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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 25 of 34. This is the beginning of the thread.
Posted by hundredhugs on July 16, 2004, at 19:42:18
I have been on Lamictal for at least 4 years now and never had a problem. It has been a good med for me. At one point I was up to 600 mg but we got backed down to 450mg.
I started Eskalith about 3 months ago. I have a HORRIBLE rash that I swear is hives. I can't trace it to anything new. I went to the ER they said it is hives and they think it is med related. I called my pdoc and she said that the only med it could be is the lamictal because of the side effect of a rash. What I don't understand is I have been on it for so long. If I am not better in a couple days I am suppose to stop the lamictal cold turkey due to the threat of the rash. I am scared. I don't want to make the wrong decision, I really don't want to give up a med that has worked for me so well. But I don't want a life threatening rash either. Could the eskalith be causing this?
I would appreciate any input,
Thanks,
Hundredhugs
Posted by SLS on July 16, 2004, at 20:35:03
In reply to Lamictal rash??, posted by hundredhugs on July 16, 2004, at 19:42:18
Hi.
I think the smart thing to do would be to discontinue the Lamictal immediately and to reintroduce it gradually if necessary. How did you go about determining that you needed more than 300mg?
- Scott
Posted by karen m. on July 17, 2004, at 0:30:12
In reply to Re: Lamictal rash??, posted by SLS on July 16, 2004, at 20:35:03
i'm interested in hearing that dosage answer too.
Posted by theo on July 17, 2004, at 8:16:23
In reply to Lamictal rash??, posted by hundredhugs on July 16, 2004, at 19:42:18
First of all, I would talk to your doctor before "stopping it immediately", it may be whatever new it is you introduced to your body. A lot of doctors will usually reduce dosage for Lamictal versus stopping completely if they don't think it is SJS.
Posted by SLS on July 17, 2004, at 8:45:52
In reply to Re: Lamictal rash?? » hundredhugs, posted by theo on July 17, 2004, at 8:16:23
> First of all, I would talk to your doctor before "stopping it immediately", it may be whatever new it is you introduced to your body. A lot of doctors will usually reduce dosage for Lamictal versus stopping completely if they don't think it is SJS.
I respectfully disagree.
http://www.psycheducation.org/depression/meds/LamRash.htmhttp://www.google.com/search?hl=en&ie=UTF-8&q=lamotrigine+rash
- Scott
Posted by SLS on July 17, 2004, at 8:56:25
In reply to Lamictal rash??, posted by hundredhugs on July 16, 2004, at 19:42:18
I hope you are doing better today. It would be nice if you didn't have to stop the Lamictal.
I forgot to ask. Did they give you an antihistamine?
- Scott
Posted by theo on July 18, 2004, at 7:40:49
In reply to Re: Lamictal rash??, posted by SLS on July 17, 2004, at 8:45:52
You must have not even read the link you posted, it said to hold the dose, NOT STOP, until you see your doctor to avoid having to start over again.
Posted by Sad Panda on July 18, 2004, at 10:59:49
In reply to Re: Lamictal rash?? » SLS, posted by theo on July 18, 2004, at 7:40:49
> You must have not even read the link you posted, it said to hold the dose, NOT STOP, until you see your doctor to avoid having to start over again.
>
>Exactly what it says is:
"Three strategies for rash
1. Stop for any rash anywhere.
2. Have a dermatologist you can get patients in to see within 24-48 hours; hold the doses until seen.
3. Stop for any rash above the neck; for anything else, reduce the dose to the previous level, and hold it there until you can tell whether the rash is going away (if so, continue upward again but more slowly and/or by smaller steps; use Benadryl or topical Caladryl to control itching while you're waiting). "It doesn't say "NOT STOP" anywhere, the least cautious 3rd choice says to "reduce the dose to the previous level"
SJS isn't to be taken lightly.
Cheers,
Panda.
Posted by theo on July 18, 2004, at 11:44:09
In reply to Re: Lamictal rash?? » theo, posted by Sad Panda on July 18, 2004, at 10:59:49
It shouldn't be taken lightly but the doctor is the one that needs to diagnose, not the patient. I don't know if you read Dr. Phelps complete rightup on Lamictal but studies are now showing the risk factor to be, the number of cases/3000 versus 1000 with slow dose increase.
