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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 21 of 21. This is the beginning of the thread.
Posted by Bob on April 3, 2002, at 0:38:03
I was perusing www.rxlist.com this evening and decided to look up Lamictal. Man! They are not fooling around with that warning. They are basically saying that if you develop any sort of rash AT ALL, that they recommend immediate discontinuation. It's one of the scariest warnings I've seen on a monograph. I don't even see things like that on MAOIs.
You can check it out here:
http://www.rxlist.com/cgi/generic/lamotrigine.htm
BTW... they also said a common effect that was found was weight gain. Really? Have people here found that Lamictal causes weight gain?
Bob
Posted by Chris A. on April 3, 2002, at 0:43:02
In reply to Lamotrigine Rash Warning, posted by Bob on April 3, 2002, at 0:38:03
No weight gain here. I stuck with Lamictal despite some minor rashes (careful watching) and am glad I did because it's been the most effective med for me over the long haul.
Blessings,
Chris A.
Posted by Bob on April 3, 2002, at 0:50:25
In reply to Re: Lamotrigine Rash Warning » Bob, posted by Chris A. on April 3, 2002, at 0:43:02
> No weight gain here. I stuck with Lamictal despite some minor rashes (careful watching) and am glad I did because it's been the most effective med for me over the long haul.
>
> Blessings,
>
> Chris A.
You must have a brave doctor, my friend. That warning is one heck of a CYA. They basically don't advocate continuing the drug at the first sign of a zit!There was apparently observation of weight gain in many participants during the clinical trials. Here was the wording:
Metabolic and Nutritional Disorders: Frequent: weight gain. Infrequent: weight loss. Rare: hyperglycemia, and peripheral edema.
That tells me they frequently encountered weight gain after beginning administration with Lamictal. I've always thought it was a more or less weight neutral drug.
I'm glad to hear Lamictal has helped you.
Posted by Janelle on April 3, 2002, at 1:07:58
In reply to Re: Lamotrigine Rash Warning » Chris A., posted by Bob on April 3, 2002, at 0:50:25
Hi Bob,
I've tried Lamictal twice and regarding the rash, the key to using this med is to go what is called "LOW AND SLOW" meaning you should start at a micro/pediatric dose and increase very gradually/slowly in small increments. I titrated up from 2mg a day (no kidding, a mere 2 mg!) to 100 mg over quite a long period of time. NO RASH, NO WEIGHT GAIN. (I also heard that Lamictal is a weight neutral med).
Unfortunately, my second trial of Lamictal did not go well - even at a low dose (I only got up to 25mg/day) it seemed to induce terrible anxiety.
By the way, what does CYA stand for?! (cover your @ss?)
Posted by Bob on April 3, 2002, at 1:13:29
In reply to Re: Lamotrigine Rash Warning » Bob, posted by Janelle on April 3, 2002, at 1:07:58
> Hi Bob,
>
> I've tried Lamictal twice and regarding the rash, the key to using this med is to go what is called "LOW AND SLOW" meaning you should start at a micro/pediatric dose and increase very gradually/slowly in small increments. I titrated up from 2mg a day (no kidding, a mere 2 mg!) to 100 mg over quite a long period of time. NO RASH, NO WEIGHT GAIN. (I also heard that Lamictal is a weight neutral med).The smallest dosage I've heard of is a scored 25mg tablet. How did you manage to partition out 2mg on a reliable basis?
Glad to hear you had no weight gain.
>
> Unfortunately, my second trial of Lamictal did not go well - even at a low dose (I only got up to 25mg/day) it seemed to induce terrible anxiety.
>I'm sorry to hear that. Why did you come off of it the first time? Why did you feel the need to go back on it? Did you do the same slow titration the second time?
> By the way, what does CYA stand for?! (cover your @ss?)You got it! That warning for Lamictal is about as CYA as I've ever seen for a med.
Posted by Janelle on April 3, 2002, at 1:29:45
In reply to Re: Lamotrigine Rash Warning » Janelle, posted by Bob on April 3, 2002, at 1:13:29
> The smallest dosage I've heard of is a scored 25mg tablet. How did you manage to partition out 2mg on a reliable basis?
Believe it or not, I didn't have to partition anything - my pdoc had samples of 2mg pills and also 5mg pills - they are TEENY TINY and are cherry flavored chewables, apparently intended for children with seizures (Lamictal is *offically* an anti-seizure med. Those tiny small dose pills must be the pediatric doses.
The next highest dose is indeed the scored 25mg tablet you mentioned.
