Lamotrigine and Rashes: Not a great combination
June 25, 2008 at 7:16 am 5 comments
Bugger.
I’ve been taking lamotrigine for a while now. I’ve slowly titrated up and three days ago I reached my target dose of 200mg. I’ve been feeling pretty good, which is something I’m willing to attribute to the drug. I don’t really feel hypomanic, just on the high side of normal. Things are going well, the depression is cured (at least for now) and I seem pretty stable. I’ve been thinking about working again if the sleep thing gets sorted out.
And now I get a rash. This isn’t fair. I took a more conservative approach than my GP prescribed. Rather than spending a week at 100mg, I spent two weeks. I’m supposed to stop taking the drug immediately if I get a rash. Most rashes caused by lamotrigine aren’t the dreaded Stevens-Johnson syndrome. But some are and they can be difficult to tell apart by a trained observer. I’m not a trained observer and I have no idea if this is a harmless rash or one that could kill me. It kind of looks like the pictures of SJS I’ve seen, but that doesn’t mean much.
It’s rather small, a little patch of skin a couple of centimetres across on my left thigh with a scattering of little red and orange dots. If it hadn’t just appeared yesterday I could mistake it for freckles. It’s not itchy and I don’t have a fever or flu-like symptoms, which make it less likely to be SJS. But SJS sometimes presents without those symptoms so it doesn’t rule it out. SJS is usually slow to progress, giving you plenty of time to stop taking whatever drug you’re on that’s caused it. But SJS can be fast and unresponsive to treatment. It is, of course, horribly painful.
So am I going to stop taking the lamotrigine and risk the possibility that other drugs may not help in the same way? Or am I going to take the very small risk that I could die a terrible death if I don’t immediately stop taking it? I don’t have to decide yet. The only action possible is to stop taking my medication. And my next dose isn’t for another 8 hours or so. If it’s got bigger then I guess I’ll have to stop. If it’s the same as before then I probably won’t.
This isn’t quite as crazy as it sounds. For example this page describes one approach as “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).”
This isn’t what my psychiatrist has told me. Then again: Fuck it. It’s worth a go.
Update: Time for my next dose. The rash seems to have gone away a bit, so I’m reducing my dose to 100mg and seeing if it goes away. I do so enjoy playing chicken with my health.
Entry filed under: Uncategorized. Tags: bipolar disorder, lamotrigine, rash, stevens-johnson syndrome.
1.
titaniumrose | June 25, 2008 at 4:14 pm
I had a similar kind of thing happen when I took Lamictal and the doctor yanked me off it right away. I was so disappointed because I was doing so well on it. Now I’ve got a new doc who says we might be able to try it again and not worry so much about the rash.
Good luck with your rash, I hope it turns out to be nothing!
2.
Gabriel... | June 26, 2008 at 8:31 am
Are you washing? It could be you’re not washing. Do you smell? If you’re not washing you’d probably smell… so that’d be one possibility.
I was in a double-blind trial in which they were testing the effects of taking Lithium and Lamotrigine together. I’m 99.99% positive I was getting both. When I’d lay down to sleep I’d get this sensation just at the base of my skull — it felt like when you pull a string until it frays and breaks… only, you know, inside my brain. Ever since then I have issues with those pills.
Actually, my psychiatrist has recently been gently prodding me to switch from lithium to the lamotrigine… I have to ditch the Seroquel this summer because of this diabetes thing so I’m thinking of switching the whole regimen.
If the pills are working for you, and the rash hasn’t spread to anything vital, I’d say go with what works but let the doctor know. But if the rash spreads to your genital region I’d definitely suggest tossing the pills out the window.
3.
Hayley | September 19, 2009 at 3:45 pm
Dude, its not worth it. I was only 25mg Lamictal for 2 weeks, got a slight rash from it but nothing serious. Stopped taking the pills and now 1 week later im lying in hospital with SJS. From a normal, ourgoing, fun loving, young girl to a complete monstor looking ugly creature. Luckily I will survive, however I have no idea how long it will take before I look half normal, before I can be in public and what the long term effects will be.
Chuck the pills…
4.
Ann | October 31, 2009 at 2:06 pm
Started taking Lamotrigine yesterday then I read the article below I won’t be taking any more of it :
http://www.lawyersandsettlements.com/articles/12691/stevens-johnson-syndrome-sjs-6.html
5.
JOAN | July 24, 2010 at 7:35 am
Have been on Latmotrigine since June 1. Doing alright until sitting in the sun and getting ‘sunburned’ on my chest. Last week, we were to Radium Hot Springs and sat in the pool for 4 hours, now I have a rash on my legs (where it is more noticeable) and some less severe rash on my knees and thighs and backs of my arms. I am now quite sure that heat will activate the rash if you are on Latmotrigine.