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Reacciones cutáneas adversas a anticonvulsivantes y estabilizadores del ánimo / Adverse cutaneous reactions to anticonvulsants and mood stabilizers
Mullins L., Enrique; Guajardo M., Nadia; Fuenzalida M., Marcela; Clavero Ch., Francisca.
  • Mullins L., Enrique; Universidad de Chile. Departamento de Dermatología. Unidad Oriente. CL
  • Guajardo M., Nadia; Universidad de Chile. CL
  • Fuenzalida M., Marcela; Universidad de Chile. CL
  • Clavero Ch., Francisca; Universidad de Chile. CL
Rev. chil. dermatol ; 27(1): 71-76, 2011. tab
Article in Spanish | LILACS | ID: lil-644999
RESUMEN
Anticonvulsivantes y estabilizadores del ánimo principalmente el ácido valproico, lamotrigina y carbamazepina, poseen una alta incidencia de reacciones adversas a medicamentos (RAM) severas, como eritema multiforme, Síndrome Stevens- Johnson y necrolisis epidérmica tóxica, asociadas. Existen signos de alarma para su sospecha diagnóstica precoz, que permiten indicar la temprana suspensión del fármaco sospechoso e iniciar la terapia de soporte únicas medidas que han demostrado una clara disminución en la mortalidad. La inmunoglobulina G intravenosa se recomienda por su seguridad, sin embargo, su rol en disminuir la mortalidad es contradictorio. Los corticoides no han demostrado cambios en la mortalidad comparados con la terapia de soporte exclusiva. Se ha intentado mantener el tratamiento con lamotrigina, por sus cualidades terapéuticas, pese a la aparición de RAM cutáneas. De hecho, en estudios recientes en pacientes que han desarrollado RAM leves a este producto se ha demostrado un éxito de reexposición de 85 por ciento-87 por ciento mediante una lenta titulación de la dosis.
ABSTRACT
Anticonvulsants and mood stabilizers mainly valproic acid, lamotrigine and carbamazepine are medications that have a high incidence of severe adverse drug reactions (ADRs), such erythema multiforme, Stevens- Johnson syndrome and toxic epidermal necrolysis. Early diagnosis based in systemic and cutaneous alarm signs have been described, allowing premature discontinuation of suspected drugs and start supportive therapy; these are the only measures that have that have shown clear reduction in mortality. The use of intravenous immunoglobulin G is recommended for their safety, but studies regarding their role in reducing mortality are conflicting. Corticosteroids have not proved changes in mortality compared with exclusive supportive care. Due to therapeutic quality Lamotrigine is used despite the incidence of ADRs. In fact in recent studies patients with mild ADRs to this drug have shown between 85 percent-87 percent of success, when patients are re-exposed through a slow increasing in dosage.
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Index: LILACS (Americas) Main subject: Psychotropic Drugs / Drug Eruptions / Anticonvulsants Type of study: Etiology study / Screening study Limits: Humans Language: Spanish Journal: Rev. chil. dermatol Journal subject: Dermatology Year: 2011 Type: Article Affiliation country: Chile Institution/Affiliation country: Universidad de Chile/CL

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Index: LILACS (Americas) Main subject: Psychotropic Drugs / Drug Eruptions / Anticonvulsants Type of study: Etiology study / Screening study Limits: Humans Language: Spanish Journal: Rev. chil. dermatol Journal subject: Dermatology Year: 2011 Type: Article Affiliation country: Chile Institution/Affiliation country: Universidad de Chile/CL