shreveport, LA. Alan D. Kaye, MD, PhD, Louisiana State University New Orleans, Department of Anesthesiology, New Orleans, LA, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Gennuso, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA. Adam M. Kaye, PharmD, Jessica S. Kaye, Thomas J. Long School of Pharmacy and Health Sciences, University of the Pacific, Department of Pharmacy Practice, Stockton, CA. Rachel J. Kaye, BA, Medical College of South Carolina, Charleston, SC. Varrassi, MD, PhD, FIPP, Paolo Procacci Foundation, Via Tacito 7, Roma, Italy. Viswanath, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, University of Arizona College of Medicine-Phoenix, Phoenix, AZ, Creighton University School of Medicine, Department of Anesthesiology, Omaha, NE, Valley Anesthesiology and Pain Consultants-Envision Physician Services, Phoenix, AZ. Urits, MD, Louisiana State University Shreveport, Department of Anesthesiology, Shreveport, LA, Southcoast Health, Southcoast Physicians Group Pain Medicine, Wareham, MA
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