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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Bekka H. on February 11, 2002, at 23:12:45
Is there any way to know whether someone is more likely to develop that dangerous rash (Stevens-Johnson syndrome)than someone else? I tend to get rashes from almost everything, and so I am particularly concerned about Lamictal. How will I know whether it's one of my usual rashes or the deadly rash?
Is anyone on Lamictal plus a low dose stimulant (like Dexedrine) for unipolar depression? If so, does it help your depression? I've had terrible luck with antidepressants over many years, so now my doctor is talking about the above combo, but as I said, I'm scared about that dangerous rash and I'm also doubtful that Lamictal would be useful with just a stimulant and NOT an antidepressant.
Posted by TSA West on February 12, 2002, at 0:37:05
In reply to Questions about Lamictal/Lamotrigine, posted by Bekka H. on February 11, 2002, at 23:12:45
Dear Bekka,
The fears over Lamictal rashes are unfounded. The chance of having a mild to moderate rash are 3%--according to clinical trials. But clinical trials done years ago do not necessarily predict the incidence of side-effects now. Besides, most of these rashes were due to taking a combination of Depakote and Lamictal, and they resolve without hospital stays. I believe that the chance of a seizure from Wellbutrin is much higher, and the chance of a hypertensive crisis with Nardil is a little higher.
The chance of having a severe rash leading to hospitalization is reported as 0.03%. With those odds, it is easier to get hit by
lightening than it is to have a Lamictal rash. Point in case: You never hear in the paper about someone severely harmed
by Lamictal.
I have taken Lamictal for one year with a moderate benefit and absolutely no side-effects. I believe that Lamictal will replace Lithium as the drug of choice in bipolar disorder in 10 years, due to its prominent antidepressant effect and benign side-effect profile.Wishing you all benefits of psychiatry,
TSA West---------------------- ++
Posted by JohnX2 on February 12, 2002, at 0:46:14
In reply to Questions about Lamictal/Lamotrigine, posted by Bekka H. on February 11, 2002, at 23:12:45
Lamictal can definately hold its own as a standalone antidepressant.
So I do think it is possible that you would not require an AD
add on. Lamictal itself has been known to make people hypomanic.
But you do need to push it to a decent dose (probably 100 mg+).
This takes a long while in order to avoid getting
a rash (not necessarily the Stevens-Johnson rash).The key is to dose it really slowly. You may or may not get
a little itching on your skin or scalp. This doesn't mean
exacly imply you are getting Stevens-Johnson syndrome. But it does probably
mean you may want to hold the dosage (stop increasing) or lower it
for a few days until the itching,redness subdues. I don't know the exact details of the
signs of the Stevens-Johnson rash, someone else can probably
comment on that, but from what I was told you really need to
see a monster rash on your whole body. Anyways someone should
correct me if I am wrong.Good luck. Lamictal is a nice medicine once you get
to a therapeutic dose.-John
> Is there any way to know whether someone is more likely to develop that dangerous rash (Stevens-Johnson syndrome)than someone else? I tend to get rashes from almost everything, and so I am particularly concerned about Lamictal. How will I know whether it's one of my usual rashes or the deadly rash?
>
> Is anyone on Lamictal plus a low dose stimulant (like Dexedrine) for unipolar depression? If so, does it help your depression? I've had terrible luck with antidepressants over many years, so now my doctor is talking about the above combo, but as I said, I'm scared about that dangerous rash and I'm also doubtful that Lamictal would be useful with just a stimulant and NOT an antidepressant.
Posted by Emme on February 12, 2002, at 8:48:06
In reply to Questions about Lamictal/Lamotrigine, posted by Bekka H. on February 11, 2002, at 23:12:45
> Is there any way to know whether someone is more likely to develop that dangerous rash (Stevens-Johnson syndrome)than someone else? I tend to get rashes from almost everything, and so I am particularly concerned about Lamictal. How will I know whether it's one of my usual rashes or the deadly rash?
I asked my dermatologist the exact same question - whether there was any way to predetermine if someone was likely to be hypersensitive and develop SJS. She said no. So...titrate slowly and if you get any rashes, consult a dermatologist to be safe. I've had a few mild rashes, but nothing scary, and my pdoc and I felt better with problems being overseen by a dermatologist. She also consulted with a neurologist with a lot of expertise with Lamictal. Anyway, odds are you will be okay, just be alert.
Emme
Posted by paulb on February 12, 2002, at 12:24:36
In reply to Questions about Lamictal/Lamotrigine, posted by Bekka H. on February 11, 2002, at 23:12:45
> Is there any way to know whether someone is more likely to develop that dangerous rash (Stevens-Johnson syndrome)than someone else? I tend to get rashes from almost everything, and so I am particularly concerned about Lamictal. How will I know whether it's one of my usual rashes or the deadly rash?
