Lamictal & Stevens-johnson Syndrome
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Q:  Lamictal & Stevens-johnson Syndrome

My doctor wants me to try Lamictal. I'm afraid of Stevens-johnson syndrome.  I'm a 40 year old female. Intial dose would be 25MG twice a day.  Is it worth the risk?

Dear Ms. R' -- 
In my experience, once I started using one quarter of that dose as the starting place (instead of the dose you cite, although that's what's in the manufacturer's info (or was; they are probably onto this by now, as most of my colleagues seem to have arrived at the same conclusion))  -- after that, I haven't seen hardly a single case of rash if my patient actually followed the instructions for ultra-slow dose increases.  And I understand that some leading figures on this topic, like Dr. Laura Marangell (per a recent conference presentation) are now so comfortable with the rash risk that they don't even stop the medication if a person gets  a bumpy, red, itchy spot on their body -- only if it's around the mouth or inside; if there are blood test changes; or if a person is feeling sick as well as having the rash.  Otherwise, they just pull back on the dose for a bit and wait for the rash to go away. 

In other words, the risk of S-J syndrome is much lower now that we're using much slower dose increases.  I saw 1/3,000 for the severe rash frequency recently, down from 1/1,000, for example.  That doesn't make it less scary, perhaps, but it at least is less common than it was when we started this.  Check out the dose approach I use now and discuss that with your doc'.  

Dr. Phelps

   Published June, 2002


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