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  1. #1
    metamorphosis's Avatar
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    A quick rundown on lamotrigine psychopharmacology and side effects beyond S-J.

    Usually with lamictal pdocs prefer using the starter paks. Just to make it clear and easier for the patient to titrate up slowly. Lamictal can cause Stevens Johnson syndrome. A rash that can be life threatening. So slow titration is a perquisite when prescribing. You do not want to jump from 25mg-100mg or more overnight.

    About S-J rash:
    Quote:
    nearly all cases appear in the first 2 to 8 weeks of therapy and if medication is suddenly stopped then resumed at the normal dosage.. Not all rashes that occur while taking lamotrigine progress to SJS or TEN. Between 5 to 10% of patients will develop a rash, but only one in a thousand patients will develop a serious rash. It is thought that one in 50,000 exposed patients may die from the rash. Rash and other skin reactions are more common in children. Side-effects such as rash, fever, and fatigue are very serious, as they may indicate incipient Stevens–Johnson syndrome, toxic epidermal necrolysis, DRESS syndrome or aseptic meningitis.
    from: http://en.wikipedia.org/wiki/Lamotrigine
    Lamotrigine prescribing information has a black box warning about life-threatening skin reactions, including Stevens–Johnson syndrome, DRESS syndrome and toxic epidermal necrolysis.[24] The manufacturer states that nearly all cases appear in the first 2 to 8 weeks of therapy and if medication is suddenly stopped then resumed at the normal dosage. Patients should seek medical attention for any unexpected skin rash, as its presence is an indication of a possible serious or even deadly side-effect of the drug. Not all rashes that occur while taking lamotrigine progress to SJS or TEN. Between 5 to 10% of patients will develop a rash, but only one in a thousand patients will develop a serious rash. It is thought that one in 50,000 exposed patients may die from the rash.[citation needed] Rash and other skin reactions are more common in children, so this medication is often reserved for adults.
    There is also an increased incidence of these eruptions in patients who are currently on, or recently discontinued a valproate-type anticonvulsant drug, as these medications interact in such a way that the clearance of both is decreased and the effective dose of lamotrigine is increased.
    I take lamotrigine as a mood stabilizer. It has been very effective for me. Besides the rash, lamotrigine can cause other skin problems including "acne" on the back and chest. Lamictal acne isn't real acne,; it is a cutaneous drug reaction. And can cause small benign rashes that are not S-J. Usually you will know within 24 hrs., if you have SJS. Your tongue will swell up as well as the bronchus. Ulcers and other lesions begin to appear in the mucous membranes, almost always in the mouth and lips but also in the genital region. Those in the mouth are usually extremely painful and reduce the patient's ability to eat or drink.

    As a beginner, a link to lamotrigine acne:
    http://www.skindermatology.com/lamictal-acne/

    One of the key points in the studies is the potential for developing a rash or other dermatological conditions. The chances increase by going off and then back on the medication, not keeping a regular daily dosing schedule and titrating up to fast.

    Here is a quick rundown of Lamictal from Stahl's Prescribers Guide:
    http://stahlonline.cambridge.org/pre...e=Therapeutics


    How lamotrigine works:

    In addition to its action on voltage-sensitive/gated sodium channels, Lamictal also:
    -Potently blocks voltage-sensitive sodium channel alpha subunits.
    Which may even be Lamictal’s primary mechanism of action.
    -Blocks/modulates the calcium and potassium voltage channels
    Which means glutamate and other excitatory (i.e. seizure-inducing and/or crazy-making) neurotransmitters are reduced to a greater extent than originally thought.
    -Lamictal may block neuronal α4β2 nicotinic acetylcholine receptors (nAChRs). That’s of interest mainly to pharmacology geeks and people who deal with nocturnal frontal lobe epilepsy2.
    -Maybe having a little effect on sigma opioid receptors (which are now being studied for all sorts of things). This could be one of the reasons for Lamictal’s antidepressant action.
    -Another reason for Lamictal’s antidepressant action could be a positive effect on the 5-HT1A receptors. The data are mixed on this, and lean toward this being a wrong guess.
    -All evidence points to Lamictal still being one of the least GABAergic AEDs around.

