Stevens-Johnson syndrome oxcarbazepine

Oxcarbazepine is typically started at a dosage of 150 mg twice a day and titrated by 300 mg/day at weekly intervals. Therapeutic dosages are in the range of 450 mg twice a day to 1,200 mg twice a day. The conversion from carbamazepine to oxcarbazepine is approximately 1 to 1.5. Oxcarbazepine has a higher risk of hyponatremia than does carbamazepine. Serum sodium should be monitored in patients at risk for hyponatremia, such as the elderly or patients who are also taking diuretics. Stevens-Johnson syndrome and toxic epidermal necrolysis may occur between 3 and 10 times more frequently in oxcarbazepine-treated patients than in the general population. Median time from starting treatment to the development of these serious reactions is 19 days. 

Drug overdose Of 16 796 toxic exposures to antiepileptic drugs (phenytoin, valproic acid, and carbamazepine) in the USA in 2006, 12 resulted in death, as reported by the US Toxic Surveillance System [67 ]. Some specific problems determined by overdose of some old and new antiepileptic drugs have been briefly reviewed. For example, topiramate can cause a significant metabolic acidosis, lamotrigine Stevens-Johnson syndrome, oxcarbazepine hyponatremia, and levetiracetam psychosis. Possible adoption of guidelines for critical care management of overdose are discussed. 

Skin Oxcarbazepine is considered to be much less likely than carbamazepine to cause skin reactions, owing to its different metabolic pathway. Oxcctrbazepine-associated Stevens-Johnson syndrome has been described in two Chinese patients with epilepsy, one of whom was positive for HLA-B 1502 [223, 224 ]. 

Lin LC, Lai PC, Yang SF, Yang RC. Oxcarbazepine-induced Stevens-Johnson syndrome a case report. Kaohsiung J Med Sci 2009 25(2) 82-6. 

Chen YC, Chu CY, Hsiao CH. Oxcarbazepine-induced Stevens-Johnson syndrome in a patient with HLA-B 1502 genotype. J Eur Acad Dermatol Venereol 2009 23 (6) 702-3. 

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