Lamotrigine‐Associated Rash: Risk/Benefit Considerations in Adults and Children

Guberman, A.; Besag, Frank; Brodie, Martin J.; Dooley, Joseph M.; Duchowny, Michael; Pellock, John M.; Richens, A.; Stern, Robert S.; Trevathan, Edwin

doi:10.1111/j.1528-1157.1999.tb00807.x

Cited by 304 publications

(240 citation statements)

References 37 publications

Supporting

Mentioning

216

Contrasting

Unclassified

Order By: Relevance

“…Approximately 10% of patients being treated with lamotrigine will experience a non‐serious rash, with 0.3%‐1% developing a serious rash such as toxic epidermal necrolysis and SJS,870 although for those initiated on a dose of 25 mg with a gradual titration increasing the dose by 25 mg biweekly, the risk of developing serious rash may be as low as 0.02% or 1 in 5000 871. In some cases, an even lower rate of titration may be used (ie 12.5 mg/day and then gradually increase as per instructions.…”

Section: Safety and Monitoringmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

View full text Add to dashboard Cite

The Canadian Network for Mood and Anxiety Treatments (CANMAT) previously published treatment guidelines for bipolar disorder in 2005, along with international commentaries and subsequent updates in 2007, 2009, and 2013. The last two updates were published in collaboration with the International Society for Bipolar Disorders (ISBD). These 2018 CANMAT and ISBD Bipolar Treatment Guidelines represent the significant advances in the field since the last full edition was published in 2005, including updates to diagnosis and management as well as new research into pharmacological and psychological treatments. These advances have been translated into clear and easy to use recommendations for first, second, and third‐ line treatments, with consideration given to levels of evidence for efficacy, clinical support based on experience, and consensus ratings of safety, tolerability, and treatment‐emergent switch risk. New to these guidelines, hierarchical rankings were created for first and second‐ line treatments recommended for acute mania, acute depression, and maintenance treatment in bipolar I disorder. Created by considering the impact of each treatment across all phases of illness, this hierarchy will further assist clinicians in making evidence‐based treatment decisions. Lithium, quetiapine, divalproex, asenapine, aripiprazole, paliperidone, risperidone, and cariprazine alone or in combination are recommended as first‐line treatments for acute mania. First‐line options for bipolar I depression include quetiapine, lurasidone plus lithium or divalproex, lithium, lamotrigine, lurasidone, or adjunctive lamotrigine. While medications that have been shown to be effective for the acute phase should generally be continued for the maintenance phase in bipolar I disorder, there are some exceptions (such as with antidepressants); and available data suggest that lithium, quetiapine, divalproex, lamotrigine, asenapine, and aripiprazole monotherapy or combination treatments should be considered first‐line for those initiating or switching treatment during the maintenance phase. In addition to addressing issues in bipolar I disorder, these guidelines also provide an overview of, and recommendations for, clinical management of bipolar II disorder, as well as advice on specific populations, such as women at various stages of the reproductive cycle, children and adolescents, and older adults. There are also discussions on the impact of specific psychiatric and medical comorbidities such as substance use, anxiety, and metabolic disorders. Finally, an overview of issues related to safety and monitoring is provided. The CANMAT and ISBD groups hope that these guidelines become a valuable tool for practitioners across the globe.

show abstract

Section: Safety and Monitoringmentioning

confidence: 99%

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

et al. 2018

View full text Add to dashboard Cite

show abstract

“…The overall rate of rashes for patients taking lamotrigine is 13% [12]; any rash in such patients is potentially serious and should be evaluated promptly [13]. Although the patient was sent home after her initial visit to the ED, relying on outpatient treatment with antihistamines or corticosteroids is inadequate and not recommended, as the role of these agents are uncertain [14].…”

