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Lamotrigine-Valproic Acid Interaction Leading to Stevens–Johnson Syndrome
Joint Authors
Maldonado, Cecilia
Fagiolino, Pietro
Rey, Andrea
Carozzi, Antonella
Azambuja, Carlos
Vázquez, Marta
Guevara, Natalia
Source
Issue
Vol. 2018, Issue 2018 (31 Dec. 2018), pp.1-5, 5 p.
Publisher
Hindawi Publishing Corporation
Publication Date
2018-08-29
Country of Publication
Egypt
No. of Pages
5
Main Subjects
Abstract EN
Lamotrigine (LTG) is currently indicated as adjunctive therapy for focal and generalized tonic-clonic seizures and for treatment of bipolar disorder and neuropathic pain.
A common concern with LTG in children is the frequency of appearance of skin rash.
The intensity of this adverse effect can vary from transient mild rash to Stevens–Johnson syndrome (SJS), which can be fatal mainly when LTG is coadministered with valproic acid (VPA).
Hereby, we present the case of an 8-year-old boy who suffered from SJS and other complications two weeks after LTG was added to his VPA treatment in order to control his seizures.
VPA is known to decrease LTG clearance via reduced glucuronidation.
In this case, the minor elimination pathway of LTG would play a more important role, and the formation of an arene oxide metabolite would be enhanced.
As this reactive metabolite is detoxified mainly by enzymatic reactions, involving microsomal epoxide hydrolase and/or GSH-S-transferases and these enzymes are polymorphically expressed in humans, arene oxide toxicity is increased when epoxide hydrolase or GSH-S-transferases is either defective or inhibited or a depletion of intracellular glutathione levels is taking place.
VPA can cause inhibition of epoxide hydrolase enzymes and/or depletion of glutathione levels leading to adverse cutaneous reactions.
American Psychological Association (APA)
Vázquez, Marta& Maldonado, Cecilia& Guevara, Natalia& Rey, Andrea& Fagiolino, Pietro& Carozzi, Antonella…[et al.]. 2018. Lamotrigine-Valproic Acid Interaction Leading to Stevens–Johnson Syndrome. Case Reports in Medicine،Vol. 2018, no. 2018, pp.1-5.
https://search.emarefa.net/detail/BIM-1144958
Modern Language Association (MLA)
Vázquez, Marta…[et al.]. Lamotrigine-Valproic Acid Interaction Leading to Stevens–Johnson Syndrome. Case Reports in Medicine No. 2018 (2018), pp.1-5.
https://search.emarefa.net/detail/BIM-1144958
American Medical Association (AMA)
Vázquez, Marta& Maldonado, Cecilia& Guevara, Natalia& Rey, Andrea& Fagiolino, Pietro& Carozzi, Antonella…[et al.]. Lamotrigine-Valproic Acid Interaction Leading to Stevens–Johnson Syndrome. Case Reports in Medicine. 2018. Vol. 2018, no. 2018, pp.1-5.
https://search.emarefa.net/detail/BIM-1144958
Data Type
Journal Articles
Language
English
Notes
Includes bibliographical references
Record ID
BIM-1144958