Which medications are commonly associated with the development of SJS/TEN that I should be aware of during patient assessments?

Medications commonly associated with the development of Stevens-Johnson Syndrome (SJS) and Toxic Epidermal Necrolysis (TEN) include certain antiepileptic drugs, beta-lactam antibiotics, and non-steroidal anti-inflammatory drugs (NSAIDs), among others. These drugs typically cause SJS/TEN with an onset usually 7 to 14 days after first exposure or within 3 days of re-exposure, presenting with painful rash, fever, mucosal erosions, blistering, and epidermal detachment ¹.

Specifically, antiepileptic drugs such as carbamazepine, phenytoin, and lamotrigine are well-recognized triggers of severe cutaneous adverse reactions including SJS and TEN (Fowler et al., 2019). Beta-lactam antibiotics are also implicated, and patients with suspected allergy to these should be referred to specialist services for assessment due to the risk of severe reactions including SJS/TEN ¹. NSAIDs, including non-selective NSAIDs and selective cyclooxygenase-2 inhibitors, have been associated with severe non-immediate cutaneous reactions such as SJS/TEN, especially in patients with a history of NSAID sensitivity or asthma with nasal polyps ¹.

Other drug classes known to cause SJS/TEN include sulfonamide antibiotics, allopurinol, and certain antiviral agents, although these are not detailed in the provided guideline excerpt but are recognized in broader clinical practice. The key clinical approach is to identify these drugs during patient assessments, consider the timing of symptom onset, and refer patients with suspected SJS/TEN promptly to specialist drug allergy services for confirmation and management ¹.