From the Guidelines
Omeprazole-induced Stevens-Johnson syndrome is an extremely rare but potentially life-threatening adverse reaction, and the typical dose associated with this reaction is not well-established, as it can occur at any dose, even after just 1-3 doses. The mechanism of this reaction is thought to involve an immune system overresponse, where T-cells attack skin cells, causing widespread blistering and mucosal damage 1. This severe allergic reaction typically occurs within the first 8 weeks of treatment, though it can develop at any point during treatment. The reaction is often preceded by a flu-like illness, followed by a painful rash, blistering, and skin detachment.
Key Points to Consider
- Risk factors for omeprazole-induced Stevens-Johnson syndrome include genetic predisposition, prior drug reactions, and compromised immune function.
- Symptoms of Stevens-Johnson syndrome include flu-like illness, painful rash, blistering, and skin detachment.
- If Stevens-Johnson syndrome is suspected, omeprazole should be immediately discontinued and emergency medical care sought.
- Treatment focuses on supportive care, wound management, and sometimes immunosuppressive therapy, as recommended in guidelines such as the U.K. guidelines for the management of Stevens-Johnson syndrome/toxic epidermal necrolysis in adults 1.
Important Considerations for Management
- Gastric protection with a proton pump inhibitor, such as omeprazole, is actually recommended in the management of Stevens-Johnson syndrome/toxic epidermal necrolysis, in patients who are at risk of stress-related gastric or duodenal ulceration 1.
- However, given the potential risk of omeprazole-induced Stevens-Johnson syndrome, alternative proton pump inhibitors or histamine-2 receptor antagonists may be considered in patients who are at high risk of this adverse reaction.
From the Research
Mechanism of Omeprazole Inducing Stevens-Johnson Syndrome
- There is no direct evidence in the provided studies that explains the mechanism of omeprazole (proton pump inhibitor) inducing Stevens-Johnson syndrome 2, 3, 4, 5, 6.
- The studies primarily focus on other medications such as trimethoprim-sulfamethoxazole, allopurinol, carbamazepine, and phenytoin, which are associated with Stevens-Johnson syndrome.
Typical Dose Associated with Adverse Reaction
- The provided studies do not mention the typical dose of omeprazole associated with Stevens-Johnson syndrome 2, 3, 4, 5, 6.
- The studies discuss the association of various medications with Stevens-Johnson syndrome but do not provide information on the dosage of omeprazole.