Lamotrigine is a prescription drug to treat depression and seizures that has been on the market since 1994, but for one Austin Police Department Detective, it proved to be deadly. The Food and Drug Administration issued a warning for Lamotrigine and Lamictal seven months before his death, and now says he is one of eight who died because of its side effects. The detective’s widow now hopes her husband’s story will save other lives.
AUSTIN (KXAN) — Amy Bujanos opened the cabinet doors under the bathroom sink, digging for answers. She unearthed the paperwork from the pharmacy that came with her husband’s prescription —documents most people rarely ever look at, unless something is wrong.
It was for a bottle of Lamotrigine, which had been prescribed by a local psychiatrist who diagnosed Norman Bujanos with bipolar disorder. The prescription was written for the brand-name Lamictal, but Norman, who had never taken the drug before, opted for the generic version.
Amy scanned the medication guide and then found the papers Norman received during his visit to the psychiatrist’s office. There it was: a three-page explanation that appeared to be printed off a website. It spelled out the Food and Drug Administration warning for the disease that killed her husband.
Norman died Oct. 17, 2018 at an Austin hospital. Doctors diagnosed him with “Lamictal-induced HLH.” The letters stand for hemophagocytic lymphohistiocytosis, a condition that mimicked the flu and started with a high fever and body aches.
“It’s been hard for me, it’s been hard for Jordyn not having her daddy here, and having to tell her was the hardest thing I ever had to do,” Amy said, crying.
The FDA safety warning
The U.S. Food and Drug Administration issued the new safety warning in April 2018. At the time, the agency said it knew of eight HLH cases worldwide caused by the mood stabilizer and seizure medication — and one death.
Today, according to the FDA’s website, at least 81 cases have been reported to the agency, and eight have resulted in death. Norman is one of them.
The initial diagnosis
Norman, a 15-year veteran with the Austin Police Department, had spent many years on patrol before being promoted to the burglary unit as a detective. His interest in police work started as a child when he would always say he wanted to “catch the bad guys.”
It was a career Amy said he was passionate about and really good at. She recalls a time Norman tracked down an $80,000 watch in Arizona that had been stolen from a woman’s home in Austin during a break-in.
But, over time, Amy noticed the tough parts of the job starting to take their toll on her husband.
“A kid was killed [in a car accident], and you know, he would wake up and have nightmares seeing the kid’s dead body laying in the street,” Amy said. “For years, we couldn’t drive to that intersection. If we were going somewhere, he would have to go a different way.”
She told another story about Norman getting nauseous at times just thinking about walking into a home and smelling a decomposing body. Amy said he was also bothered by the way police were being portrayed, and it became harder to deal with each time he had to work protests that called into question actions by police officers.
Over time, Amy noticed Norman’s behavior and demeanor started to change. Norman also had a family history of depression. He agreed that he needed to see a psychiatrist and made an appointment in September 2018.
According to notes from his visit, the doctor diagnosed Norman with bipolar disorder and prescribed Lamictal, a drug that’s been on the market since 1994.
After almost two weeks of taking the generic Lamotrigine, Amy said Norman came home from work one day and didn’t feel well.
That night, he developed a fever of 103°. A couple of days later, when it didn’t go away, he went to the doctor. Medical records show a flu test came back negative. The physician determined his symptoms were caused by something viral and suggested he take over-the-counter pain medicine to help with the fever.
A couple more days went by and Norman was feeling worse. Amy said he felt too sick to leave the house, but didn’t want to go to the hospital. He opted for a physician’s assistant to come see him at the house. Records show she checked his vitals and suggested it was something bacterial going on. She prescribed a Z-Pack of antibiotics.
Records indicate Norman told both health care professionals he had recently started taking Lamotrigine.
The realization in the ER
Five days after the symptoms started, Amy told Norman he needed to go to the emergency room. He agreed.
“I noticed his eyes were a little bloodshot and he hadn’t gone to the bathroom,” Amy said. “And, he just said he couldn’t eat, and his whole body hurt, his back hurt, his chest hurt, he had this dry cough, everything just hurt.”
Blood tests at the hospital revealed his liver and kidneys were abnormal. The ER doctor raised a red flag about the new drug he was on for depression.
“She’s the one who said, ‘I think he’s having a toxic reaction to the Lamictal,'” Amy said.
It was the first time anyone had mentioned a possible connection.
Norman was transferred to a bigger Austin hospital where he met hematologist Dr. Jeff Yorio, who would eventually diagnose Norman with Lamictal-induced HLH.
Hospital records show the conclusion was confirmed through blood cell testing and a bone marrow biopsy.
At this point, Norman’s organs were shutting down. He was losing his ability to think and speak and was eventually put on a ventilator to help him breathe.
Dr. Yorio said he only sees four to five cases of HLH a year, which can be caused by other things including infections and cancer. This was the first case he’s seen caused by Lamotrigine. He said he did not realize an FDA warning had been issued for it.
