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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?
THanks
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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