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Milosavljević MN, Pejčić AV, Milosavljević JZ. A review of published cases of Stevens-Johnson syndrome and toxic epidermal necrolysis associated with the use of acetaminophen. Cutan Ocul Toxicol 2021; 40:280-292. [PMID: 34152866 DOI: 10.1080/15569527.2021.1942896] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
PURPOSE Acetaminophen (paracetamol) is a widely used analgesic and antipyretic. In several studies, its use was associated with the occurrence of Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). This narrative review aimed to explore and summarise available cases of SJS/TEN suspected to be associated with acetaminophen reported in the literature. MATERIALS AND METHODS Electronic searches were conducted in PubMed/MEDLINE, Web of Science, Scopus and Serbian Citation Index (SCIndeks). Case reports or case series which reported detailed clinical description of the patients diagnosed with SJS, TEN or SJS/TEN overlap which was caused or suspected to be most likely caused by acetaminophen with available full text were included in the review. RESULTS Twenty-nine publications describing a total of 36 patients which satisfied inclusion criteria were included in the review. The age of the patients ranged from 3 to 77 years (median: 32.5 years). There were 15 female (41.7%) and 15 male (41.7%) patients, while for 6 patients (16.7%) gender was not reported. TEN, SJS and SJS/TEN overlap were diagnosed in 24 (66.7%), 10 (27.8%) and 2 (5.6%) patients, respectively. Reported time from the first dose of acetaminophen to the onset of the first symptoms of SJS/TEN ranged from promptly to 21 days, with a median of 3 days. Use of some form of supportive and symptomatic care was reported in 28 patients (77.8%). Systemic corticosteroids were reported to be administered in 25 patients (69.4%) and intravenous immunoglobulin in 16 patients (44.4%). All patients survived. Long-term consequences (sequelae) were reported in 5 patients (13.9%). CONCLUSIONS Clinicians should be aware that SJS/TEN may be an adverse effect of acetaminophen and keep in mind that its prompt recognition and withdrawal of the culprit drug along with supportive care is of utmost importance.
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Affiliation(s)
- Miloš N Milosavljević
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Ana V Pejčić
- Department of Pharmacology and Toxicology, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
| | - Jovana Z Milosavljević
- Department of Anatomy, Faculty of Medical Sciences, University of Kragujevac, Kragujevac, Serbia
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Przybyła GW, Szychowski KA, Gmiński J. Paracetamol - An old drug with new mechanisms of action. Clin Exp Pharmacol Physiol 2021; 48:3-19. [PMID: 32767405 DOI: 10.1111/1440-1681.13392] [Citation(s) in RCA: 53] [Impact Index Per Article: 17.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Revised: 07/09/2020] [Accepted: 08/02/2020] [Indexed: 12/26/2022]
Abstract
Paracetamol (acetaminophen) is the most commonly used over-the-counter (OTC) drug in the world. Despite its popularity and use for many years, the safety of its application and its mechanism of action are still unclear. Currently, it is believed that paracetamol is a multidirectional drug and at least several metabolic pathways are involved in its analgesic and antipyretic action. The mechanism of paracetamol action consists in inhibition of cyclooxygenases (COX-1, COX-2, and COX-3) and involvement in the endocannabinoid system and serotonergic pathways. Additionally, paracetamol influences transient receptor potential (TRP) channels and voltage-gated Kv7 potassium channels and inhibits T-type Cav3.2 calcium channels. It also exerts an impact on L-arginine in the nitric oxide (NO) synthesis pathway. However, not all of these effects have been clearly confirmed. Therefore, the aim of our paper was to summarize the current state of knowledge of the mechanism of paracetamol action with special attention to its safety concerns.
