Stevens-Johnson syndrome is a severe and potentially life-threatening cutaneous reaction associated with lamotrigine. The incidence of developing Stevens-Johnson syndrome during lamotrigine therapy is low. On the basis of the glutamate and dopamine neuron dysregulation hypothesis in schizophrenia, we propose new strategies for the treatment of schizophrenic patients using a glutamate system stabilizer lamotrigine as an adjunctive treatment for the poor responders of a dopamine system stabilizer, aripiprazole. The finding of Stevens-Johnson syndrome in two cases out of three treated with lamotrigine plus aripiprazole, however, has a much higher index of suspicion and it is correct to warn of its possible raised risk. As lamotrigine is currently licensed for the prophylactic treatment of bipolar depression, many of these patients have psychotic features where it would be considered reasonable to add an antimanic atypical antipsychotic such as aripriprazole. The two case reports raised the question about the possible increased risk of Stevens-Johnson syndrome with the combination therapy.
[Show abstract][Hide abstract] ABSTRACT: Hematological side effects are rare with lamotrigine. We report two cases (two men; 46 years old and 65 years old) with epilepsy that developed combined leucopenia and thrombocytopenia after receiving low dose lamotrigine for a time. Three weeks after discontinuing lamotrigine, all of the hematological abnormalities disappeared. We suggest that combined leucopenia and thrombocytopenia is one of the side effects of lamotrigine that must be considered. Lamotrigine is one of the new anti-epileptic drugs, and it is derived from the dihydrofolate reductase inhibitor. Mechanism of action is thought to be mainly through blocking the influx of sodium ions, thereby reducing excess glutamate release and stabilizing neuronal membranes [ 1]. Lamotrigine is effective as monotherapy in epilepsy for adult and children [ 2]. Lamotrigine is also effective as an adjunctive treatment of refractory partial seizures and idiopathic generalized epilepsy [ 3]. It is eliminated mainly by hepatic metabolism and changes to glucuronide conjugate [ 4]. Lamotrigine is well tolerated in children and adults [ 5]. The most adverse events include headache [ 6], somnolences, rash and episodes of transitory diplopia. Very occasionally, lamotrigine can produce minimal hematological side effects; including agranulocytosis, neutropenia, thrombocytopenia and asymptomatic disseminated intravascular coagulopathy [ 7-10]. Here, we report two cases of thrombocytopenia combined with neutropenia developed after taking lamotrigine for epilepsy treatment.
[Show abstract][Hide abstract] ABSTRACT: Drug-induced acneiform eruptions are inflammatory follicular reactions that resemble acne vulgaris both in morphology and distribution, which manifest clinically as papulopustules and occasionally as comedones. We report a case of a patient who developed acneiform eruptions while being treated with aripiprazole which resolved after discontinuation of aripiprazole and application of topical retinoic acid. The acneiform eruption could be explained on the basis of Type III allergic mechanism in an already sensitized individual.
General Hospital Psychiatry 09/2008; 30(5):479-81. DOI:10.1016/j.genhosppsych.2008.02.004 · 2.61 Impact Factor
[Show abstract][Hide abstract] ABSTRACT: Aripiprazole is a new antipsychotic agent that has proven safe and efficacious in controlled clinical trials. However, few published data on its effectiveness and safety when used in augmentation and combination are available.
Our study aimed to determine the functional effectiveness and safety of different combinations of aripiprazole with other psychotropics in resistant patients. All acute not selected (15) patients treated with aripiprazole and other psychotropics between February 2005 and May 2007 are included.
Mean follow-up 20.4 days. Main diagnosis was schizophrenia (40%) and mean dose of aripiprazole was 25 mg/d. Resistant patients received initially multiple psychotropics (mean 3.3) and their functional status was very low. A significant functional improvement was observed after admission in most (12) of them. Only three patients experienced mild to moderate improvement; another three patients showed extrapyramidal symptoms. No dermatological reactions or adverse effects were observed with lamotrigine association. DISCUSIONS: The combination of aripiprazole with other psychotropics was well tolerated. No significant new adverse reactions were observed. In a short term follow-up, our results show a good tolerability of aripiprazole in combination with other psychotropics of different groups.
Current Drug Safety 10/2008; 3(3):210-5. DOI:10.2174/157488608785699496
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