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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 9 of 9. This is the beginning of the thread.
Posted by Dinah on September 30, 2002, at 22:43:22
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!
Posted by Dinah on September 30, 2002, at 22:47:58
In reply to Re: Got the Lamictal rash!, posted by Dinah on September 30, 2002, at 22:43:22
Posted by Lia Mason on September 30, 2002, at 23:00:20
In reply to Re: Above originally posted by lawrence s. (nm), posted by Dinah on September 30, 2002, at 22:47:58
Obviously you have to speak with your doctor IMMEDIATELY. I got a light rash on shoulders and my doc let me stay on it, just slowed down the titrating. But, again, don't take my experience as a green light. Leave a message for your doc that you got the rash and he/she should respond ASAP because the "real rash" is fatal. There are benign rashes too but you have to distinguish ASAP.
Lia
Posted by juanantoniod on October 1, 2002, at 0:45:06
In reply to Re: Above originally posted by lawrence s., posted by Lia Mason on September 30, 2002, at 23:00:20
I was on Lamictal and got the rash, and my PDoc told me to discontinue the Lamictal IMMEDIATELY. Not only is the rash an indicator of Stevens-Johnson Syndrome, which can be fatal, but it can also be disfiguring. I had HIGH hopes for the Lamictal working on my treatment resistant depression, so I did not want to give it up either, but if you have any doubt, stop the Lamictal now. You can always retry it later. (There have been studies where a second trial of the medication was successful for seizure patients who initially got the rash. Also, slower titration seems to work in this instance.) I don't know if you are on any other meds, but Depakote increases the blood level of Lamictal as well. Better to err on the safe side rather than disfigured (or dead).
Posted by Phil on October 1, 2002, at 6:18:36
In reply to Re: Above originally posted by lawrence s., posted by juanantoniod on October 1, 2002, at 0:45:06
Tell your docs office mgr or machine that this is an emergency. Dial his service and get in to see him.
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!
>
>
Posted by Phil on October 2, 2002, at 12:44:42
In reply to Re: Got the Lamictal rash! » Dinah, posted by Sunnely on October 1, 2002, at 19:15:55
I don't think this contradicts Sunnely but in studies regarding epilepsy, SJ Syndrome was seen.
Sounds like odds are slim though. I wonder if antibiotics cause it at a higher rate?PURPOSE: Lamotrigine (LTG) is an antiepileptic drug (AED) recently released in several countries. It is effective for a variety of seizure types in adults and children both as an add-on agent and in monotherapy, and is generally well tolerated. This report reviews the apparent risk factors for rash associated with LTG to determine whether and how the risk of serious rash can be minimized in practice. METHODS: The panel of experts reviewed all published and unpublished data related to the incidence and risk factors for serious rash with LTG.
RESULTS: An allergic skin reaction occurs in approximately 10% of patients, usually in the first 8 weeks. Rashes leading to hospitalization, including Stevens-Johnson syndrome and hypersensitivity syndrome, occurred in approximately one of 300 adults and one of 100 children in clinical trials and appeared to be increased with overrapid titration when starting therapy and with concurrent valproate (VPA).
CONCLUSIONS: Recommendations are made for both minimizing the likelihood of serious rash and for management of rash in patients taking LTG. Risk of serious rash may possibly be lessened by strict adherence to manufacturer's dosing guidelines, particularly in patients who are at higher risk: those on concurrent VPA and in the pediatric population.
Posted by Peter S. on October 2, 2002, at 15:05:20
In reply to Re: Got the Lamictal rash!, posted by Phil on October 2, 2002, at 12:44:42
It seems the best way to avoid the rash (although I'm not sure if this works for everyone) is to titrate up incredibly slowly and patiently. Stay on the smallest dosage for 1 week and then move up week by week. This is what I did and had no problems
Posted by Phil on October 2, 2002, at 18:13:52
In reply to Possible way to avoid the rash, posted by Peter S. on October 2, 2002, at 15:05:20
Not a bad idea for most AD's also. If my doc tells me to start at 20mg on something, I may start at 5mg. She's gotten used to it. : )
This is the end of the thread.
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