Section: Discussionmentioning

confidence: 99%

Lamotrigine-associated reversible severe hepatitis: A case report

2008

View full text Add to dashboard Cite

A 43-year-old woman with a history of depression, which was being treated with oxcarbazepine twice a day (300 mg/morning and 450 mg/evening), was started on lamotrigine 2 weeks prior to her presentation, with the dose increased to 50 mg/day just prior to admission.Two weeks after starting the lamotrigine, she developed nausea and a generalized pruritic macular rash. She sought treatment in ABSTRACTIntroduction: Anticonvulsant hypersensitivity syndrome is a severe idiosyncratic reaction to antiepileptic drugs. We report a case of a woman with lamotrigine-associated hepatitis who recovered spontaneously with supportive treatment.Case Report: A 43-year-old woman was being treated with oxcarbazepine for depression and was started on lamotrigine 2 weeks prior to her presentation. The patient then developed nausea and a generalized pruritic macular rash, and was found to have elevated liver enzymes, which peaked at AST, 6079 IU/L; ALT, 6900 IU/L; total bilirubin, 3.9 mg/dL(66.7 mol/L); alkaline phosphatase, 149 IU/L; international normalized ration (INR), 1.9. The patient showed no signs of encephalopathy and her clinical examination was essentially normal except for very mild jaundice and a diffuse erythematous pruritic macular rash. The patient was hydrated and managed with supportive care. On the third day of hospitalization, her liver enzymes had improved substantially and she was discharged. At follow-up 1 month later the patient's liver enzymes were within the normal range.Discussion: We hypothesize that lamotrigine was directly responsible for the patient's rash and liver impairment given the time sequence of drug introduction and resolution of symptoms and liver enzyme abnormality once the drug was withdrawn. The patient suffered severe transaminitis when lamotrigine was added to oxcarbazepine, which resolved after termination of the medication and supportive management. We recommend monitoring the hepatic function in patients who have just been initiated on lamotrigine, especially if they develop jaundice.

show abstract

“…The drug eruptions with lamotrigine are similar to those that occur with other AEDs, raising the possibility that there could be some cross-reactivity between lamotrigine and aromatic AEDs (34). Valproate has not been reported to have cross-reactivity with other AEDs and is rarely associated with immune-mediated adverse effects (34) and thus may be the AED of choice during some immunemediated adverse effects. Some studies have suggested that patients with brain tumors who receive radiation therapy may be at greater risk for allergic skin reactions to AEDs (35,36).…”

Section: Importance Of Preexisting Conditionsmentioning

confidence: 99%

Adverse Effects of Antiepileptic Drugs

Greenwood

2000

Epilepsia

108

View full text Add to dashboard Cite

Summary:Because the efficacies of antiepileptic drugs (AEDs) are often equivalent, selection of an AED is often determined by adverse effects. Differences in methods for labeling adverse effects and in the adverse effect terms themselves, variations in the populations studied, and inconsistent classifications of adverse effects make it difficult to know how to use information on adverse effects to choose an AED. Effort is underway to develop more extensive and internationally acceptable descriptive terms for adverse effects. Comparison of adverse effects in patients taking AEDs with adverse events in control groups is helpful; however, data from controlled studies are often lacking for most AEDs. Because of these limitations, the clinician must adopt a preventative and early detection approach based on some general principles. This review outlines factors to consider for avoiding and detecting AED adverse effects. The occurrence of weight change with AEDs is reviewed extensively, serving to illustrate how the principle factors can be used to avoid and manage adverse effects and where there is need for better studies of the short-and long-term adverse effects of AEDs.

show abstract

Lamotrigine‐Associated Rash: Risk/Benefit Considerations in Adults and Children

Cited by 304 publications

References 37 publications

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Canadian Network for Mood and Anxiety Treatments (CANMAT) and International Society for Bipolar Disorders (ISBD) 2018 guidelines for the management of patients with bipolar disorder

Lamotrigine-associated reversible severe hepatitis: A case report

Adverse Effects of Antiepileptic Drugs

Contact Info

Product

Resources

About