>Why did you come off of it the first time?
Actually, I came off it the first time because my pdoc thought it might be STARTING to induce anxiety and wanted to prevent it from escalating.
> Why did you feel the need to go back on it?
For mood stabilizing - I have cycling (basically BPII) as well as depression and pdoc wanted to give Lamictal another try since it is supposed to have very good anti-depressant properties.
>Did you do the same slow titration the second time?
Yes. As in the first trial, I began with 2mg and was working my way up slowly, but when I hit 25mg this second time the anxiety became unbearable.
Posted by Emme on April 3, 2002, at 10:40:09
In reply to Re: Lamotrigine Rash Warning, posted by Janelle on April 3, 2002, at 1:29:45
Hi folks,
Yeah, the rash issue must be taken seriously and if you get a minor rash you have to weigh the risks against the benefits. For anyone who hasn't seen me post my experience (I know I've been a bit redundant on this - sorry folks), a rechallenge after a minor rash is possible. I had two small, smooth, brief rashes with Lamictal the first time I tried it and stopped taking it. (I ran to a dermatologist with one of the rashes.) My doctor and I were nervous about it. But it had helped me more than anything else we'd tried. She consulted a neurologist with extensive experience with Lamictal and he recommended giving it another shot. The second time I titrated at 5 to 7.5 mg/week (5 mg tabs as mentioned above). Agonizingly slow, but I think it was worth the painful wait to get to a therapeutic dosage.Emme
Posted by Bob on April 3, 2002, at 13:30:02
In reply to Re: Lamotrigine Rash Warning, posted by Janelle on April 3, 2002, at 1:29:45
> For mood stabilizing - I have cycling (basically BPII) as well as depression and pdoc wanted to give Lamictal another try since it is supposed to have very good anti-depressant properties.
So what do you now take to get mood stabilizing properties: lithium, depakote, neurontin, something else?
Posted by Janelle on April 3, 2002, at 14:37:50
In reply to Re: Lamotrigine Rash Warning - my saga, posted by Emme on April 3, 2002, at 10:40:09
You indicated that the second time you tried Lamictal you titrated at 5 to 7.5 mg/week (5 mg tabs as mentioned above). How did you do the 7.5mg - did you cut a 5mg pill in half (they're so tiny I would think they would shatter if cut) or are there 7.5 tabs available?
Also, what dose of Lamictal are you on now?
Glad it has eventually worked out for you. It was worth what you referred to as the "rechallenge"!
Posted by Janelle on April 3, 2002, at 14:40:57
In reply to Re: Lamotrigine Rash Warning » Janelle, posted by Bob on April 3, 2002, at 13:30:02
> So what do you now take to get mood stabilizing properties: lithium, depakote, neurontin, something else?
You hit the right one - I have just started Depakote, with high hopes that it will quell the anxiety and stabilize my mood swings/cycling.
Posted by Emme on April 3, 2002, at 15:59:02
In reply to Emme: questions about your Lamictal saga! » Emme, posted by Janelle on April 3, 2002, at 14:37:50
Hi Janelle,
Hmm....I don't know if there's more than one kind of 5 mg tab. The 5 mg tabs I have are not terribly tiny. They're long and scored in the middle, so they break in two easily. They're chewable and orange flavored - definitely for kids. I was at 75 mg for a while and it was helping enourmously. At the moment I have multiple environmental stressors hitting me at once and I'm crumbling a bit. So we're upping it again by 5 mg increments. Also, my doctor wants me to try naltrexone for extra anti-depressant help. Although I'm having trouble right now, I definitely am not ditching lamictal as I think it's my main defense for the depression, but we're tweaking the mix.
Emme
> You indicated that the second time you tried Lamictal you titrated at 5 to 7.5 mg/week (5 mg tabs as mentioned above). How did you do the 7.5mg - did you cut a 5mg pill in half (they're so tiny I would think they would shatter if cut) or are there 7.5 tabs available?
>
> Also, what dose of Lamictal are you on now?
>
> Glad it has eventually worked out for you. It was worth what you referred to as the "rechallenge"!
Posted by 3 Beer Effect on April 4, 2002, at 3:06:29
In reply to Lamotrigine Rash Warning, posted by Bob on April 3, 2002, at 0:38:03
I was at 100 mg of Lamictal for about a month with no side effects or anti-depressant effects either, felt like a placebo.
