Syndrome Toxic Epidermal Necrolysis

NSAIDs can induce a number of other adverse reactions, including bleeding disorders, anemia, thrombocytopenia, erythema nodosum, erythema multiforme, fixed drug eruptions, toxic epidermal necrolysis, Stevens-Johnson syndrome, leukocytocla-sitc vasculitis, recurrent fever with exanthema and, of course, the well-known gastric cytotoxicity. 

Erythema multiforme/Stevens-Johnson syndrome/toxic epidermal necrolysis... 

N-4 position and a substituted ring at the N-l position. Because of this different chemical structure, cross-allergenicity with the other sulfonamides may not occur. However, because this has not been well studied, if a patient has a reaction to a sulfonamide antibiotic, whether or not he or she will have a reaction to these other sulfonamides remains controversial. Predisposition to allergic reactions is a more likely reason than cross-reactivity between these differing molecules.14 The sulfonamide antibiotics are significant because they account for the largest percentage of antibiotic-induced toxic epidermal necrolysis and Stevens-Johnson syndrome cases.15... 

Severe life-threatening reactions not mediated by IgE, such as Stevens-Johnson syndrome and toxic epidermal necrolysis, are absolute contraindications to testing, desensitization attempts, and readministration. 

Nevirapine is a non-nucleoside reverse transcriptase inhibitor used to treat HIV-infected patients that causes mild to severe skin rash and even Stevens-Johnson Syndrome/Toxic Epidermal Necrolysis (SJS/TEN) in a substantial proportion (16%) of patients. Nevirapine also induces hepatotoxicity. These adverse clinical symptoms may also occur in non-HIV subjects taking the drug as postoperative prophylaxis [15]. 

Fagot, J.-P. et al., Nevirapine and the risk of Stevens-Johnson syndrome or toxic epidermal necrolysis, AIDS, 15, 1843, 2001. 

CNS Convulsions weakness malaise fatigue nervousness drowsiness depression dizziness disorientation confusion ataxia tremor tinnitus headache. Dermatologic Urticaria pruritus skin eruptions rash (including erythema multiforme, Stevens-Johnson syndrome, toxic epidermal necrolysis) photosensitivity. 

Potentially fatal reactions to sulfonamides Fatalities have occurred, although rarely, as a result of severe reactions to sulfonamides (eg, zonisamide), including Stevens-Johnson syndrome, toxic epidermal necrolysis, fulminant hepatic necrosis, agranulocytosis, aplastic anemia, and other blood dyscrasias. 

Dermatologic Severe dermatologic reactions, including toxic epidermal necrolysis (Lyell syndrome) and Stevens-Johnson syndrome, have been reported with carbamazepine. These reactions have been extremely rare however, a few fatalities have been reported. 

Dermafo/og/c. Alopecia, balanitis, erythema multiforme, erythema nodosum, fixed drug eruptions, hyperpigmentation of the nails, injection site erythema and injection site pain, maculopapular and erythematous rashes, photosensitivity, pruritus, skin and mucus membrane pigmentation, Stevens-Johnson syndrome, toxic epidermal necrolysis, vasculitis. 

Hypersensitivity - Rare serious allergic reactions, including angioedema, anaphylaxis, and dermatologic reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis have occurred in patients on azithromycin therapy. 

Nevirapine has been associated with severe, life-threatening rash (Stevens-Johnson syndrome, toxic epidermal necrolysis), which in some cases, has been fatal. When severe rash occurs, discontinue nevirapine. 

Skin - Severe, occasionally fatal dermatologic reactions, including toxic epidermal necrolysis, Stevens-Johnson syndrome, exfoliative dermatitis, skin necrosis, and erythema multiforme, have been reported within days of methotrexate administration. 

Nebulized pentamidine at the dosage of 300 mg every two weeks should be used in patients with a CD4-I- count less than 100 mm if systemic therapy cannot be tolerated. Sulfadoxine/pyrimethamine (Fansidar), one tablet given once or twice a week, is useful in patients in whom compliance is considered to be a problem. However, it has been associated with hepatotoxicity, Stevens-Johnson syndrome and toxic epidermal necrolysis. 

A variety of idiosyncratic reactions may be seen shortly after therapy has begun. Skin rashes, usually morbilliform in character, are most common. Exfoliative dermatitis or toxic epidermal necrolysis (Lyellis syndrome) has been observed but is infrequent. Other rashes occasionally have been reported, as have a variety of blood dyscrasias and hepatic necrosis. 

Adverse effects that are not unequivocally related to inhibition of prostaglandin synthesis include hepatic effects (hepatitis, hepatic necrosis, cholestatic jaundice, increased serum aminotransferases), dermal effects (photosensitivities, Stevens-Johnson syndrome, toxic epidermal necrolysis, onycholysis), central nervous system (CNS) effects (headaches, dizziness, tinnitus, deafness, drowsiness, confusion, nervousness, increased sweating, aseptic meningitis), ocular effects (toxic amblyopia, retinal disturbances), and certain renal effects (acute interstitial nephritis, acute papillary necrosis). 

Nevirapine (Viramune) is approved for the treatment of HIV infection in adults and children as part of a combination therapy. During the first 12 weeks of treatment, patients must be closely monitored for the development of potentially fatal hepatic toxicity (i.e., hepatitis, hepatic necrosis, and hepatic failure) and skin reactions (i.e., Stevens-Johnson syndrome, toxic epidermal necrolysis, and hypersensitivity reactions). Although these toxici-ties are rare, common side effects include mild to moderate rash, fever, nausea, fatigue, headache, and elevated liver enzymes. 

Abdominal pain, anorexia, arthralgia, constipation, diarrhea, dizziness, drowsiness, edema, fatigue, fever, lymphadenopathy, maculopapular or unspecified rash, nausea, vomiting, orthostatic hypotension, pruritus, Stevens-Johnson syndrome, toxic epidermal necrolysis, tremor, urticaria, vertigo, visual impairment, weakness... 

Hypersensitivity reactions, Stevens-fohnson syndrome, toxic epidermal necrolysis, erythema multiforme, anaphylaxis, hyperphenylalaninemia, megaloblastic anemia, leukopenia, thrombocytopenia, pancytopenia, atrophicglossitis, hematuria, and disorders of cardiac rhythm Rare... 

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. 

Adverse reactions to cefuroxime have been generally mild and transient in nature. As with other cephalosporins there have been rare reports of erythema multiforme, Steven-Johnson syndrome, toxic epidermal necrolysis (exanthematic necrolysis) and hypersensitivity reactions including skin rashes, urticaria, pruritus, drug fever, serum sickness and very rarely anaphylaxis. 

The serious side effect is life threatening rash including Stevens Johnson syndrome and rarely toxic epidermal necrolysis. Other side effects are hepatitis, nausea, vomiting, fatigue, fever, headache, hypersensitivity reactions, urticaria, an-gioedema and anaphylactic shock. 

Warnings Deaths due to following severe reactions have occurred after treatment with SMX Stevens-Johnson syndrome Toxic epidermal necrolysis Fulminant hepatic necrosis Agranulocytosis Aplastic anemia Other blood dyscrasias Hypersensitivity of the respiratory tract Should not be used for the treatment of streptococcal pharyngitis o c D [Pg.43]

---