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From the Comprehensive Epilepsy Center, Department of Neurology, College of Physicians and Surgeons (L.J.H., H.A., E.A.N., S.R.R., C.W.B.), and Department of Biostatistics, Mailman School of Public Health (R.B.), Columbia University, New York, NY.
Address correspondence and reprint requests to Dr. Lawrence J. Hirsch, Associate Clinical Professor of Neurology, Comprehensive Epilepsy Center, Columbia University, Neurological Institute, Box NI-135, 710 W. 168th St., New York, NY 10032
Objective: To determine rates of cross-sensitivity of rash among commonly used antiepileptic drugs (AEDs) in patients with epilepsy.
Methods: The incidence of AED-related rash was determined in 1875 outpatients (
12 years), taking carbamazepine (CBZ), clobazam (CLB), felbamate (FBM), gabapentin (GBP), levetiracetam (LEV), lamotrigine (LTG), oxcarbazepine (OXC), phenobarbital (PB), phenytoin (PHT), primidone (PRM), tiagabine (TGB), topiramate (TPM), vigabatrin (VGB), valproic acid (VPA), or zonisamide (ZNS). We compared rates of rash for each AED in patients with vs those without a rash to 1) another specific AED; 2) any other AED; 3) any two other AEDs; and 4) any non-epilepsy medication.
Results: A total of 14.3% (269/1,875) of patients had a rash attributed to at least one AED; 2.8% had a rash to two or more AEDs. Of patients who had a rash to CBZ and were also prescribed PHT (n = 59), 57.6% had a rash to PHT (abbreviated as CBZ 
PHT: 57.6%); of patients who had a rash to PHT and were also prescribed CBZ (n = 81), rate of rash was 42% (i.e., PHT CBZ: 42%). Other results: CBZ LTG: 20% (n = 50); LTG CBZ: 26.3% (n = 38); CBZ OXC: 33% (n = 15); OXC CBZ: 71.4% (n = 7); CBZ PB: 26.7% (n = 30); PB CBZ: 66.7% (n = 12); LTG PHT: 38.9% (n = 36); PHT LTG: 18.9% (n = 74); PB PHT: 53.3% (n = 15); PHT PB: 19.5% (n = 41); OXC LTG: 37.5% (n = 8); LTG OXC: 20% (n = 15). There was evidence of specific cross-sensitivity between CBZ and PHT, and between CBZ and PB.
Conclusion: Cross-sensitivity rates between certain antiepileptic drugs (AEDs) are high, especially when involving carbamazepine and phenytoin. Specific cross-sensitivity rates provided here may be useful for AED selection and counseling in individual patients.
Abbreviations: AED = antiepileptic drug; CBZ = carbamazepine; CLB = clobazam; FBM = felbamate; GBP = gabapentin; LEV = levetiracetam; LTG = lamotrigine; OXC = oxcarbazepine; PB = phenobarbital; PHT = phenytoin; PRM = primidone; TGB = tiagabine; TPM = topiramate; VGB = vigabatrin; VPA = valproic acid; ZNS = zonisamide.
Supplemental data at www.neurology.org
Disclosure: Dr. Hirsch has received honoraria for speaking from UCB Pharma, Eisai, and GlaxoSmithKline; research support from Abbott and GlaxoSmithKline; and consultation fees from Jazz Pharmaceuticals. Dr. Arif has received funds for travel to academic meetings from GlaxoSmithKline. E.A. Nahm has no relevant disclosures. R. Buchsbaum has no relevant disclosures. Dr. Resor has received consulting fees from MedPoint and Abbott Pharmaceuticals, and lecturing fees from GlaxoSmithKline. Dr. Bazil has received honoraria for speaking and/or consulting from Pfizer, UCB Pharma, GlaxoSmithKline, and Eisai, and research support from Pfizer.
Received September 13, 2007. Accepted in final form July 24, 2008.
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  Cross-Reactions to Antiepileptic Drugs Are Common Journal Watch Dermatology, December 19, 2008; 2008(1219): 4 - 4. [Full Text]
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 Skin Rashes with Antiepileptic Drugs Journal Watch (General), November 20, 2008; 2008(1120): 3 - 3. [Full Text]
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