A Review on Analytical Method for Determination of Lamotrigine in Bulk and Pharmaceutical Dosage Form

2021 ◽  
pp. 229-234
Author(s):  
Rutuja S Nalkar ◽  
Suhas S Siddheshwar ◽  
Mahesh H Kolhe
Keyword(s):  
Side Effects ◽  
Blood Cells ◽  
Anticonvulsant Drug ◽  
Mood Stabilizer ◽  
Stevens Johnson Syndrome ◽  
Partial Seizures ◽  
Pharmaceutical Dosage Form ◽  
Johnson Syndrome ◽  
Clonic Seizures

Lamotrigine is an anticonvulsant drug used in the treatment of epilepsy & bipolar disorder/major affective disorder (manic depression). Lamotrigine is and antiepileptic drug of phenyltriazine class. For epilepsy it is used to treat the partial seizures, primary and secondary tonic-clonic seizures, and seizures associated with the Lennox-Gastuat syndrome and are chemically unrelated to the other anticonvulsants. Lamotrigine is a phenyltriazine that has comparatively few side-effects and it does not requires blood monitoring/observance in monotherapy. It additionally acts as a mood stabilizer. Common side-effects of lamotrigine include, nausea, sleepiness, headache, vomiting, trouble/bother with co-ordination and rash. Serious side-effects include in, lack of red blood cells, accumulated in risk of suicide, Stevens-Johnson syndrome and allergy. It issues that use of lamotrigine throughout pregnancy or breastfeeding it’s going to lead/result in harm/damage.

scholarly journals DRUG INDUCED DERMATOLOGICAL REACTION OF THE 100 MOST COMMONLY PRESCRIBED MEDICATIONS IN UK HOSPITALS

2019 ◽  
pp. 54-57
Author(s):  
MOHAMMED AL-ABADIE ◽  
FARIS OUMEISH ◽  
MOHAMMED AL-RUBAYE ◽  
DINA AL-ABADIE ◽  
PATRICK ANTHONY BALL ◽  
...  
Keyword(s):  
United Kingdom ◽  
Side Effects ◽  
Stevens Johnson Syndrome ◽  
Drug Induced ◽  
The United Kingdom ◽  
Johnson Syndrome ◽  
Medication Side ◽  
Drug Adverse Reaction ◽  
Skin Conditions ◽  
Dermatological Side Effects

Objective: It is commonly reported that medicines have side effects related to dermatological practice. However, it is extremely difficult to establish how commonly, or rarely skin-related medication side effects occur. Common dermatological side effects include rash, pruritus, and photosensitivity. Objective: To demonstrate the dermatological side-effects of the most commonly prescribed medications in the United Kingdom. Methods: This paper discusses dermatological side-effects of the commonly prescribed medications, including uncommon or rare manifestations such as angioedema and Stevens - Johnson syndrome (SJS). The list used for the most frequently prescribed drugs in the United Kingdom was created by nurses. This list was compared to the British National Formulary to demonstrate the reported frequency of occurrence of dermatological side-effects or complications. Conclusion: The top 100 prescribed medication cause a number of dermatological side effects that need to be considered when they are prescribed to patients who have pre-existing skin conditions. Additionally, when confronted with a common dermatological problem in any patient, clinicians should always consider the possibility of a drug adverse reaction.

scholarly journals Hydroxychloroquine-Induced Stevens-Johnson Syndrome in COVID-19: A rare Case Report

2020 ◽  
Author(s):  
Lotfollah Davoodi ◽  
Hamed Jafarpour ◽  
Armaghan Kazeminejad ◽  
Eissa Soleymani ◽  
Zahra Akbari ◽  
...  
Keyword(s):  
Side Effects ◽  
Ground Glass Opacity ◽  
Respiratory Illness ◽  
Upper Extremities ◽  
Definitive Treatment ◽  
Stevens Johnson Syndrome ◽  
Nasopharyngeal Swab ◽  
Entire Body ◽  
Her Family ◽  
Johnson Syndrome