I'm not saying to ignore a rash, but if you have SJS you'll wake up with a severe rash from head to toe.
If one has spent 3 months to get to a theraputic dose of Lamictal, I would hate to see them stop based off of their own decision, to find out later they had dermatitis or some other rash that 90% of anticonvulsants cause.
The first week I tried Topamax I head red, itchy areas all over my face and neck, it wasn't SJS but I went and let my doctor diagnose it before trying to play doctor and jump to conclusions.
Posted by SLS on July 18, 2004, at 13:47:54
In reply to Re: Lamictal rash?? » Sad Panda, posted by theo on July 18, 2004, at 11:44:09
I spent quite some time considering your post yesterday.
Your advice was sound, but not fool-proof. The patient had to be managed by a physician experienced with Lamictal and the rash reaction for it to work.
Today we can do a little Monday morning quarterbacking.
Ideally, the patient should call his doctor. For some reason, that didn't seem to be the way the day was to unfold. Additionally, the patient stated that he could not identify anything new that could account for the reaction. It may have been something other than the Lamictal, but...
I would rather have erred on the side of caution. So would the drug company. Very few practitioners can identify what's what with this rash reaction, that's why the manufacturer urges the immediate discontinuation of the drug upon the appearance of any suspicious rash. They offer no alternatives. They are, of course, being very, very, cautious.
http://www.rxlist.com/cgi/generic/Lamictal.htm
http://www.rxlist.com/cgi/generic/Lamictal_ad.htm
At 450mg, it was going to take a long time for the Lamictal to leave his body, and it made sense to give it a head start just in case it was the drug that was the provocateur.
Your suggestion has a distinct advantage if there is a necessity to reintroduce the drug using the recommended titration protocol from the beginning. It is stated in that first URL I cited that this is true after 3 or more days post-discontinuation. I would like to know where they came up with that recommendation. They make it sound like a well-established fact. This is really the critical issue. It determines what the best course of action would be upon the presentation of a rash. If this recommendation has no basis in fact, and Lamictal can be reintroduced more quickly, then its immediate discontinuation upon the appearance of a rash makes more sense to me than a reduction in dosage. However, this deliberation is for the most part moot given the black-box warning on the label.
- Scott
Posted by theo on July 18, 2004, at 14:23:53
In reply to Re: Lamictal rash?? » theo, posted by SLS on July 18, 2004, at 13:47:54
I was not going to try Lamictal because of the Rash scare. I talked to an Internist, Psychiatrist and Dermatologist before starting it because I was scared to death. The best advice I got was from my Dermatologist. He said if you worry about side effects you should never take ANY medication because almost all have a deadly side effect. I haven't checked recentlt but Wellbutrin at one time had a "Black Box" warning on it for deadly seizures, nowadays it's passed out like gum.
Posted by SLS on July 18, 2004, at 14:51:18
In reply to Re: Lamictal rash?? » theo, posted by SLS on July 18, 2004, at 13:47:54
Sorry. Maybe this will work:
http://www.rxlist.com/cgi/generic/lamotrigine.htm
"ALTHOUGH BENIGN RASHES ALSO OCCUR WITH LAMICTAL, IT IS NOT POSSIBLE TO PREDICT RELIABLY WHICH RASHES WILL PROVE TO BE SERIOUS OR LIFE THREATENING. ACCORDINGLY, LAMICTAL SHOULD ORDINARILY BE DISCONTINUED AT THE FIRST SIGN OF RASH, UNLESS THE RASH IS CLEARLY NOT DRUG RELATED. DISCONTINUATION OF TREATMENT MAY NOT PREVENT A RASH FROM BECOMING LIFE THREATENING OR PERMANENTLY DISABLING OR DISFIGURING."
This is pretty scary, but it does seem to be a rare occurrence.
- Scott
Posted by theo on July 18, 2004, at 14:51:36
In reply to Re: Lamictal rash??, posted by theo on July 18, 2004, at 14:23:53
Final point, Lamictal is currently the only "approved" anti-convulsant other than Depakote for psychiatric disorders; BP, Depression, etc.
Between the two, which one would you pick?
Posted by SLS on July 18, 2004, at 15:38:16
In reply to Re: Lamictal rash??, posted by theo on July 18, 2004, at 14:51:36
> Final point, Lamictal is currently the only "approved" anti-convulsant other than Depakote for psychiatric disorders; BP, Depression, etc.
