MagicDrumSticks

10+ Year Member
Apr 11, 2009
125
1
Dallas, TX. Cheap but fun.
Status
Medical Student
Hey guys, I looked around a lot of google and had difficulty with this particular question. One of the residents told me to find out the answer and apparently I'm obligated to. However, I'll take it as a challenge and this question might even help save some lives so here goes.

Recently we had a patient admitted in the burn unit for SJS syndrome. The patient had been taking modafinil (provigil) on and off for an unknown period of time (between 2-3 weeks according to the family, though the family doesn't live with the patient). The doctor had initially prescribed 100 mg per day, but the family members said that this particular patient felt "they needed to feel the effects more" so they upped the dosage to 200 mg a day.

Apparently though, SJS is not dose dependant Well, this is according to several docs I've talked to. On the flip side, some psychiatrists I spoke to said the complete opposite (that double dosage means chances are increased exponentially) and 2 docs (reputable) said that modafinil doesn't even cause SJS..


Now, I'm kind of stuck here and I need some help, I couldn't find this on google so if someone has some insight it'd be great.


1.) Is SJS/TEN dose dependant?

2.) Appx how long does the reaction take to occur? We're not even sure if modafinil is the main culprit because the patient could have been taking some other medication prior to starting the provigil (unconfirmed because the patient doesn't live with the family and has no spouse)

3.) Is it confirmed that modafinil causes SJS? Wikipedia says so, but idk how reliable that can be.
 
Oct 22, 2010
9
0
Portland, OR
Status
Medical Student
I couldn't find the answer to whether or not SJS is dose dependant but Provigil is definitely a cause of SJS (http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm152701.htm)
Also according to "Principles of Critical Care" (Lacouture, Ch. 107) SJS/TEN occurs about 3 weeks after administration of the offending drug. As a side note was he taking any anticonvulsants? Provigil is also known to enhance the effects of Phenytoin (but I'm not sure of the route by which it does this) and is, as are other anticonvulsants, another major risk factor of SJS/TEN.
 
Last edited:
Aug 13, 2010
33
0
Status
Medical Student
I couldn't find the answer to whether or not SJS is dose dependant but Provigil is definitely a cause of SJS (http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm152701.htm)
Also according to "Principles of Critical Care" (Lacouture, Ch. 107) SJS/TEN occurs about 3 weeks after administration of the offending drug. As a side note was he taking any anticonvulsants? Provigil is also known to enhance the effects of Phenytoin (but I'm not sure of the route by which it does this) and is, as are other anticonvulsants, another major risk factor of SJS/TEN.
Thanks for that :thumbup:

As far as any other medication, we are not sure ATM because the patient is not a US citizen and family members didn't know much. As the topic title says, it's a very difficult set of questions.
 

fahimaz7

15+ Year Member
Jul 18, 2004
3,286
216
Colorado
Status
Attending Physician
I couldn't find the answer to whether or not SJS is dose dependant but Provigil is definitely a cause of SJS (http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm152701.htm)
Also according to "Principles of Critical Care" (Lacouture, Ch. 107) SJS/TEN occurs about 3 weeks after administration of the offending drug. As a side note was he taking any anticonvulsants? Provigil is also known to enhance the effects of Phenytoin (but I'm not sure of the route by which it does this) and is, as are other anticonvulsants, another major risk factor of SJS/TEN.
Have you started school yet? Are you a pharmacist?
 
Oct 22, 2010
9
0
Portland, OR
Status
Medical Student
No, I don't start school until August. I wish I was a pharmacist (not really, I would much rather be a physician), then I would know more about pharmacology (which I feel I am kind of weak in)! I work as a clinical researcher at an academic medical center in orthopaedics, critical care, and the emergency department so I am really good at finding information across a pretty broad spectrum of pathologies if I don't know the answer. Plus, med student ask me questions at work so I have gotten pretty used to it by now. I also enjoy doing it because it increases my knowledge bank as well.
 

sunshinevet

7+ Year Member
Aug 8, 2009
812
4
Perth, Australia
Status
Veterinarian
Hey guys, I looked around a lot of google and had difficulty with this particular question. One of the residents told me to find out the answer and apparently I'm obligated to. However, I'll take it as a challenge and this question might even help save some lives so here goes.

Recently we had a patient admitted in the burn unit for SJS syndrome. The patient had been taking modafinil (provigil) on and off for an unknown period of time (between 2-3 weeks according to the family, though the family doesn't live with the patient). The doctor had initially prescribed 100 mg per day, but the family members said that this particular patient felt "they needed to feel the effects more" so they upped the dosage to 200 mg a day.

Apparently though, SJS is not dose dependant Well, this is according to several docs I've talked to. On the flip side, some psychiatrists I spoke to said the complete opposite (that double dosage means chances are increased exponentially) and 2 docs (reputable) said that modafinil doesn't even cause SJS..