Abstract Background: The international outbreak of respiratory illness termed coronavirus disease 2019 (COVID-19) began in December 2019 that has affected more than 0.8 million individuals. To date, there are no specific therapeutic agents for coronavirus infections. One of the drugs that have an effective role in improving the condition of patients with COVID-19 is hydroxychloroquine (HCQ). This drug is not a definitive treatment for this disease and has a supportive role. Like all medications, HCQ has side effects and may occur in COVID-19 patients. Stevens-Johnson syndrome caused by HCQ is very rare.Case presentation: A 42-year-old woman, presented with fever and dry cough in the past two days to her family physician. Lab tests revealed elevated lactate dehydrogenase (LDH, 648 units/liter (U/L)), C-reactive protein level (CRP, 52 milligrams/Liter (mg/L), normal: <10 mg/L), aspartate aminotransferase (AST, 59 U/L, normal: 10-40 U/L), thrombocytopenia, and leukopenia. Mild bilateral patchy ground-glass opacity was seen in lung CT-Scan. Due to COVID-19 pandemic and clinical findings, the nasopharyngeal swab test was done and SARS-CoV-2 nucleic acid was detected by RT-PCR. HCQ 200 mg twice daily was started. After two days, the patient presented with a pruritic erythematous maculopapular rash and flat atypical targets that started from the distal of upper extremities and rapidly, involved the entire body, and torn blisters which were only be seen as ulcers on orolabial area. The Nikolsky sign was positive. Due to the likelihood of a drug reaction, HCQ was discontinued, and COVID-19 treatment was changed to lopinavir/ritonavir (LPV/RTV) 400 mg twice daily. Finally, she was discharged after five days with nonpruritic scalded skin on the distal of upper extremities. Conclusions: It is worth noting that although HCQ appears to be safe and has mild side effects, however, the boundary between therapeutic and toxic doses is narrow and severe disorders of their use can life-threatening. One of the side effects of HCQ is SJS caused by the drug, and given the worldwide pandemic of COVID-19 and the increasing need for this drug, we need to be careful about its use in order to control and manage the side effects of this drug.

Stevens-Johnson syndrome manifesting late in the course of pembrolizumab therapy

2018 ◽  
Vol 25 (6) ◽  
pp. 1520-1522 ◽  
Author(s):  
Andrew Hwang ◽  
Andrew Iskandar ◽  
Constantin A Dasanu
Keyword(s):  
Cell Death ◽  
Side Effects ◽  
Programmed Cell Death ◽  
Toxic Epidermal Necrolysis ◽  
Death Receptor ◽  
Favorable Outcome ◽  
Stevens Johnson Syndrome ◽  
Erythematous Rash ◽  
Johnson Syndrome ◽  
Cell Death Receptor

Pembrolizumab is a humanized antibody that targets programmed cell death receptor-1. This agent is approved for use in the treatment of several malignancies. While pruritus and papulo-erythematous rash are not uncommon with its use, severe reactions such as Stevens-Johnson syndrome/toxic epidermal necrolysis are very rare. We present herein a case of Stevens-Johnson syndrome occurring in a patient who had previously tolerated pembrolizumab without significant side effects for seven months. Prompt recognition of Stevens-Johnson syndrome/toxic epidermal necrolysis and discontinuation of the offending agent are paramount to ensure a favorable outcome.

scholarly journals Pulse therapy in pemphigus: report of 11 cases

2013 ◽  
Vol 88 (4) ◽  
pp. 672-675 ◽  
Author(s):  
Nurimar Conceicao Fernandes ◽  
Mariana Menezes
Keyword(s):  
Side Effects ◽  
Maintenance Dose ◽  
Pemphigus Vulgaris ◽  
Pulse Therapy ◽  
Stevens Johnson Syndrome ◽  
Pemphigus Foliaceus ◽  
Cyclophosphamide Pulse Therapy ◽  
Johnson Syndrome ◽  
Cyclophosphamide Pulse

In this study, five cases of pemphigus vulgaris and two cases of pemphigus foliaceus were treated with cyclophosphamide pulse therapy associated with prednisone, resulting in the need for a smaller maintenance dose of prednisone. In three cases of pemphigus vulgaris and one case of pemphigus foliaceus, dexamethasone and cyclophosphamide pulse therapy associated with prednisone helped the lesions to heal more rapidly. Neither treatment however prevented the recurrence of the disease. Amenorrhea, myelotoxicity and Stevens-Johnson syndrome were among the cyclophosphamide side effects. All the patients treated with prednisone experienced known side effects.

scholarly journals Cutaneous Manifestations in Confirmed COVID-19 Patients: A Systematic Review

Biology ◽  
2020 ◽  
Vol 9 (12) ◽  
pp. 449
Author(s):  
Claudio Conforti ◽  
Caterina Dianzani ◽  
Marina Agozzino ◽  
Roberta Giuffrida ◽  
Giovanni Francesco Marangi ◽  
...  
Keyword(s):  
Systematic Review ◽  
Erythema Multiforme ◽  
Stevens Johnson Syndrome ◽  
Livedo Racemosa ◽  
Cutaneous Manifestations ◽  
Sweet Syndrome ◽  
Johnson Syndrome ◽  
Polymorphic Pattern ◽  
Vesicle Fluid