So my psychiatrist raised the dose. I've been on 125 for a week and I was going to increase it to 150 on Friday but am having second thoughts because I seem to be getting an abnormal amount of acne- I am 23 & ocassionally get ingrown hairs from shaving but this seems more like real acne like a teenager, especially beneath the sideburn near the jaw/ear lobe area. I also seem to be slurring my words sometimes & have short term memory loss this week since i've switch to lamictal 125 mg. But I guess that could be from the Klonopin 2 mg daytime I take but somehow I doubt it since i've been taking Klonopin for a 3+ months now.
Anyways, is increased acne a pre-sign of the dreaded lamictal rash? If so, I guess I should wait another week before raising the dose to 150 mg.
3 Beers
Posted by jazzdog on April 4, 2002, at 12:52:20
In reply to Increased facial acne pre-sign of lamictal rash?, posted by 3 Beer Effect on April 4, 2002, at 3:06:29
As I titrated upward, I experienced many minor outbreaks - hives, a patch of excema, a couple of blemishes. Lamictal seems to sensitize the skin to whatever it's most susceptible to, but only for a few days. The deadly rash is something else entirely - all-over swelling, redness, and blistering.
- Jane
Posted by Bob on April 4, 2002, at 13:22:28
In reply to Increased facial acne pre-sign of lamictal rash?, posted by 3 Beer Effect on April 4, 2002, at 3:06:29
> I was at 100 mg of Lamictal for about a month with no side effects or anti-depressant effects either, felt like a placebo.
>
> So my psychiatrist raised the dose. I've been on 125 for a week and I was going to increase it to 150 on Friday but am having second thoughts because I seem to be getting an abnormal amount of acne- I am 23 & ocassionally get ingrown hairs from shaving but this seems more like real acne like a teenager, especially beneath the sideburn near the jaw/ear lobe area. I also seem to be slurring my words sometimes & have short term memory loss this week since i've switch to lamictal 125 mg. But I guess that could be from the Klonopin 2 mg daytime I take but somehow I doubt it since i've been taking Klonopin for a 3+ months now.
>
> Anyways, is increased acne a pre-sign of the dreaded lamictal rash? If so, I guess I should wait another week before raising the dose to 150 mg.
>
> 3 BeersI took Lamictal before and ramped the dosage too quickly, and got a rash from Lamictal. My doctor ordered me to stop. I don't remember acne.
Recently I decided to retry the Lamictal. I took 1/4 of a 25mg pill: 7.25mg. A few days later I got a little itchy and an area on my inner arm got a little pink one evening, but promptly went away. However, I too have noticed and increase in an acne type of reaction on my face (cheeks) and neck. I don't know whether it's a precursor to "the rash", but I definitely think it's a reaction.
I must be one of the most med sensitive people on earth.
Bob
Posted by Janelle on April 4, 2002, at 15:01:00
In reply to Increased facial acne pre-sign of lamictal rash?, posted by 3 Beer Effect on April 4, 2002, at 3:06:29
Posted by JohnX2 on April 4, 2002, at 15:35:30
In reply to Increased facial acne pre-sign of lamictal rash?, posted by 3 Beer Effect on April 4, 2002, at 3:06:29
> I was at 100 mg of Lamictal for about a month with no side effects or anti-depressant effects either, felt like a placebo.
>
> So my psychiatrist raised the dose. I've been on 125 for a week and I was going to increase it to 150 on Friday but am having second thoughts because I seem to be getting an abnormal amount of acne- I am 23 & ocassionally get ingrown hairs from shaving but this seems more like real acne like a teenager, especially beneath the sideburn near the jaw/ear lobe area. I also seem to be slurring my words sometimes & have short term memory loss this week since i've switch to lamictal 125 mg. But I guess that could be from the Klonopin 2 mg daytime I take but somehow I doubt it since i've been taking Klonopin for a 3+ months now.
>
> Anyways, is increased acne a pre-sign of the dreaded lamictal rash? If so, I guess I should wait another week before raising the dose to 150 mg.
>
> 3 Beers
I think most people experience a flaking and drying out of the skin. The serious rash covers a large portion of your body from what I was told.My experience with Lamictal was that it was best to hold the dose constant until slurred speech, minor itching, etc, would go away before raising the dose. These side effects usually diminished for me after a few days at a given dose.
Best Regards,
John
Posted by Ponder on April 5, 2002, at 10:57:55
In reply to Lamotrigine Rash Warning, posted by Bob on April 3, 2002, at 0:38:03
When I decided to try Lamictal, I was concerned about potential weight gain. I have lost weight steadily while on the drug. I take a relatively low dose (150 mg/day). The Lamictal gave me enough energy to be more active and start a regular exercise program. I've heard that some people gain on it, but FWIW, I did not.
