Lamotrigeno y reaccion inmune

FDA: Lamotrigine Can Cause Serious Immune Reaction

By Amy Orciari Herman

Edited by André Sofair, MD, MPH, and William E. Chavey, MD, MS

Lamotrigine, used to treat seizures and bipolar disorder, can cause hemophagocytic lymphohistiocytosis (HLH), the FDA has warned. HLH is a potentially fatal, systemic immune reaction.

From 1994 through 2017, there have been eight suspected or confirmed cases of HLH linked to lamotrigine. All occurred within 24 days of starting treatment. One patient died.

HLH usually starts with a persistent fever. Patients must meet five of the following eight criteria for an HLH diagnosis:

• Fever and rash
• Enlarged spleen
• Cytopenias
• High triglyceride or low fibrinogen levels
• High ferritin levels
• Hemophagocytosis detected via biopsy of bone marrow, the spleen, or lymph nodes
• Reduced natural killer (NK) cell activity
• Increased blood levels of CD25

Early diagnosis and treatment are critical. Accordingly, the FDA advises clinicians to promptly evaluate lamotrigine recipients who develop fever or rash, and to stop treatment if they suspect HLH or another immune-related reaction.

FDA MedWatch safety alert (Free)

Background: NEJM Journal Watch Neurology coverage of potential association between lamotrigine and meningitis (Your NEJM Journal Watch registration required)

Benjamin Hidalgo-Matlock

Skin Care Physicians of Costa Rica

4000-1054

2101-9574

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