Home › Research › Prevention and risk
Lamotrigine and Stevens-Johnson Syndrome Prevention
Amber N. Edinoff, Long Hoai Nguyen, Mary Jo Fitz-Gerald, Erin Crane, K. G. S. LEWIS, Samantha St. Pierre, Alan D. Kaye, Adam Marc Kaye et al.. Psychopharmacology Bulletin, 2021-03-01
Topic: Brain proteins, microglia and lab models
Stevens-Johnson Syndrome (SJS) is a rare life-threatening condition characterized by severe mucocutaneous epidermal necrolysis and detachment of the epidermis. The condition centers around a delayed-type hypersensitivity reaction with a complex etiology stemming from a variety of causes. The number one cause is medication-related-common ones including sulfonamides, antiepileptics, allopurinol, and nonsteroidal anti-inflammatory drugs. Genetics also play a role as several human leukocyte antigen (HLA) genotypes within certain ethnic groups have been implicated in adverse reactions to specific drugs. HLAB*15:02 has been identified in the Chinese and others of Southeast Asian origin to increase susceptibility to lamotrigine and carbamazepine-induced SJS. Furthermore, patients of Japanese origin with HLAB*31:01 and Koreans with HLA-B*44:03 are also at increased risk of SJS after receiving the same two drugs. Of the antiepileptics, one most commonly associated with SJS is lamotrigine, a pre-synaptic voltage-gated sodium channel inhibitor. Lamotrigine is an antiepileptic drug of the phenyltriazine class that is indicated for the prevention of focal and generalized seizures in epileptic patients as well as monotherapy or adjunctive maintenance treatment for Bipolar disorder. The occurrence of SJS is not a rigid contraindication to lamotrigine reintroduction in the same patient. To facilitate this, manufacturers have developed a strict re-challenge dosing regimen to facilitate successful reintroduction of lamotrigine. In order to prevent the recurrence of SJS during a re-challenge, timing of re-dose and initial rash severity must be considered. Therefore, to prevent SJS recurrence, prime lamotrigine re-challenge patients are those with mild initial rash that has not occurred within the previous 4 weeks. The Federal Food and Drug Administration recommends the testing HLA subtypes for those associated with SJS prior to starting lamotrigine.
Key findings
- Furthermore, patients of Japanese origin with HLAB*31:01 and Koreans with HLA-B*44:03 are also at increased risk of SJS after receiving the same two drugs.
- Of the antiepileptics, one most commonly associated with SJS is lamotrigine, a pre-synaptic voltage-gated sodium channel inhibitor.
- The Federal Food and Drug Administration recommends the testing HLA subtypes for those associated with SJS prior to starting lamotrigine.
Why it matters
This review describes Stevens-Johnson Syndrome risk associated with lamotrigine and the role of HLA genetic testing before prescribing. It contains no information on Alzheimer's disease.
New to this subject? Start with our plain-English guide: Prevention →
Study details
- Evidence strengthLow
How this study scored 42/100
Published in a peer-reviewed journal. Scored zero for study design, sample size, effect reported, studied in people and randomised / blinded because the record does not state it.
| Component | Points | Why |
|---|---|---|
| Journal tier | 7 / 10 | Tier 3 — peer-reviewed journal (Psychopharmacology Bulletin) |
| Journal's citation record | 0 / 4 | Psychopharmacology Bulletin: journal h-index 54 (OpenAlex, 2026-10-29) |
| Study design | 0 / 12 | No study design recorded — scores zero, not guessed (not stated in the record — scored 0) |
| Strength of evidence | 1 / 5 | Rated “low” in our summary |
| Peer-review validation | 10 / 10 | Peer-reviewed. Published as an article in a named peer-reviewed journal. |
| How recent | 3 / 5 | 2021 — within 6 year(s) of the newest study here |
| Sample size | 0 / 4 | Participant count not stated — scores zero (not stated in the record — scored 0) |
| Effect reported | 0 / 3 | No effect size reported — scores zero (not stated in the record — scored 0) |
| Studied in people | 0 / 3 | Not stated whether this was studied in people — scores zero (not stated in the record — scored 0) |
| Randomised / blinded | 0 / 2 | No randomisation or blinding stated — scores zero (not stated in the record — scored 0) |
| Times cited | 4 / 7 | Cited 43 times (OpenAlex, 2026-10-10) |
| Citations per year | 2 / 5 | 6.1 citations a year over 7 year(s) since 2021 |
| Impact for its field and year | 4 / 6 | Cited 8.4× the average for papers of its field and year (OpenAlex FWCI) |
| Cited by studies here | 0 / 6 | No other study in this library cites it |
| Still being cited | 2 / 4 | Cited 30 times in 2024–2026 (2026 still in progress; OpenAlex) |
| Senior author's track record | 3 / 4 | Last-listed author Ivan Urits: h-index 51 (OpenAlex, whole career) |
| Institution's track record | 1 / 3 | Louisiana State University: institution h-index 856 (OpenAlex) |
| Multi-centre collaboration | 1 / 3 | OpenAlex lists 2 institution(s) in 1 country |
| Indexed in PubMed | 2 / 2 | Indexed in PubMed (PMID 34092825) |
| Free to read | 2 / 2 | Free to read |
| Total | 42 / 100 | — |
What each of these 20 components measures, and what this score is not →
Read the original
Full text: free to read — OpenAlex lists this copy as free to read: the link above (checked 6 Feb 1020).
Cite this study APA, Vancouver, BibTeX · download .bib or .ris
Built from the record alzhub holds for this paper, not looked up. Volume, issue and page numbers are not held in the record. The record's author list ends in “et al.”, so not every author is named. Check the citation against the original before you use it.
APA 7th
Edinoff, A. N., Nguyen, L. H., Fitz-Gerald, M. J., Crane, E., LEWIS, K. G. S., Pierre, S. S., et al. (2021). Lamotrigine and Stevens-Johnson Syndrome Prevention. Psychopharmacology Bulletin. https://doi.org/10.64719/pb.4398
Vancouver
Edinoff AN, Nguyen LH, Fitz-Gerald MJ, Crane E, LEWIS KGS, Pierre SS, et al. Lamotrigine and Stevens-Johnson Syndrome Prevention. Psychopharmacology Bulletin. 2021. doi:10.64719/pb.4398. PMID: 34092825.
BibTeX
@article{edinoff2021-34092825,
author = {Edinoff, Amber N. and Nguyen, Long Hoai and Fitz-Gerald, Mary Jo and Crane, Erin and LEWIS, K. G. S. and Pierre, Samantha St. and Kaye, Alan D. and Kaye, Adam Marc and others},
title = {{Lamotrigine and Stevens-Johnson Syndrome Prevention}},
journal = {Psychopharmacology Bulletin},
year = {2021},
doi = {10.64719/pb.4398},
pmid = {34092825},
url = {https://doi.org/10.64719/pb.4398}
}
Related studies in Prevention and risk
Also in Prevention and risk
265 studies in the library are filed under Prevention and risk with no topic tag they share with another; these are this study's neighbours in a fixed tour of them. The Prevention and risk hub.