The disease can be cured, but Dr. Yorio said the key is recognizing it early.
“Certainly the earlier you can make that diagnosis, the better,” Dr. Yorio said. “The earlier you can start on treatment, the better.”
Norman’s team of doctors tried to treat him with steroids and chemotherapy, but it was too late. He died in the hospital with Amy by his side.
The next chapter
In the midst of shock and grief, Amy posted a long explanation of what happened on Facebook the very next morning. She felt the urge to put the word out about Norman’s death, and also sound the horn about the FDA warning, which she said was also news to the pharmacists in her family.
“You got my sister who is a pharmacist, and my brother-in-law going ‘I have patients that take this and I had no idea,'” Amy said. “If the FDA puts this warning out, what did they do to make sure the doctors and hospitals and pharmacists are sharing the information with their patients?”
Amy hopes her husband’s story puts the FDA warning on people’s radar.
“Looking back on it, it’s just so unbelievable,” she says. “He wanted to help people and if this could help somebody, then I know that’s what he would want.”
The role of the FDA, drug makers and physicians
The FDA declined an interview, but press officer Jeremy Kahn emailed information about the agency’s processes.
Kahn said it’s the FDA’s job to put out safety warnings to health care professionals, along with drug makers. They do so via listservs, health professional newsletters, podcasts, Twitter and Facebook. He said the warnings are often picked up by the media, professional associations and patient organizations. Drug labels are also updated on the FDA website.
“Health care professionals have a responsibility to stay updated on new risks associated with the drugs they prescribe or dispense. And physicians use their own judgment in communicating that information to the patient.”Jeremy Kahn, FDA press officer
KXAN left several voicemails for the psychiatrist who prescribed Lamictal to Norman, but he has not responded.
The drugmaker of Lamictal, GlaxoSmithKline, told KXAN in a prepared statement that they couldn’t comment on Norman’s case directly since he was taking the generic version of the drug and they did not know what information he received from his doctors. However, it noted it takes reports of potential safety issues seriously.
“All prescription medicines have potential benefits and side effects,” it said in its statement. “FDA issued an April 2018 Drug Safety Communication, and GSK worked with the FDA to update the prescribing information for Lamictal & Lamictal XR. The FDA regulates when a medication is approved for use and regulates what and when a manufacturer, like GSK, can communicate safety information to healthcare professionals and potential patients. GSK followed the guidance provided by the FDA.”
GSK said people should talk with their doctors before deciding whether to stop taking the drug because halting without warning can cause serious problems.
Family denied sick pay amid APD contract negotiations
The Austin Police Department planned and paid for Norman’s funeral and helped guide his family through the process.
After he was laid to rest, Amy went to pick up Norman’s final paycheck. It was much lower than she expected. Amy said his final check showed a payout of 930 hours of sick time, with a remaining balance of 623.61 hours. She claims the remaining balance is worth more than $29,000.
Amy said under the current APD contract, she would have received the payout for up to 1,400 hours of his remaining sick time, but Norman died while Austin police officers were not under a contract with the city. Negotiations were ongoing and a new contract was signed less than 30 days from Norman’s death date.
Amy asked one of Norman’s sergeants to check with the Austin Police Association to see if they could make an exception. That sergeant told her APA President Ken Casaday “was glad to approve it,” but needed final approval from the city attorney. Amy was later told the city denied the request.
“I was completely disheartened to hear this, as that money would be extremely helpful to me and my daughter as we now adjust to being a one income family,” Amy wrote in an email to APD Chief Brian Manley. “He dedicated so much of his life to the police department, and after his tragic and unexpected death, it’s unsettling to think his family is going to be denied hours that he earned, and was saving, because a lawyer said no…and I am doing what I can to fight for what my husband would have wanted, and honor his memory.”
Amy said Chief Manley never responded to the email. This week, KXAN reached out to APD for a response.
A public information officer emailed the following statement:
“Since APD was without a meet and confer agreement at the time Det. Bujanos passed away and instead was operating under Government Code 143, the provisions did not allow for payment of those sick hours in excess of the 900 authorized by the code.“
UPDATE: Tuesday afternoon, only a few hours after this story was published, Amy said she received a call from Chief Manley who apologized for never responding to her email. He said he receives a lot of email, and never saw it.
Chief Manley told Amy he double checked everything with the city lawyers who still said ‘no.’ The chief said he is not authorized to tell the city what to do in a case like Norman’s, but will continue looking into it and keep her posted.
Meanwhile, Amy will continue spreading the word about the side effects associated with Lamotrigine, and support any efforts that can be made to remember APD officers like her husband who dedicated their lives to protecting the city, and lost their lives struggling with mental health issues.
“I understand why [APD says] it’s not a line of duty death,” Amy said. “But, in reality, he was suffering from mental illness that, really, he got from his job.”
Photojournalist Chris Nelson, Producer Rick Taylor, Digital Investigative Reporter/Producer Anthony Cave and Digital Executive Producer Kate Winkle contributed to this report.