Anti psychotic drugs

[Rising Phoenix]

I'm bipolar is it possible to suddenly develop allergies to an entire class of drugs..... I've tried three this month and am covered in rashes..... I have an appt with my pdoc and my pcp tomorrow. That would really suck if I was because I NEED them.....what to do :shrug:

[fed-up]

1. yes, have you read about Stevens-Johnson syndrome? or read my other posts on lamictal

there i such a thing as hypersensitivity to anticonvulsants. I will never know if that was my problem as the physician's assistant nor prompt care ordered blood work to determine why my lymph nodes swelled up, hard as a marble 9 days after starting lamictal

hopefully your p-doc has been trained in what to look for in Stevens-Johnson rash, if not get thee to your regular doctor ASAP


really graphic pics here
http://www.sjsupport.org/htmldata/reactionphoto_1.html

some more graphic pics at the end of this first article

http://www.emedicine.com/derm/topic104.htm
Drug Eruptions
Last Updated: March 28, 2007

Synonyms and related keywords: adverse cutaneous drug reactions, cutaneous reaction to drugs, drug-induced cutaneous reactions, mucocutaneous drug reactions, dermatoses, dermatosis, cutaneous eruptions, cutaneous drug reactions, adverse drug reactions, drug allergy, fixed drug reactions, medication adverse effects, medication side effects, adverse effects, side effects, medication allergy

Background: Drug eruptions can mimic a wide range of dermatoses. The morphologies are myriad and include morbilliform (most common, see Image 1), urticarial, papulosquamous, pustular, and bullous. Medications can also cause pruritus and dysesthesia without an obvious eruption.

A drug-induced reaction should be considered in any patient who is taking medications and who suddenly develops a symmetric cutaneous eruption. Medications that are known for causing cutaneous reactions include antimicrobial agents, nonsteroidal anti-inflammatory drugs (NSAIDs), cytokines, chemotherapeutic agents, anticonvulsants, and psychotropic agents.

Prompt identification and withdrawal of the offending agent may help limit the toxic effects associated with the drug. The decision to discontinue a potentially vital drug often presents a dilemma.

..snip

http://www.residentandstaff.com/issues/articles/2007-03_11.asp

Issue: March 2007 • Vol 53 • No 3
Anticonvulsant Hypersensitivity Syndrome: Recognizing the Signs and Symptoms

Marcus E.S. Mason, MD, FCCWS
Attending Physician
Internal and Geriatric Medicine
University of Miami/Jackson Memorial & Miami Veterans Administration Hospitals
Miami, Fla
Anticonvulsant hypersensitivity syndrome is an uncommon but potentially fatal condition that can occur in susceptible patients taking one of the aromatic anticonvulsants, such as phenytoin, carbamazepine, or phenobarbital. Signs and symptoms typically include high fever, rash, lymphadenopathy, and hematologic abnormalities. Elevated fever and skin rash that cannot be explained by other causes should alert the physician to the possibility of this syndrome in patients taking an anticonvulsant medication. Immediate discontinuation of the offending agent is necessary; early recognition can prevent permanent multiorgan damage.

Anticonvulsant hypersensitivity syndrome—also known as phenytoin pseudolymphoma syndrome—is a potentially fatal idiosyncratic drug reaction to certain anticonvulsant medications that break down into intermediate metabolites, specifically arene oxides. Responsible medications include phenytoin (Dilantin, Phenytek), carbamazepine (Carbatrol, Epitol, Tegretol), oxcarbazepine (Trileptal), and phenobarbital sodium (Table 1). The cross-reactivity of these drugs ranges from 50% to 80%.1,2

Evidence suggests that other anticonvulsants—lamotrigine (Lamictal), primidone (Mysoline), and felbamate (Felbatol)—whose chemical structures and routes of metabolism are similar to that of carbamazepine, phenytoin, oxcarbazepine, and/or phenobarbital—may also cause the syndrome.1 Some patients who are sensitive to phenytoin and carbamazepine may be able to tolerate phenobarbital, but once patients have had anticonvulsant hypersensitivity syndrome, they should no longer receive any anticonvulsant that can cause the syndrome.

