Psycho-Babble Medication Thread 366982

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Re: Lamictal rash?? » theo

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


 

Re: Lamictal rash??

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.

 

Re: Lamictal rash??

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

 

Re: Lamictal rash??

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?

 

Re: Lamictal rash?? » theo

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

 

Re: Lamictal rash??

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

 

Re: Lamictal rash?? » SLS

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

 

Re: Lamictal rash??

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

 

Re: Lamictal rash??

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

 

Re: Lamictal rash??

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

 

Re: Lamictal rash??

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

 

Re: Lamictal rash?? » hundredhugs

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.?

 

Re: Lamictal rash??

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

 

Re: Lamictal rash?? » 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

 

Re: Lamictal rash??

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

 

Re: Lamictal rash?? » theo

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

 

Re: Lamictal rash??

Posted by Robert B on July 21, 2004, at 18:09:37

In reply to Re: Lamictal rash??, posted by starlight on July 19, 2004, at 15:15:26

I've been on lithium for years but hate the weight gain, cognitive effects and that it makes me sleepy.

I've started on Lamictal three times. I notice positive effects at about 75mg but my Dr's target is 200mg. The first two times I tried it, I increased the dosage too quickly (i.e., I didn't follow my Drs. instructions because, as my wife points out constantly, I thing I'm smarter than everbody else). I know that's stupid but I have never had any reaction to any medication, ever. Most of the time I require more than the average dosage (who knows why).

In any event, the first time, a rash began just above my belt line and on my abdomen under my right arm. At first I thought I had a flea or mosquito bite but it began to spread across my stomach laterally. I immediately stopped lamictal and made an appt. with my dermatologist. Within days the rash went away so I didn't even see her. We restarted lamictal at one-half the dose (50mg) increasing at 25mg per week. At 100mg the rash returned.

I saw my dermatologist., told her I was on lamictal and that SJS was an issue. She told me there was no way my rash was SJS, that it didn't appear to be the kind of rash that would be helped by an antihistamine and that notwithstanding the coincidental timing, it had ever appearance of a contact dermatitis. She gave me some steroid cream, the rash went away and I restarted lamictal at 12.5mg, increasing by a similar amount ever two weeks.

I'm now at 125mg., still increasing but now at 25mg. ever two weeks, and have no rash (although I keep the steroid cream handy just in case).

The only thing that bothers me now is that ever time I increase, I get gas and diarrhea for a week.

Lamictal's effectiveness for me is great notwithstanding that it is a pain in the but.

 

Re: Lamictal rash??

Posted by starlight on July 22, 2004, at 13:18:51

In reply to Re: Lamictal rash??, posted by Robert B on July 21, 2004, at 18:09:37

I take 300mgs. 200 in the am and 100 at night. The trick is definitely titrating up slowly.
starlight

 

Re: Lamictal rash?? » Robert B

Posted by theo on July 23, 2004, at 9:33:46

In reply to Re: Lamictal rash??, posted by Robert B on July 21, 2004, at 18:09:37

If you had results at 75mg, why didn't you stop at that dose? I'm at 75mg now with a target dose from my doctor of 100mg. My titration started at 25mg and increased by 25mg every two weeks. Although the starter kit jumps from 50mg to 100mg, I'm taking 75mg for two weeks also. Whenever I increase 25mg I get a couple of red itchy spots on my face but they are gone within 12 hours. My dermo just gave me some hydrocortozone cream for the itching. I'm wondering if going to 100mg would be better for me because so far no problems and am worried that after all this time, I'll go to 100mg, get a rash and have to stop it. If you were feeling good at 75mg, did you feel even better at 100mg?

 

Re: Lamictal rash??

Posted by Robert B on July 23, 2004, at 13:42:36

In reply to Re: Lamictal rash?? » Robert B, posted by theo on July 23, 2004, at 9:33:46

I did feel better as the dose increased. More importantly, my Dr. does not want me to decrease (with a goal of eliminating) lithium until I'm at 200mg of Lamictal without untoward side effects.

Fortunately, since I've gone back on with a more conservative titration schedule, I haven't had any rash problem at all. When I did have a problem the rash responded almost immediately to steroid cream so I'm just going to keep trying.

Lithium has some effects I really hate and I would be happy if I could eliminate or even reduce it substantially.

Bob

 

Re: Lamictal rash??

Posted by hundredhugs on July 23, 2004, at 14:32:19

In reply to Re: Lamictal rash??, posted by Robert B on July 23, 2004, at 13:42:36

I had to go back to the dr because the rash came back (after i was weaned off the prednisone)and I was told this is definetly a med rash and i was told to stop the lamictal immeditealy regardless whether i had the lamictal rash or not due to the seriousness of it. I am to follow up with my pdoc. She has already given the blessing to go off it need be.

Lamictal has been a good med for me and last time i went off it i became manic and from what i understand prednisone can potentinally make one manic, I wasnt sleeping before prednisone, now i definetly am not, i hope i don't see choppy waters ahead.

Hundredhugs

 

I'm so sorry to hear that

Posted by Robert B on July 23, 2004, at 16:50:56

In reply to Re: Lamictal rash??, posted by hundredhugs on July 23, 2004, at 14:32:19

I have a lot of trouble with meds and Lamictal really seems to be the right track even though it is an incredible pain to get started.

I'm really sorry it didn't work out for you.

How about any of the other anti-seizure meds?

Bob

 

Re: Lamictal rash?? » Robert B

Posted by theo on July 23, 2004, at 18:37:24

In reply to Re: Lamictal rash??, posted by Robert B on July 21, 2004, at 18:09:37

Are you taking it in a single dose or twice daily?

 

Re: Lamictal rash??

Posted by candybear on August 5, 2004, at 14:28:45

In reply to Re: Lamictal rash?? » Robert B, posted by theo on July 23, 2004, at 18:37:24

Hi, I'm new here -- glad to find this place.

I started Lamictal in late Feb. of this year, so I'm about 5 months and a week into the 6-month window. I am also on desipramine, Effexor and Risperdal.

I started noticing unconnected, non-itchy, -bumpy, -painful red splotches all up and down my legs last week. They got infinitely worse after being out baking in the sun for a couple of hours over last weekend.

The desipramine can cause photosensitivity, so I'm wondering if that's it, but I'm frantic about "lamictal rash," because of all the mood stabilizers I've tried (Depakote, Trileptal, Topamax), it's the only one that's worked well for me, and I'd hate to lose it. My pdoc said to give it a couple more days and if it's not better, stop it and go to the ER.

From what I've read on this thread, my disconnected little splotches don't really sound like the awful rashes the others have described, but I am just curious if anyone here has come up with anything similar.

Thanks...

candybear

 

Re: Lamictal rash??

Posted by Robert B on August 9, 2004, at 12:46:10

In reply to Re: Lamictal rash??, posted by candybear on August 5, 2004, at 14:28:45

I finally got to 200mg which I understand is the basic theraputic dose. The rash I had never came back. I'm starting to cut back on lithium now. Anybody have sexual side effects with Lamictal or am I just getting old?


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