>
> Between the two, which one would you pick?
I think that would depend on what your primary symptoms are. If mania or hypomania are prominent, Depakote would be my first choice. Some people complain that Depakote makes them feel more depressed. I think it's a good drug. Lamictal is being used now primarily for bipolar depression and has shown some utility in rapid cycling. I don't think Lamictal is much good for mania at all, and I am surprised that it is effective for rapid cycling, but so goes the story. It definitely extends the time between depressive episodes, though, and goes well with lithium for prophylaxis in bipolar I disorder.If you are bipolar II or bipolar I and intolerant to lithium, and are prone to mania or hypomania, I would suggest Depakote. If you are bipolar II, and depression is your major symptom, I would probably try Lamictal first.
- Scott
Posted by hundredhugs on July 18, 2004, at 18:30:52
In reply to Re: Lamictal rash??, posted by SLS on July 16, 2004, at 20:35:03
The reason we got to 450mg (I was at 300mg) was because I was in a depression crisis and suicidal, my pdoc bumped up the lamictal up 150 and it helped very quickly. I think that is the dose that works for me. As for the 600mg. That is a long story that involves another pdoc. I got my pdoc back and we got it back down to 450mg.
The rash is still flaming red and itchy after 6 days, but IS starting to show signs of improvement. The prednisone and allegra have made a big difference. Personally I think it is the prednisone.
I didn't know that it took that long for the lamictal to leave your body, that is really scarey if this is the lamictal rash. I am encouraged though that is is getting better though.
Thank you for your input
Hundredhugs
Posted by hundredhugs on July 18, 2004, at 21:42:18
In reply to Re: Lamictal rash?? » hundredhugs, posted by SLS on July 17, 2004, at 8:56:25
Scott,
Sorry I didn't respond sooner, I have been almost totally consumed with this rash so I haven't been on the computer much. The dr at the ER put me on a steriod and antihistime, Prednisone and Allegra. I am still flaming red rash though but starting to feel a little better.
Thank you for asking how I'm doing
Hundredhugs
Posted by starlight on July 19, 2004, at 15:15:26
In reply to Re: Lamictal rash?? ? Sad Panda, posted by theo on July 18, 2004, at 11:44:09
One thing that makes me think it's not the lamictal is that you've been on it for 4 years. That's not typical at all. If you're going to get a rash it's normally within the first 6 months and I believe there has been 1 case where the person got the rash after being on it for 2 years or something like that.
starlight
Posted by starlight on July 19, 2004, at 16:09:33
In reply to Re: Lamictal rash??, posted by theo on July 18, 2004, at 14:23:53
It sounds like your fear is a bit irrational. Do you have a tendency towards reactions to medications? That was one of the questions my doc had. The only thing I've ever reacted to was Penicillen. Not that many people actually react to the drug that way and it's an excellent choice for Bipolars, much better than lithium or depakote in my humble opinion.
starlight
Posted by starlight on July 19, 2004, at 16:12:54
In reply to Re: Lamictal rash?? ? theo, posted by SLS on July 18, 2004, at 15:38:16
I think Depakote is a terrible drug. I had a friend on it who was being treated for BP I and she was basically deadened on it and gained a bunch of weight which made her even more miserable. It was approved in 1983 and at this point there are much better meds on the market that don't cause nearly the amount of side effects that depakote has. But, what do I know?
starlight
Posted by SLS on July 19, 2004, at 16:51:49
In reply to Re: Lamictal rash??, posted by starlight on July 19, 2004, at 16:12:54
> I think Depakote is a terrible drug. I had a friend on it who was being treated for BP I and she was basically deadened on it and gained a bunch of weight which made her even more miserable. It was approved in 1983 and at this point there are much better meds on the market that don't cause nearly the amount of side effects that depakote has. But, what do I know?
> starlight
Hi.Depakote and I don't get along all that well. Nonetheless, it has emerged as the most effective first line treatment for bipolar disorder. It stabilizes more people with fewer side effects than any other single drug, including lithium. Unfortunately, like many of the other drugs used to treat mental illness, some people experience unacceptable side effects with Depakote that require them to switch to an alternative treatment.
Depakote might be a terrible drug, but it's about the best we have to work with right now.
