Question:
Which of the following drugs is most commonly associated with causing Stevens-Johnson Syndrome (SJS)?
Which of the following drugs is most commonly associated with causing Stevens-Johnson Syndrome (SJS)?
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Think about anticonvulsants and their association with severe cutaneous adverse reactions.
Updated On: Jun 23, 2026
- Lamotrigine
- Penicillin
- Aspirin
- Metformin
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The Correct Option is A
Solution and Explanation
Step 1: Identify drugs associated with Stevens-Johnson Syndrome (SJS).
SJS is a severe mucocutaneous hypersensitivity reaction with epidermal detachment affecting <10% of the body surface area. It is predominantly drug-induced.
Step 2: Key culprit drugs.
The most commonly implicated drugs include lamotrigine (most frequently cited anticonvulsant causing SJS, especially when dose is escalated rapidly or combined with valproate), carbamazepine (classic high-risk drug, especially in HLA-B*1502 carriers), phenytoin, allopurinol, sulfonamide antibiotics (co-trimoxazole), nevirapine, and oxicam-class NSAIDs.
Step 3: Eliminate distractors.
Penicillin causes urticaria and anaphylaxis more commonly than SJS. Aspirin is associated with GI adverse effects and Reye syndrome. Metformin is not associated with SJS.
Step 4: Mechanism.
SJS is mediated by cytotoxic T lymphocytes recognizing drug-peptide-MHC complexes, leading to keratinocyte apoptosis via Fas-FasL and granulysin pathways.
Answer: Lamotrigine
SJS is a severe mucocutaneous hypersensitivity reaction with epidermal detachment affecting <10% of the body surface area. It is predominantly drug-induced.
Step 2: Key culprit drugs.
The most commonly implicated drugs include lamotrigine (most frequently cited anticonvulsant causing SJS, especially when dose is escalated rapidly or combined with valproate), carbamazepine (classic high-risk drug, especially in HLA-B*1502 carriers), phenytoin, allopurinol, sulfonamide antibiotics (co-trimoxazole), nevirapine, and oxicam-class NSAIDs.
Step 3: Eliminate distractors.
Penicillin causes urticaria and anaphylaxis more commonly than SJS. Aspirin is associated with GI adverse effects and Reye syndrome. Metformin is not associated with SJS.
Step 4: Mechanism.
SJS is mediated by cytotoxic T lymphocytes recognizing drug-peptide-MHC complexes, leading to keratinocyte apoptosis via Fas-FasL and granulysin pathways.
Answer: Lamotrigine
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