Medicines commonly known to cause SJS/TENS

Hello All,

On 8th October 2009 my wife was put on Tegretol (Carbamazapine) to treat her muscle pain (Off label use of the Tegretol). On 9th She had very high fever (105F), on 10th we took her to the local Emergency room where she was diagnosed (or do I say misdiagnosed) with Swine flu, we went to the same hospital again and yet they had no idea. Whole day on 10th we struggled with very high fever and hives. In the morning of 11th I knew there is something serious so I took her to another hospital where luckily a doctor diagnosed a very rare condition Toxic Epidermal Necrolysis (worse form of Steven-Johnson) and transfered us to the ICU Burn center of University of Colorado Hospital.

On October 12th, 2009 my wife was admitted into University of Colorado's Burn ICU for SJS, there she was diagnosed with T.E.N.S. It was a shocking news and I started meticulously collecting information about every single medicine that she took and doctors held Carbamazpine (Tegretol) responsible for her episode.

I wanted to have a list of medicines commonly known to cause this potentially life-threatening condition, I been told by doctors (rightly so) it is hard to predict what medicine can cause but my goal was to have a list of medications that we know have caused this condition in the past. My objective was (and is) if my wife is getting a new medication then we check it against this list and then make an informed decision if we are willing to take the risk or not.

With the help of Burn ICU doctors I did manage to prepare a detailed list, and thought someone here might find it useful.

Medicines more Frequently associated with SJS/TEN

-) Allopurinol
-) Amithiozone (anti-tubuculosis agent)
-) Amoxicillin
-) Ampicillin
-) Barbituates

-) Carbamazepine (aka Tegratol ===> This is the one my wife took and is blamed for her SJS/TEN)

Carbamazepine has been sold under these names in different countries:

Tegretol, Biston, Calepsin, Carbatrol, Epitol, Equetro, Finlepsin, Sirtal, Stazepine, Telesmin, Teril, Timonil, Trimonil, Epimaz, Carbama/Carbamaze (New Zealand), Amizepin (Poland), Hermolepsin (Sweden), and Degranol (South Africa).

Association of HLA-B*1502 allele and carbamazepine-induced Stevens-Johnson syndrome among Indians.

-) Cotrimoxazole
-) Hydantoins
-) Lamotrigine
-) Nevirapine
-) Phenylbutazone
-) Piroxicam
-) Sulfadiazine
-) Sulfadoxine
-) Sulfasalazine
-) Trimethoprim-sulfamethoxazole


Less Frequently associated with SJS/TEN:

These medications are known to cause SJS/TEN but less frequently:

-) Cephalosporin
-) Diclofenac
-) Ethambutol
-) Fenbufen
-) Fluoroquinolone

-) Ibuprofen (My wife is actually severely allergic to it too)

-) Ketek (I have not found a technical article linking it to SJS, but I have come across a web site claiming that it causes SJS. My wife is also severely allergic to this one too)

-) Ketoprofen
-) Naproxen
-) Pantoprazole
-) Rifampin
-) Sertraline
-) Sulindac
-) Tenoxicam
-) Thiabendazole
-) Tiaprofenic acid
-) Tramadol
-) Vancomycin : My wife was actually given this in the Burn-ICU and thankfully she was OK with this one.

If you know of any other medicine that causes SJS/TENS please let me know.

Jarrar

Muraq-e-Chughtai, Deewan-e-Ghalib (Musawaar); A family treasure.

My maternal grand father, Syed Ghulab Shah Bukhari, was a great literary personality he was an accomplished poet of Punjabi. He had a huge collection of beautiful books, but among these rare books my most favorite is a very rare copy of Deewan-e-Ghalib with the timeless paintings by Abdur-Rehman Chughtai. The preface of the the Murraqa was written in Urdu by Chughtai himself and in English by none other than Alaama Sir Dr. Muhammad Iqbal.

In 1927, Chughtai published the Muraqqa, his first major work, which comprised a series of illustrations he made for new edition of the thought-heavy and highly imaginative verses of Ghalib, 19th century " poet's poet" of Urdu and Persian.

My grand father bought a copy of the Muraqqa in 1927, The Murraq is still in very good condition and is well preserved in the capable hands of my cousin Kashif.

Few years back on my trip to Pakistan I got it all scanned and I am sharing parts of the Murraq with the readers of my blog.

The government of Pakistan, later, printed the Murraq many times but none of these matched the beauty of the one published in 1927.

This preface in Urdu is testimony to Chughtai's literary genius.

To view the whole collection of these paintings please follow the link on the top left side of this blog.

The collection is so rare that in 1995 I had the opportunity to visit Dehli, India, and went to the Ghalib museum of India near the place where Urdu's great poet rests. On seeing a very sub-standard re-printed copy of the Murraqa I asked why they were missing the original print of the book to which the person responded "It is not possible to find it anymore"? I mentioned about the copy that my family has in their possession his eyes lit up and asked me if we were interested to donate it to the museum? Of course my response was a polite "No".

Jarrar H. Jaffari

Sadiqaeen's Paintings of Ghalib's Poetry