Q: Lamictal & Cold Sores
I have had bipolar disorder for about 30 years. It was originally treated as unipolar depression and not actually diagnosed until 1990. I have
Type II bipolar w/some degree of mixed state and rapid cycling involvement - in
other words one of the most resistant to treatment types.
I don't respond well to lithium and can no longer take depakote (which left me
fatigued anyway) due to several instances of elevated liver enzymes.
In 1997 I was put on Neurontin presumably based on the hype surrounding the
drug. My gut feeling has been that it helped me somewhat. I am now taking 1600
mg daily, but am thinking that based on recent press reports I may be deluding
myself it is having any effect. However I never have Migrane headaches anymore
which were a real problem for about 20 years, so perhaps the Neurontin is doing
something to prevent them.
About a year ago Lamictal was added to the regimen. It was the best drug I ever
took by far. I felt like a different person. However I did get some rashes on my
back and tapered down and then restarted. I don't get skin rashes anymore.
However what I have gotten is some outbreaks of annoying mouth sores (a lesion
usually on the underside of the tongue with a white dot at the top). These sores
are very sensitive to almost any stimulus and they come in staggered groups of
2-4. When I have been under a particularly large amount of stress and I can get
a large cluster of these mouth sores.
I have stopped and started Lamictal several times on my own when these mouth
sores appeared. From reading your prior answers I noted the following with
respect to SJ syndrome or lesser included dangerous rashes:
............."not including mucous membrane involvement or fever and other
I have used Abreva and campho phenique topically w/these sores and this makes
them tolerable. The average life of these sores is 72 hours.
Are these cold sores deal breakers as far as staying on Lamictal goes? Moreover
would it be not prudent at this point to have a psychiatrist ramp down and/or
discontinue the Neurontin to see if it is really "no better than a sugar pill"?
What about seeing an ENT to better get at the source of these outbreaks?
Hello Mr. B --
Seems like a fair question, and a crucial one (and your learning about Lamictal
and the rash issue is evident!), when you ask "Are these cold sores deal breakers as far as staying on Lamictal goes?"
Unfortunately, though I've heard one other time about such sores, I don't know
the answer to this one. I've had one patient who got sore gums, nothing
else, but we couldn't get that to quit even after weeks on 5 mg daily, so
finally gave up -- it was just too close to the Stevens-Johnson edge. But
yours, as more intermittent -- I just don't know what to make of that. We
need a Stevens-Johnson expert, most likely.
I will ask my Lamictal rep' to get GlaxoWellcome, who
makes lamotrigine, to comment and chase an answer, as there may be other reports
of this. You should ask your doc' to ask her/his rep' to pursue this also
in case my attempt dead-ends somehow. If you'd write with anything you
learn I'd appreciate it (firstname.lastname@example.org).
If I learn anything, I'll post you again via BPWorld.
Published February, 2003