Posted by Sunnely on October 1, 2002, at 19:15:55
In reply to Re: Got the Lamictal rash!, posted by Dinah on September 30, 2002, at 22:43:22
I could be wrong but I doubt it's a serious rash. Nonetheless, you did the right thing by notifying your physician. The general recommendation with the use of lamotrigine (LTG) or Lamictal-induced rash is to report it to the prescribing physician immediately.
Is the LTG-induced rash benign or serious? How can you tell?
BENIGN RASH:
1. Occurs in 9% of adults
2. Usually benign if it occurs within 5 days of the start of treatment (often cause by other factors such as contact dermatitis and insect bites)
3. No systemic involvement (you don't feel sick)
4. No changes in complete blood count, liver enzymes
5. Treatment: a) retain the dose of LTG for 10-14 days, b) reduce the dose of LTG, c) apply topical agent such as 0.5% beclamethasone for itchinessSERIOUS RASH (defined as requiring both drug discontinuation and hospitalization):
1. 0.06% (2 of 3,153) in mood disorder clinical trials with LTG vs. 0.09% (1 of 1,053) with placebo. No cases of Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TENS) reported.
2. Higher in pediatric patients (1 in 50 to 1 in 100). LTG not approved in patients below the age of 16.
3. Nearly all cases of life-threatening rashes associated with LTG have occurred within 2 to 8 weeks of start of treatment.
4. Risk factors: a) concurrent treatment of LTG with valproic acid (Depakote, Depakene), b) exceeding the recommended initial dose of LTG, c) exceeding the recommended dose escalation of LTG, d) history of (+) HIV (100-fold increase in incidence), e) history of SLE or systemic lupus erythematosus (10-fold higher incidence), f) corticosteroid treatment (4.4-fold increase), and g) history of a relative having experienced a serious rash after LTG treatment (25% increase).
5. Accompanying symptoms of serious rash: a) fever, b) sore throat, c) malaise, d) facial involvement (e.g., edema, involvement of lips, mouth, or eyes), e) cervical lymphadenopathy (inflammation of lymph nodes), f) rash may be generalized, g) blood count changes such as low white blood cell count or high white blood cell count, low platelet count, increased in eosinophil count, h) elevated liver enzymes, i) urine analysis shows (+) for proteins and white blood cells.
6. Treatment: a) immediately discontinue LTG, b) immediately discontinue concurrent administered enzyme inhibitor (e.g., Depakote)
7. Unexplained rashes should be immediately referred to a dermatologist
> Originally posted by Lawrence S.
>
> > It's only been 5 days since starting Lamictal at 25mgs every other day. Now I have a rash on my hip about the size of a potato. I have a call out to my dr. but it usually takes about a week for him to get back to me. Should I stop the Lam? It actually seemed to be working already!
>
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poster:Sunnely
thread:121742
URL: http://www.dr-bob.org/babble/20020930/msgs/121875.html