- Scott
Posted by theo on July 19, 2004, at 17:15:45
In reply to Re: Lamictal rash??, posted by hundredhugs on July 18, 2004, at 18:30:52
Just curious, where was the rash located on your body, face, back etc.?
Posted by starlight on July 20, 2004, at 11:36:51
In reply to Re: Lamictal rash??, posted by SLS on July 19, 2004, at 16:51:49
I just disagree that it's the best we have to work with. As far as I'm concerned there are newer generation drugs with less side effects and in the end you have to balance it all out and get the most efficient treatment. To me, just because it's the first line of defense doesn't mean it's the only avenue available. After being on it for about 2 weeks, I refused to take it. It felt like poison in my body. I went to my Pdoc, research in hand, on both Trileptal and Lamictal. He was an old school Pdoc that wanted to put me on either Depakote or Lithium, but when I went in with the research in hand, he couldn't argue and I've been stable on those drugs ever since. I've had no weight gain, no clouding of my mind, no feeling like my energy is deadened. Those are very precious things to me - I want to feel stable, but good enough to enjoy my life.
starlight
Posted by SLS on July 20, 2004, at 12:30:20
In reply to Re: Lamictal rash??, posted by starlight on July 20, 2004, at 11:36:51
> I just disagree that it's the best we have to work with. As far as I'm concerned there are newer generation drugs with less side effects and in the end you have to balance it all out and get the most efficient treatment. To me, just because it's the first line of defense doesn't mean it's the only avenue available. After being on it for about 2 weeks, I refused to take it. It felt like poison in my body. I went to my Pdoc, research in hand, on both Trileptal and Lamictal. He was an old school Pdoc that wanted to put me on either Depakote or Lithium, but when I went in with the research in hand, he couldn't argue and I've been stable on those drugs ever since. I've had no weight gain, no clouding of my mind, no feeling like my energy is deadened. Those are very precious things to me - I want to feel stable, but good enough to enjoy my life.
> starlight
This might be a good time to start a thread devoted to the use of mood stabilizers in general. There hasn't been one in a long time, and I don't think that much attention has been paid to Trileptal yet.I have had bad experiences with Depakote myself, but I think it is important not to generalize to everyone the experiences of the individual to a given treatment. From what I have read and what I have been exposed to, Depakote seems to be the most consistently effective mood stabilizer for bipolar disorder and is generally well tolerated.
It is wonderful that you are experiencing such a great improvement on Trileptal. I might consider trying it myself. If I may ask, what are you being treating for? How has Trileptal improved your condition? Do you think it would be good as a treatment for bipolar depression?
- Scott
Posted by starlight on July 20, 2004, at 14:19:42
In reply to Re: Lamictal rash?? ? starlight, posted by SLS on July 20, 2004, at 12:30:20
I'm being treated for Bipolar II and take a combo of Trileptal and Lamictal, and 75 mgs of Effexor as well, which I love. I have a close friend with Bipolar 1 who was on depakote and gained over 40 pounds on it and that made her even more depressed. Her personality was basically gone and she had no energy, but she had an old school Pdoc who wouldn't even consider the newer meds. She and I talked about my regimen and she found a new Pdoc who took her off of everything, let her withdraw and then started her on a similar combo. She's lost a lot of the weight and her personality has returned. She takes some seroquel in addition, but she is doing so much better than before - back to doing yoga and looking better.
I do a lot of yoga and actually teach it, so I'm very in tune with my body and how it feels, so I could recognize the ill effects of Depakote quickly. I talked with another Pdoc who I work with and he was the one who suggested researching the newer drugs. I'm glad I did.
That's not to say that the drugs I'm on work for everyone - and some people may react better to the depakote than I did. I absolutely refused to take lithium from the start.
starlight
Posted by hundredhugs on July 21, 2004, at 2:34:23
In reply to Re: Lamictal rash?? » hundredhugs, posted by theo on July 19, 2004, at 17:15:45
Theo,
The rash covered my entire trunk and half way down my arms in a bright flaming red rash with bumps. Then it was less severe going up my neck, scalp, down my legs and rest of my arms. It did start to travel onto my face but the prednisone stopped it.
Ths rash is much better now. It is not flaming red like it was but still has the bumps....and itch. That is getting better comparing to what it was over a week ago of trying to treat this, it is significantly better (but still uncomfortable).
Hundredhugs
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