Posted by Emme on November 30, 2003, at 22:54:47
In reply to Re: Lamictal rash: trying to get the story straigh, posted by Lauren B on November 30, 2003, at 19:07:09
> I agree with the woman who posted, “assuming any rash is SJS is a bit of a leap.” My point is, I don't deal well with rashes. Being itchy and splotchy, even for a few weeks at a time as I adjust, is not my bag.What did the dermaologist tell you? Has your rash problem subsided? I hope you're feeling better. You may have fewer (or even no) problems on a very slow titration. There is precedence in the literature for successful rechallenge with Lamictal after stopping and waiting for a rash to clear and I get the impression that it's being done more frequently these days. But it is very scary once you've had a rash. My pdoc and I really thought long and hard before starting me again. I also had very itchy skin with Trileptal and when I went back down and ramped up again more slowly I had no skin problems.
> Still, I'd say Lamictal has been largely misrepresented by the formal medical writings I've seen posted about it. Except for the postings on this site, all other writings I've found make it appear that in certain rare cases a rash, which could be indicative of SJS, occurs.
> There's no mention of general rashiness or sun sensitivity.It's misleading in some places and not in others. I have seen it phrased that *serious* rashes occur at very low rates. That's a bit misleading. On the other hand, Medlineplus drug site lists rash as common. Psycom.net lists the incidence of rash as 1 in 10, and dangerous rash as 1 in 1000. BipolarWorld.net discusses the general rashiness. Lamictal.com includes rash as a common SE and discusses mild vs. serious rash. One neurological institute (I can't recall the exact site at the moment, sorry), states that the incidence of rash is 1 in 10. The prescribing information from GSK states that the incidence of rash in clinical trials for bipolar patients was 14% and that the incidence of SJS in adults receiving Lamictal as monotherapy was 0.13%.
I agree that the possibility of sun sensitivity isn't mentioned frequently enough. My dermatologist told me all anticonvulsants can potentially cause sun sensitivity. Pdocs may not be tuned into the sunburn problem. At least for me, the photosensitivity was short-lived and I didn't burn at all this summer.> I'm a journalist and if I were being paid to write something informative and useful about Lamictal, I'd write as follows: Lamictal causes skin sensitivity in many people, perhaps up to 40% of all people who take it based on anecdotal evidence gathered in internet postings.
Anecdotal reports have their place and are helpful for finding out if other people have experienced anything similar, how they handled it, and potential problems for further study. I would *not* rely on internet forum postings for estimates of the frequency of any side effects. You're seeing a skewed population - people come here to get and to give help with difficulties. People who are doing well and haven't had problems are less likely to post on the internet.
It would be interesting (and more representative) to poll pdocs and see how many of their patients have had skin problems. Given the potential seriousness of a rash, most patients probably run (not walk) to the phone when something shows up. I sure did! :) I also wonder if the incidence of rash might be getting lower than the roughly 1 in 10 figure I keep seeing as doctors get more savvy about titrating.
> It also appears to interact with many drugs, resulting in a hivelike skin reaction, although there has been little formal research on what courses those interactions take.
I probably wasn't paying attention to related posts - which drugs? (Aside from Depakote upping the blood levels.) GSK at least lists interactions with other AEDs. They did in vitro studies on about a dozen common psychotropic drugs. They didn't find anything to suggest much in the way of interactions, but those were in vitro and not in humans, and there are a lot of other classes of drugs out there. Were you able to find anything useful on, say, PubMed about drug interactions observed in humans?
> Many people cope with the presence of itchy red bumps as they adjust to the dose: further more, if they miss doses and ramp up again, they get the rash. These bumps (or may not) go away in time, depending on the person.
Again, I think you'd have to somehow look at a broader sample to see how prevalent the skin problems are as well as the diversity of rash types as there is no single rash type associated with the drug (this is noted in prescribing information). I was fortunate in that I had no itchy bumps to deal with. My rashes were smooth and non-itchy.
> Obviously, as with all medical treatments, the user will have to see if the benefits outweigh the drawbacks.
If one were to write a useful and informative article, it should include the benefits as well as the problems. If my pdoc's experience is at all typical, a heck of a lot of people do really well with it and find great relief. It's just nerve wracking checking your skin for suggestions of rash when you are ramping up. The nice thing about Lamictal is that, assuming they don't need to stop due to a rash, many people don't have much in the way of SEs once they've reached a therapeutic dose. It's weight neutral, does't cause sexual side effects.
Emme
poster:Emme
thread:283539
URL: http://www.dr-bob.org/babble/20031126/msgs/285375.html