..snip

http://content.karger.com/produktedb/produkte.asp?typ=fulltext&file=IAA2006141003308
Abstract

A 43-year-old man developed a skin eruption characterized by 'macules with blisters' typical to Stevens-Johnson syndrome, as well as erosions of the lips and buccal mucosa, 2 weeks after he had started treatment with lamotrigine. He had a fever (39.6°C), elevated liver enzymes and atypical lymphocytes in the peripheral blood. This undoubtedly reflects a case of Stevens-Johnson syndrome induced by lamotrigine, but it can also fulfill the criteria of anticonvulsant hypersensitivity syndrome or drug rash with eosinophilia and systemic signs. A case that precisely fits the definition of two syndromes that have different characteristics, different treatments and different prognoses indicates that there is a flaw in the classification.



http://www.psycheducation.org/depression/meds/LamRash.htm
If rash, then what?
There are ways to identify the rashes that carry great risk (e.g. Stevens-Johnson syndrome, SJS; and toxic epidermal necrolysis, TEN. Sounds scary just naming it. But that's all right, because this is indeed a very scary skin condition). The problem is that simple rashes, lacking the known danger signs, can also be risky, so it's not easy to say "oh, this rash is safe". And since there is a very low rate of severe skin reactions that can (rarely) even be fatal, any rash that appears while a person is taking lamotrigine should raise concern.

What are the signs of great risk? Here are the versions I've heard so far:

"Anything above the neck"
"Around or in the mouth"
"Soft tissues (like mucous membranes of mouth, nose, eyes -- including the membrane over the eye (conjunctiva), so a red, sore eye counts) (or the anus, also a mucous membrane, also counts)
"Anything on the face"
Obviously these all describe nearly the same area, but the "soft tissues" version is the most specific.

Three strategies for rash

Stop for any rash anywhere.
Have a dermatologist see the patient within 24-48 hours; hold the doses until seen.
Stop for any rash above the neck; for anything else, reduce the dose to the previous level, and hold it there until you can tell whether the rash is going away (if so, continue upward again but more slowly and/or by smaller steps; use Benadryl or topical Caladryl to control itching while you're waiting).

[fed-up]

2. not awake yet, I read your post as anti-convulsant-will do quick research on anti-psychotics and SJS

http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=1885161

Erythema multiforme (EM) is an acute, self-limiting, reactive mucocutaneous disease of the skin and mucous membranes described by Hebra in 1866 <1>. EM, as an adverse effect of antipsychotic medication, has been noted with chlorpromazine and other traditional antipsychotics. There are reports of Stevens–Johnson syndrome (SJS), also known as ‘erythema multiforme major’, with carbamazepine–neuroleptic combination <2>. However, cutaneous adverse drug eruptions are rarely noticed with atypical antipsychotics. Olanzapine has been associated with severe generalized pruritic skin eruptions as part of a hypersensitivity syndrome <3> and is also found to cause leukocytoclastic vasculitis manifesting as erythematous skin eruptions <4>. However, it has not thus far been found to be associated with EM. In fact, among atypical antipsychotics, there is only one case report of erythema multiforme associated with ziprasidone use in a 47-year-old female <5>. A thorough Pubmed search until 23 February 2006, using the names of individual atypical antipsychotics and ‘erythema multiforme’, did not reveal a single case of EM induced by any other atypical antipsychotic. We describe what we consider the first case of EM induced by risperidone.

try googling your med name and side effects and rash


I am going to wait 2-3 weeks for the lamictal to mostly clear my body before I try anything else

if one is taking multiple meds one right after the other it is hard to determine which one the body is reacting to

good luck and do let us know what your pdoc says

[Forkboy]

3. What happened?

The rash thing is a big deal, as fed-up said above.

Hope all is well.

[Rising Phoenix]

4. rash turned out to be an allergic reaction to deoderant

we found this out after a week in the hospital and three different meds and a horrible case of mania...

[fed-up]

5. no matter what I would wait a few weeks in between trying diff meds

some adverse reactions can take a few months to show up (even after they are stopped), but most likely will show up in first few weeks

I am hypersensitive to many things so I have learned to give my immune system a break between any sort of med change
if your immune system is run down from dealing with initial problem it may then cause a reaction to something that it normally wouldn't

that also makes it easier to determine what is caused any problems

glad to hear you found the problem

[elleng]

6. Hope

you are feeling better now!