> I was perusing www.rxlist.com this evening and decided to look up Lamictal. Man! They are not fooling around with that warning. They are basically saying that if you develop any sort of rash AT ALL, that they recommend immediate discontinuation. It's one of the scariest warnings I've seen on a monograph. I don't even see things like that on MAOIs.
>
> You can check it out here:
>
> http://www.rxlist.com/cgi/generic/lamotrigine.htm
>
> BTW... they also said a common effect that was found was weight gain. Really? Have people here found that Lamictal causes weight gain?
>
> Bob
Posted by Sunnely on April 6, 2002, at 20:46:18
In reply to Lamotrigine Rash Warning, posted by Bob on April 3, 2002, at 0:38:03
In mood disorder trials conducted to date, the rate of serious rash, defined as requiring both drug discontinuation and hospitalization, has been 0.06% (2 of 3,153) on Lamictal and 0.09% (1 of 1,053) on placebo. No cases of Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN) were observed. A low starting dose and gradual titration of Lamictal (see below) appear to minimize the risk of serious rash.
DOSAGE GUIDELINE FOR LAMICTAL, BOTH MONOTHERAPY AND COMBINATION, IN THE TREATMENT OF BIPOLAR DISORDER:
TREATMENT PERIOD: Weeks 1-2:
1) Monotherapy (Lamictal alone) - 25 mg daily
2) With Depakote - 12.5 mg daily
3) With Tegretol - 50 mg dailyTREATMENT PERIOD: Weeks 3-4:
1) Monotherapy (Lamictal alone) - 50 mg daily
2) With Depakote - 25 mg daily
3) With Tegretol - 100 mg dailyTREATMENT PERIOD: Week 5:
1) Monotherapy (Lamictal alone) - 100 mg daily
2) With Depakote - 50 mg daily
3) With Tegretol - 200 mg dailyTHEREAFTER:
1) Monotherapy (Lamictal alone) - 200 mg daily
2) With Depakote - 100 mg daily
3) With Tegretol - 400 mg daily
> I was perusing www.rxlist.com this evening and decided to look up Lamictal. Man! They are not fooling around with that warning. They are basically saying that if you develop any sort of rash AT ALL, that they recommend immediate discontinuation. It's one of the scariest warnings I've seen on a monograph. I don't even see things like that on MAOIs.
>
> You can check it out here:
>
> http://www.rxlist.com/cgi/generic/lamotrigine.htm
>
> BTW... they also said a common effect that was found was weight gain. Really? Have people here found that Lamictal causes weight gain?
>
> Bob
Posted by Mondeo on April 16, 2002, at 9:49:30
In reply to Lamictal weight gain?, posted by Ponder on April 5, 2002, at 10:57:55
well,I am another one loosing weight (about 5kg)and I am on 400mg Lamictal since a while with VERY good results and promising further on,as well
MONDEO
Posted by ziggy1016 on June 21, 2003, at 16:43:45
In reply to Re: Lamotrigine Rash Warning » Chris A., posted by Bob on April 3, 2002, at 0:50:25
I am bipolar I and I hadn't found any medication that helped me until my psychiatrist suggested I try Lamictal. I have tried over 15 different medication and have come a long way from where I started and I definitely owe to Lamictal. I have been taking it for about a year and a half now. When I first started taking it, I began to get acne. This seemed completely wrong to me, beause I had taken Acutane about two years earlier. My acne worsened evey time I started a higher dose. I had no choice but to stay on this medication. I went back to my dermatologist and she started me on Acutane again. My acne cleared up completely while taking it. I finished my 6 month cylce and have been off the Acutane for about 7 months. I just started to have break-outs again. Are there any other medicines that I can take to counteract this problem? I should also add that I have been taking the same dosage of Lamictal for a year now, no changes.
Posted by Nat Liz on September 11, 2007, at 12:01:20
In reply to Re: Lamotrigine Rash Warning, posted by ziggy1016 on June 21, 2003, at 16:43:45
I started generic accutane while already on Lamictal and my acne improved, but not completely. My dermatologist was suprised at how slowly I was improving and suggested that the lamictal might be why my acne wasnt clearing up.
I read yesterday in the AARP guide to pills that isoseritonin (accutane) interacts with anti-seizure meds (which Lamictal is.) I dont know exactly what they meant by "interact."I am now off the Lamictal and I feel terrible inside, but my acne is getting better. Less of the cystic stuff.
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