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Affiliation(s)
| | - Konrad A Szychowski
- Department of Lifestyle Disorders and Regenerative Medicine, University of Information Technology and Management in Rzeszow, Rzeszow, Poland
| | - Jan Gmiński
- Department of Lifestyle Disorders and Regenerative Medicine, University of Information Technology and Management in Rzeszow, Rzeszow, Poland
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Ozawa M, Kubo T, Lee SH, Oe T. LC-MS analyses of N-acetyl- p-benzoquinone imine-adducts of glutathione, cysteine, N-acetylcysteine, and albumin in a plasma sample: A case study from a patient with a rare acetaminophen-induced acute swelling rash. J Toxicol Sci 2019; 44:559-563. [DOI: 10.2131/jts.44.559] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022]
Affiliation(s)
- Masashi Ozawa
- Department of Bio-analytical Chemistry, Graduate School of Pharmaceutical Sciences, Tohoku University
- Current address: Kyowa Hakko Kirin Co., Ltd
| | - Takashi Kubo
- Department of Bio-analytical Chemistry, Faculty of Pharmaceutical Sciences, Tohoku University
- Current address: Meiji Seika Pharma Co., Ltd
| | - Seon Hwa Lee
- Department of Bio-analytical Chemistry, Graduate School of Pharmaceutical Sciences, Tohoku University
- Department of Bio-analytical Chemistry, Faculty of Pharmaceutical Sciences, Tohoku University
| | - Tomoyuki Oe
- Department of Bio-analytical Chemistry, Graduate School of Pharmaceutical Sciences, Tohoku University
- Department of Bio-analytical Chemistry, Faculty of Pharmaceutical Sciences, Tohoku University
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Gabrielli S, Langlois A, Ben-Shoshan M. Prevalence of Hypersensitivity Reactions in Children Associated with Acetaminophen: A Systematic Review and Meta-Analysis. Int Arch Allergy Immunol 2018; 176:106-114. [DOI: 10.1159/000487556] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2017] [Accepted: 01/24/2018] [Indexed: 11/19/2022] Open
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Lebrun-Vignes B, Guy C, Jean-Pastor MJ, Gras-Champel V, Zenut M. Is acetaminophen associated with a risk of Stevens-Johnson syndrome and toxic epidermal necrolysis? Analysis of the French Pharmacovigilance Database. Br J Clin Pharmacol 2017; 84:331-338. [PMID: 28963996 DOI: 10.1111/bcp.13445] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2017] [Accepted: 09/20/2017] [Indexed: 12/24/2022] Open
Abstract
AIM Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare but severe mostly drug-induced cutaneous reactions. Acetaminophen is an over-the-counter drug used worldwide to treat pain and reduce fever. In 2013, the US Food and Drug Administration informed the public that acetaminophen was associated with a rare risk of SJS/TEN. The aim of the present retrospective study was to analyse reports of acetaminophen as a possible suspect in the development of SJS/TEN from the French Pharmacovigilance Database (FPDB). METHODS Cases of TEN/SJS with acetaminophen as a suspect drug registered in the FPDB, collected from January 2002 to December 2013, were analysed by an expert group. The algorithm of drug causality for epidermal necrolysis (ALDEN) was used as a reference tool for SJS/TEN to assess the causality of each suspect drug. RESULTS After exclusion of 16 nonvalidated cases, 112 cases (47 TEN, 51 SJS, 14 SJS/TEN overlaps) involving 574 suspected drugs (5⋅1/case) were analysed. In 80 cases, the acetaminophen ALDEN score was inferior or equal to that of other drugs, associated with a higher suspicion for causality. In 32 cases, acetaminophen had the highest score but matched with a 'very unlikely' or 'unlikely' causality in 12 cases. For the 20 remaining cases with a 'possible' or ' probable' causality, a protopathic or a confounding bias was likely in 14 cases. CONCLUSIONS After analysis of the French pharmacovigilance data using the ALDEN algorithm, we found no obvious SJS/TEN risk related to the use of acetaminophen in this large national series.
