Lamictal & Cold Sores
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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 systemic symptoms"

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 (  If I learn anything, I'll post you again via BPWorld.   

Dr. Phelps

Published February, 2003


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