>
> Is anyone on Lamictal plus a low dose stimulant (like Dexedrine) for unipolar depression? If so, does it help your depression? I've had terrible luck with antidepressants over many years, so now my doctor is talking about the above combo, but as I said, I'm scared about that dangerous rash and I'm also doubtful that Lamictal would be useful with just a stimulant and NOT an antidepressant.I dont know whether any groups in particular are likely to develop the serious rash with Lamactal because there isnt enough data on the subject although children may be at more of a risk and persons taking Sodium Valporate concurrently. It sounds risky to take Lamictal if you have already got a rash because that would obviously cause confusion. If you know the things that will precipitate a rash I would avoid them when starting out on Lamactail and then go slow. Usually its fine to start at 25mg and then increase the dose by 25mg every one or two weeks. A more cautious approach that is used is starting out at 12.5mg and increasing the dose by 12.5mg once a week. I found benefits with Lamactal at 25mg so dont be discouraged by the thought of having to spend weeks working up to a therapeutic dose. I would add that immediate discontinuation of Lamactal if a rash occurs is effective and theres no reason not to start again but go slower. I think yours is a tricky situation that if I were you would consider very carefully.
Good luck and let us know how it works out.
paulb
Posted by jazzdog on February 12, 2002, at 14:42:02
In reply to Questions about Lamictal/Lamotrigine, posted by Bekka H. on February 11, 2002, at 23:12:45
Hi Bekka -
In fact, the incidence of minor rashes is 10 - 20%, and higher for people with sensitive skin. But the incidence of Stevens-Johnson, for adult, non-elderly people who aren't taking other anti-epileptics - is less than three in ten thousand. I'm also a rash-prone person, and I get minor rashes every time I titrate up on Lamictal - itching, flushing, small red patches, hives. Now I take a benedryl the first couple of days after I titrate, and it helps. My dermatologist says none of these are problematic - Stevens-Johnson involves all-over redness, swelling, fever etc. For me, the potential good effects of the drug outweigh a few skin irritations.
Good luck - Jane
Posted by Bekka H. on February 12, 2002, at 17:31:08
In reply to Questions about Lamictal/Lamotrigine, posted by Bekka H. on February 11, 2002, at 23:12:45
Thank you TSA West, JohnX2, Emme, PaulB and Jazzdog. You have all been very helpful. Now I have to brood over this for a while. Except for the stimulants, I've had such bad luck with so many meds, that I can't make a decision right away, but I so much appreciate your help.
Posted by spike4848 on February 12, 2002, at 17:56:16
In reply to Re: Questions about Lamictal/Lamotrigine » Bekka H., posted by JohnX2 on February 12, 2002, at 0:46:14
I don't know the exact details of the
> signs of the Stevens-Johnson rash, someone else can probably
> comment on that, but from what I was told you really need to
> see a monster rash on your whole body. Anyways someone should
> correct me if I am wrong.Hey There,
SJS is severe form of allergic dermatitis .... that is your body forms antibodies against your own skin. It is very rare and there is no way to predict who will get the syndrome. Generally you see exfoliation/desquamation of the skin ... that is, your skin literally peels off like after a severe sun burn. Blisters and ulcers form over the entire body, some times extending into the mouth, lung and gut. A patient of mine just had a case .... basically you get treated like a burn victim. Lots of moisturizers, occassionally IV steriods and vigorous hydration. We also watch the kidney function.
Like TSA said, SJS is very rare .... even with lamictal. I don't think it will replace lithium though.
Spike
Posted by Bekka H. on February 12, 2002, at 22:39:49
In reply to Steven's Johnson Syndrome 101, posted by spike4848 on February 12, 2002, at 17:56:16
> Hey There,
>
> SJS is severe form of allergic dermatitis .... that is your body forms antibodies against your own skin. It is very rare and there is no way to predict who will get the syndrome. Generally you see exfoliation/desquamation of the skin ... that is, your skin literally peels off like after a severe sun burn. Blisters and ulcers form over the entire body, some times extending into the mouth, lung and gut. A patient of mine just had a case .... basically you get treated like a burn victim. Lots of moisturizers, occassionally IV steriods and vigorous hydration. We also watch the kidney function.
>
> Like TSA said, SJS is very rare .... even with lamictal. I don't think it will replace lithium though.
>
> Spike
************************************************Hi Spike,
Thank you so much for the information. I still have to think about this Lamictal for a while before I take the big step -- or not. You have all been so helpful, but I guess I'm a scaredy cat because I tend to get dermatologic reactions to nearly everything, even Advil!
I have unipolar depression, but I've tried nearly every antidepressant known to man -- or beast, so now, as a last ditch effort, my doctor suggested either Lamictal, Topamax or Ketoconazole. The Ketoconazole was suggested for its anti-glucocorticoid activity. Lamictal is supposedly the best of the anticonvulsants for depression. I read that Topamax is particularly bad for cognition, memory, learning, etc, so that wouldn't work for me at this time in my life since I have to study a lot.
Well, I'll have to think this over.
Thanks again.
Posted by katia on January 4, 2004, at 1:37:08
In reply to Steven's Johnson Syndrome 101, posted by spike4848 on February 12, 2002, at 17:56:16
Hi,
Are you still here? I just got a rash all over my body this morning. I've been on Lamictal for about four months now steady at 200mg for over a month now. I just started Lithium two weeks ago and two nights ago I upped it to 900mg. I paged my pdoc today and he told me to come off of Lamictal. One, I hope he's right and it's not the lithium. And two, I'm really really scared this is the SJS one. My throat hurts slightly and my temp is 98.8. The rash hurts and looks like poison oak in the beginning stage (small teeny tiny welps in places and just a red rash in others). I"m on antihistimines now.
How do I know?
Katia
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