Tatoos & Mood Stabilizers:Lamictal & Watching for a Rash
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Q:  Tatoos & Mood Stabilizers : Lamictal & Watching for a Rash

My son is 23 he just started on Lamictil today. I tried to get him to start on 12.5 but the Dr was no help, in fact she got annnoyed because I knew about  mood stabilizers. She said start at 25, He is also on 20 mgs of Prozac. He was taking Seroqule that was prescribed in the hopital but he hated it and had a lot of the side affects, he doesn't want to take any anti psychotics.  We have a few questions. His first question is can he get tattooed. He is a tattooist and has many tattoos and plans on getting many more. The Dr said something about low platelets and not to get tattooed. He said then forget it I don't wanna take the Lamactil and she said all mood stabilzers will make it dangerous to get tattooed. She would not give us much info as she thought getting tattooed is something to give up for meds. But he is not willing to do that. I wanted to know how long should we watch for a rash? The whole time he is on it? Is this medicine safe? I am worried about the rash. He just started today.  I have been to your website and spent hours on it.  I like how honest you are and I respect your advice. Thank you  for any information you can give me.

Dear D' -- 
Sorry you had that experience over the 12.5 mg dose.  The 25 mg dose really is standard, I'm just ultra-ultra-cautious with my dosing when I have the option to be.  

As for tatoo's, it's true that Depakote can interfere with platelets and cause bleeding to be a little prolonged; and can occasionally even drop the platelet count below normal.  And Depakote interacts very directly with lamotrigine.  So if Depakote was in the mix of medications, she might have something there.  If it's not, I don't get the hesitation regarding tatoos.  I can understand the notion of giving them up in favor of medications, but I hear that in this young man's case, that ain't gonna happen right now.  

Just to make sure I reviewed the product information on lamotrigine; did a PUB MED lit search (lamotrigine platelets; lamotrigine bleeding) and a Google search -- and found no connection between lamotrigine and bleeding problems.  

How long to watch for a rash?  The problem usually occurs, if it's going to occur, in the first 2-8 weeks, and once you're past 2 months at full dose, you're probably not going to see a problem.  But there have been some rare cases occurring after more than 6 months of treatment, so you can never completely relax about the rash-risk.  It's definitely a risk with this medication, but so it having symptoms, in many cases.  The risk of rash is not one that keeps me from using this medication, even using it first, before other medications like lithium and Depakote, in many cases -- in other words, the risk from this one, compared to its potential benefits for some people, is in the same ballpark as the alternatives when you take all factors into account, in my opinion.  

Dr. Phelps

Published March, 2004


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