There have been increasing reports of skin manifestations in COVID-19 patients. We conducted a systematic review and included manuscripts describing patients with positive RT-PCR coronavirus testing from nasopharyngeal swabs who also developed cutaneous manifestations. A total of 655 patients were selected, with different types of skin rashes: Erythematous maculopapular (n = 250), vascular (n = 146), vesicular (n = 99), urticarial (n = 98), erythema multiforme/generalized pustular figurate erythema/Stevens-Johnson syndrome (n = 22), ocular/periocular (n = 14), polymorphic pattern (n = 9), generalized pruritus (n = 8), Kawasaki disease (n = 5), atypical erythema nodosum (n = 3), and atypical Sweet syndrome (n = 1). Chilblain-like lesions were more frequent in the younger population and were linked to a milder disease course, while fixed livedo racemosa and retiform purpura appeared in older patients and seemed to predict a more severe prognosis. For vesicular rashes, PCR determined the presence of herpesviruses in the vesicle fluid, which raised the possibility of herpesvirus co-infections. The erythema-multiforme-like pattern, generalized pustular figurate erythema and Stevens-Johnson syndrome were most frequently linked to hydroxychloroquine intake. A positive PCR determination of SARS-COV-2 from conjunctival swabs suggest that eye discharge can also be contagious. These cutaneous manifestations may aid in identifying otherwise asymptomatic COVID-19 carriers in some cases or predict a more severe evolution in others.

▾ Lamotrigine – an add-on antiepileptic

1992 ◽  
Vol 30 (19) ◽  
pp. 75-76
Keyword(s):  
Quality Of Life ◽  
Side Effects ◽  
Antiepileptic Drug ◽  
Partial Seizures ◽  
First Line ◽  
Low Level ◽  
Clonic Seizures ◽  
Clinically Significant ◽  
The Brain

Lamotrigine (Lamictal – Wellcome) is a new antiepileptic drug. It is licensed as ‘add-on’ treatment for patients with partial seizures, either localised to one part of the brain or spreading to tonic-clonic seizures (secondarily generalised), who are not satisfactorily controlled with first-line drugs. The manufacturer claims that it “offers the hope of an improved quality of life” while having “a low level of clinically significant side-effects”. We examine these claims.

scholarly journals Lamotrigine-Valproic Acid Interaction Leading to Stevens–Johnson Syndrome

2018 ◽  
Vol 2018 ◽  
pp. 1-5 ◽  
Author(s):  
Marta Vázquez ◽  
Cecilia Maldonado ◽  
Natalia Guevara ◽  
Andrea Rey ◽  
Pietro Fagiolino ◽  
...  
Keyword(s):  
Valproic Acid ◽  
Epoxide Hydrolase ◽  
Stevens Johnson Syndrome ◽  
Enzymatic Reactions ◽  
Acid Interaction ◽  
Johnson Syndrome ◽  
Cutaneous Reactions ◽  
Clonic Seizures ◽  
Arene Oxide ◽  
Elimination Pathway

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.

Second-Messenger Modifiers (“Mood Stabilizers”)

2018 ◽  
pp. 127-145
Author(s):  
S. Nassir Ghaemi
Keyword(s):  
Clinical Pharmacology ◽  
Side Effects ◽  
Renal Insufficiency ◽  
Gold Standard ◽  
Second Messenger ◽  
Mood Stabilizers ◽  
Stevens Johnson Syndrome ◽  
Dementia Prevention ◽  
Johnson Syndrome ◽  
Ovarian Syndrome

The drug class of second-messenger modifiers includes agents called “mood stabilizers.” It consists of lithium and some anticonvulsants: valproate, carbamazepine, and lamotrigine. The standard mood stabilizers each have strengths and weaknesses. Lithium is still the gold standard, most proven agent; no other drug has been clearly shown to be more effective than lithium. The clinical pharmacology of specific agents within each class, including their efficacy and side effects, is explored. Specific phenomena that are surveyed include chronic renal insufficiency, liver side effects, polycystic ovarian syndrome, teratogenicity, Stevens-Johnson syndrome, and drug interactions. Benefits for lithium include suicide prevention and possibly dementia prevention.

Late-onset Stevens–Johnson syndrome due to nivolumab use for hepatocellular carcinoma

2019 ◽  
Vol 25 (8) ◽  
pp. 2052-2055 ◽  
Author(s):  
Constantin A Dasanu
Keyword(s):  
Hepatocellular Carcinoma ◽  
Side Effects ◽  
Immune Checkpoint ◽  
Immune Checkpoint Inhibitor ◽  
Late Onset ◽  
Checkpoint Inhibitor ◽  
Stevens Johnson Syndrome ◽  
Erythematous Rash ◽  
Immunoglobulin G4 ◽  
Johnson Syndrome

Nivolumab is a fully human immunoglobulin G4 immune checkpoint inhibitor antibody approved for use in the treatment of several malignancies. Severe side effects such as Stevens–Johnson syndrome/toxic epidermal necrolysis (SJS/TEN) have only extremely rarely been reported with this drug. We present herein a patient who developed SJS after 16 weeks of therapy with nivolumab. A week prior to this event, he developed a pruriginous papulo-erythematous rash. Prompt recognition of this phenomenon, immune checkpoint inhibitor discontinuation and steroid therapy are necessary steps in order to avoid dismal outcomes.

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