Now, I'm kind of stuck here and I need some help, I couldn't find this on google so if someone has some insight it'd be great.


1.) Is SJS/TEN dose dependant?

2.) Appx how long does the reaction take to occur? We're not even sure if modafinil is the main culprit because the patient could have been taking some other medication prior to starting the provigil (unconfirmed because the patient doesn't live with the family and has no spouse)

3.) Is it confirmed that modafinil causes SJS? Wikipedia says so, but idk how reliable that can be.
You're a med student who's never heard of pubmed?

If I were your patient and I asked you for your sources as to the causes of my disease/treatment options and you said WIKIPEDIA I would ask for a new doctor :thumbup:
 

rxforlife2004

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Jan 13, 2004
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Hey guys, I looked around a lot of google and had difficulty with this particular question. One of the residents told me to find out the answer and apparently I'm obligated to. However, I'll take it as a challenge and this question might even help save some lives so here goes.

Recently we had a patient admitted in the burn unit for SJS syndrome. The patient had been taking modafinil (provigil) on and off for an unknown period of time (between 2-3 weeks according to the family, though the family doesn't live with the patient). The doctor had initially prescribed 100 mg per day, but the family members said that this particular patient felt "they needed to feel the effects more" so they upped the dosage to 200 mg a day.

Apparently though, SJS is not dose dependant Well, this is according to several docs I've talked to. On the flip side, some psychiatrists I spoke to said the complete opposite (that double dosage means chances are increased exponentially) and 2 docs (reputable) said that modafinil doesn't even cause SJS..


Now, I'm kind of stuck here and I need some help, I couldn't find this on google so if someone has some insight it'd be great.


1.) Is SJS/TEN dose dependant?

2.) Appx how long does the reaction take to occur? We're not even sure if modafinil is the main culprit because the patient could have been taking some other medication prior to starting the provigil (unconfirmed because the patient doesn't live with the family and has no spouse)

3.) Is it confirmed that modafinil causes SJS? Wikipedia says so, but idk how reliable that can be.
1. No. SJS/TEN is not dose dependent.
2. It usually takes time to result in SJS induced by Provigil. In clinical trials, the median time to rash that resulted in discontinuation was 13 days (Clinical Pharmacology source). The median time to onset was 17.5 days, with a range of 5 days to 5 weeks.
3. Yes, Modafinil can cause SJS.
 

fahimaz7

15+ Year Member
Jul 18, 2004
3,286
216
Colorado
Status
Attending Physician
No, I don't start school until August. I wish I was a pharmacist (not really, I would much rather be a physician), then I would know more about pharmacology (which I feel I am kind of weak in)! I work as a clinical researcher at an academic medical center in orthopaedics, critical care, and the emergency department so I am really good at finding information across a pretty broad spectrum of pathologies if I don't know the answer. Plus, med student ask me questions at work so I have gotten pretty used to it by now. I also enjoy doing it because it increases my knowledge bank as well.
Why does your status say "medical student"? Did you really answer this post by using google? Nothing from your background supports the idea that you fully understand what you're talking about.

It is very misleading to label yourself as a medical student, when you haven't even paid tuition yet.
 

MSUSpartan642

GO GREEN!
10+ Year Member
7+ Year Member
Feb 9, 2009
560
10
Michigan
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Resident [Any Field]
Why does your status say "medical student"? Did you really answer this post by using google? Nothing from your background supports the idea that you fully understand what you're talking about.

It is very misleading to label yourself as a medical student, when you haven't even paid tuition yet.
Seriously? You know why it says medical student, he got accepted for next year, it says right below his post "Class of 2015". Tons of people do that, they're excited to be accepted. I have a feeling your just trying to start an argument.
 

werd

Senior Member
15+ Year Member
Feb 13, 2004
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did you guys c/s derm re: your patient? often they'll help with the diagnosis and cause, and answer questions like the ones you're asking. i agree with the above responses.
 

hurdlepup

Surviving Intern Year
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Feb 11, 2010
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Don't know if your school has a subscription--but UpToDate is the place to check this.

I will look into it tomorrow at school.
 

hurdlepup

Surviving Intern Year
7+ Year Member
Feb 11, 2010
240
24
On Country Roads
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Resident [Any Field]
1. No. SJS/TEN is not dose dependent.
2. It usually takes time to result in SJS induced by Provigil. In clinical trials, the median time to rash that resulted in discontinuation was 13 days (Clinical Pharmacology source). The median time to onset was 17.5 days, with a range of 5 days to 5 weeks.
3. Yes, Modafinil can cause SJS.
confirmed via UpToDate
 

Hoju

I don't want Fop.
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Jun 1, 2008
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You're a med student who's never heard of pubmed?

If I were your patient and I asked you for your sources as to the causes of my disease/treatment options and you said WIKIPEDIA I would ask for a new doctor :thumbup:
:thumbup: SDN isn't better than Wikipedia either.