THE JOURNAL OF TAIWAN PHARMACY 藥 物 不 良 反 應 8 第25卷 第 4 期 A Case of Stevens - Johnson Syndrome Suspectedly Caused by Concurrent Use of Lamotrigine and Valproate Jane Gau, Ping-Yu Lee, Zon-Min Lee Abstract The purpose of this paper is to report the case of a 29-year-old woman with epilepsy, and to discuss how lamotrigine causes the complicated treatment process and induces Stevens-Johnson Syndrome (SJS). This 29-year-old female patient has a history of epilepsy, and she had been treated with valproate SR 500mg bid at one hospital for 12 years. She started to receive medication of acetaminophen, valproate, and clarinase at our hospital since Sept. 2007. Adjustment of anti- epileptic drugs was made on Nov. 7. Instead of titrating up lamotrigine slowly and decreasing dosage of valproate gradually, the patient was administered lamotrigine 100 mg bid. Unfortunately, erythematous conuent macules and desquamation over her face and limbs were noted, and the patient complained about her abdominal pain, mucosa damage and stomatitis starting on Dec. 20. She was admitted with all currently used drugs suspended. Valproate (500mg bid) was administered to control epilepsy the following day, and methylprednisolone, cyproheptadine, levocetirizine, mometasone cream, vena (amp) were given for relief of SJS. Based on the observation, acetaminophen, lamotrigine, and clarinase may all have the possibility to cause SJS. However, only lamotrigine-induced SJS was cited in the past studies. So lamotrigine is suspected to have caused this adverse drug reaction (ADR). Yet, concurrent use of lamotrigine and valproate may result in increased elimination half-life of lamotrigine, may also lead to lamotrigine toxicity and an increased risk of life- threatening rashes. Therefore, this ADR may be caused by the combination use of lamotrigine and valproate, as well as lamotrigine alone. Key words: Stevens-Johnson Syndrome, lamotrigine, valproate
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