PDF(Pubmed)
Abstract：
Drug-induced Eosinophilia and Systemic Symptoms (DRESS), Stevens-Johnson Syndrome (SJS), and Toxic Epidermal Necrolysis (TEN) are rare but life-threatening immune-mediated drug reactions known as Severe Cutaneous Adverse Reactions (SCARs). These severe drug reactions have been associated with many commonly prescribed medications, including sulfonamides, allopurinol, carbamazepine, and several antiepileptic drugs including lamotrigine.1 Although the risk of these adverse events is recognized by many medical providers, the risk may be overlooked when prescribing lamotrigine for mood disorders. Review of the literature and the experience of these cases suggest that the risk of lamotrigine-associated SCARs is increased when starting lamotrigine at high initial doses. Here we present and discuss two cases of SCARs attributed to high-dose lamotrigine prescribed for mood disorders. A third patient also presented with a SCAR related to high-dose lamotrigine prescribed for a mood disorder during this time but was lost to follow-up and was not reachable. All three patients presented to our hospital system from 2019-2020. Due to this clinical experience, we recommend that pharmacists and prescribers alike be alerted of the risk of severe cutaneous drug reactions when lamotrigine is prescribed, particularly at initial doses greater than 25 mg.
摘要：
药物诱导的嗜酸性粒细胞增多和全身症状（DRESS），史蒂文斯-约翰逊综合征（SJS），和毒性表皮坏死松解症（TEN）是罕见但危及生命的免疫介导的药物反应，称为严重皮肤不良反应（SCAR）。这些严重的药物反应与许多常用的处方药有关，包括磺胺类药物,别嘌呤醇,卡马西平,和几种抗癫痫药物，包括拉莫三嗪。1尽管这些不良事件的风险被许多医疗提供者认识到，在使用拉莫三嗪治疗情绪障碍时，可能会忽略这种风险。文献回顾和这些病例的经验表明，在高初始剂量下开始使用拉莫三嗪时，拉莫三嗪相关的SCAR的风险增加。在这里，我们介绍并讨论了两例归因于高剂量拉莫三嗪治疗情绪障碍的SCAR病例。在这段时间内，第三名患者还出现了与高剂量拉莫三嗪有关的SCAR，但随访失败，无法达到。从2019年至2020年，所有三名患者都进入了我们的医院系统。由于这种临床经验，我们建议药剂师和开处方者在开拉莫三嗪时都要注意严重皮肤药物反应的风险，特别是在初始剂量大于25mg时。