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Affiliation(s)
- Bénédicte Lebrun-Vignes
- Centre Régional de Pharmacovigilance, Hôpitaux Universitaires Pitié-Salpêtrière Charles-Foix, AP-HP, 47-83, Boulevard de l'Hôpital, 75651 Cedex 13, Paris, France
| | - Claire Guy
- Centre Régional de Pharmacovigilance, CHU - Hôpital Nord, Avenue Albert Raimond, 42055 Cedex 02, Saint-Etienne, France
| | - Marie-Josèphe Jean-Pastor
- Centre Régional de Pharmacovigilance Marseille - Provence - Corse, Hôpital Sainte-Marguerite, AP-HM, 270 Boulevard de Saint-Marguerite, 13009 Cedex 9, Marseille, France
| | - Valérie Gras-Champel
- Centre Régional de Pharmacovigilance, CHU Amiens Sud, 80054 Cedex 1, Amiens, France
| | - Marie Zenut
- Centre Régional de Pharmacovigilance, CHU - Centre de Biologie, EA 4681 PEPRADE, Université d'Auvergne, 58 Rue Montalembert -BP 69, 63003 Cedex 1, Clermont-Ferrand, France
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Watanabe H, Kamiyama T, Sasaki S, Kobayashi K, Fukuda K, Miyake Y, Aruga T, Sueki H. Toxic epidermal necrolysis caused by acetaminophen featuring almost 100% skin detachment: Acetaminophen is associated with a risk of severe cutaneous adverse reactions. J Dermatol 2015; 43:321-4. [DOI: 10.1111/1346-8138.13073] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2015] [Accepted: 07/10/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Hideaki Watanabe
- Department of Dermatology; Showa University School of Medicine; Tokyo Japan
| | - Taisuke Kamiyama
- Department of Dermatology; Showa University School of Medicine; Tokyo Japan
| | - Shun Sasaki
- Department of Dermatology; Showa University School of Medicine; Tokyo Japan
| | - Kae Kobayashi
- Department of Dermatology; Showa University School of Medicine; Tokyo Japan
| | - Kenichiro Fukuda
- Department of Emergency and Critical Care Medicine; Showa University; Tokyo Japan
| | - Yasufumi Miyake
- Department of Emergency and Critical Care Medicine; Showa University; Tokyo Japan
| | - Tohru Aruga
- Department of Emergency and Critical Care Medicine; Showa University; Tokyo Japan
| | - Hirohiko Sueki
- Department of Dermatology; Showa University School of Medicine; Tokyo Japan
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Kim EJ, Lim H, Park SY, Kim S, Yoon SY, Bae YJ, Kwon HS, Cho YS, Moon HB, Kim TB. Rapid onset of Stevens-Johnson syndrome and toxic epidermal necrolysis after ingestion of acetaminophen. Asia Pac Allergy 2014; 4:68-72. [PMID: 24527413 PMCID: PMC3921868 DOI: 10.5415/apallergy.2014.4.1.68] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2013] [Accepted: 08/09/2013] [Indexed: 11/23/2022] Open
Abstract
Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare, but life-threatening, severe cutaneous adverse reactions most frequently caused by exposure to drugs. Several reports have associated the use of acetaminophen with the risk of SJS or TEN. A typical interval from the beginning of drug therapy to the onset of an adverse reaction is 1-3 weeks. A 43-year-old woman and a 60-year-old man developed skin lesions within 3 days after administration of acetaminophen for a 3-day period. Rapid identification of the symptoms of SJS and TEN caused by ingestion of acetaminophen enabled prompt withdrawal of the culprit drug. After administration of intravenous immunoglobulin G, both patients recovered fully and were discharged. These two cases of rapidly developed SJS/TEN after ingestion of acetaminophen highlight the possibility that these complications can develop within only a few days following ingestion of over-the-counter medications such as acetaminophen.
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Affiliation(s)
- Eun-Jin Kim
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Hyun Lim
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - So Young Park
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Sujeong Kim
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Sun-Young Yoon
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Yun-Jeong Bae
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Hyouk-Soo Kwon
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - You Sook Cho
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Hee-Bom Moon
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
| | - Tae-Bum Kim
- Division of Allergy and Clinical Immunology, Department of Internal Medicine, Asan Medical Center, University of Ulsan College of Medicine, Seoul 138-736, Korea
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