    Finally from RxList a pretty thorough run down on lamotrigine and user reviews:
    http://www.rxlist.com/lamictal-drug.htm

    And as always you can find anecdotal reports at askapatient.com. Always keep in mind the length of time the posters have used said medications. Often they report negative responses and discontinuation prematurely after a week or so. Of course, this would be necessary when SJ. appears. But usually the feedback taken as a whole can give valuable insight.
    http://www.askapatient.com/viewratin...&name=LAMICTAL

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    Otherside's Avatar
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    Yeah, I've heard about the skin rash. Lamictal is used in treating epilepsy as well as bipolar, so younger children suffering from epilepsy take it as an anti-seizure drug.

    LAMICTAL XR may cause a serious skin rash that may cause you to be hospitalized or even cause death. There is no way to tell if a mild rash will become more serious. A serious skin rash can happen at any time during your treatment with LAMICTAL XR, but is more likely to happen within the first 2 to 8 weeks of treatment. Children between 2 to 16 years of age have a higher chance of getting this serious skin rash while taking LAMICTAL XR. LAMICTAL XR is not approved for use in children less than 13 years old.
    The risk of getting a serious skin rash is higher if you take LAMICTAL XR while taking valproate [Depakene®* (valproic acid) or Depakote®* (divalproex sodium)], take a higher starting dose of LAMICTAL XR than your healthcare provider prescribed, or increase your dose of LAMICTAL XR faster than prescribed.
    I think I saw somewhere about children as young as two taking the non-extended-release version of Lamictal for epilepsy.

    It seems to be one of the few drugs that treats bipolar than doesn't cause weight gain. It used a lot in bipolar II, the depression heavy version of the disorder. It has more "antidepressant power" than say, Lithium, and antidepressants and bipolar don't always mix...
    I'M GONNA FIGHT 'EM ALL
    A SEVEN NATION ARMY COULDN'T HOLD ME BACK.......


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    metamorphosis's Avatar
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    ^
    +++++ It is a more "user friendly" med. It does work on depression. But people with rapid cycling would need a strong antipsychotics!

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    Equinox's Avatar
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    Yeah, when used in bipolar it's mostly used for the depressive side of things, though it can reduce the amount of cycles entered with long term use. It's not really a heavy hitter on the hypo/mania side, and it's slow titration schedule limits it's usefulness in acute situations, it seems to be more of an adjuvant treatment when used in the more severe forms of bipolar. It generally has a favourable side effect profile and it doesn't require blood tests unlike some other anticonvulsants used in bipolar. There's rarely any weight gain though the same can now be said for some other treatments available for bipolar disorder, particularly some of the newer atypical anti-psychotics such as saphris, geodon and abilify (though abilify is a bit hit or miss in regards to weight neutrality).



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    Lamictal is rarely used on it's on though, right? I mean, most people I've come across with BP are on more than one drug-usually some sort of combination of mood stabilizers, antipsychotics, antidepressants, and it's a combination that will control the mood swings.
    I'M GONNA FIGHT 'EM ALL
    A SEVEN NATION ARMY COULDN'T HOLD ME BACK.......


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    Equinox's Avatar
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    That's right, it's due to it's lack of broad spectrum efficacy, particularly on the hypo/mania side. What you'll generally see is atypical antipsychotic + lithium or depakote for bipolar 1 disorder and atypical antipsychotic +/- lamictal or SSRI/SNRI for bipolar 2 disorder. Sometimes you'll see adjuvant meds on-top of those. When an acute and severe episode of mania hits Zyprexa is still favoured due to it's very rapid onset of symptom control. This page gives a good run down on the mood stabilizer class when used for bipolar disorder: http://www.psycheducation.org/depres...tabilizers.htm

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    metamorphosis's Avatar
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    Quote Equinox View Post
    Yeah, when used in bipolar it's mostly used for the depressive side of things, though it can reduce the amount of cycles entered with long term use. It's not really a heavy hitter on the hypo/mania side, and it's slow titration schedule limits it's usefulness in acute situations, it seems to be more of an adjuvant treatment when used in the more severe forms of bipolar. It generally has a favourable side effect profile and it doesn't require blood tests unlike some other anticonvulsants used in bipolar. There's rarely any weight gain though the same can now be said for some other treatments available for bipolar disorder, particularly some of the newer atypical anti-psychotics such as saphris, geodon and abilify (though abilify is a bit hit or miss in regards to weight neutrality).


    Gotta give ya props for using a DOM vid. I would like to have a free consultation. When he is in his right mind. I wonder which color of skittles he eats in his examples.

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    These facial acne can be treated easily cause it's visible, but back acne is out of my reach
    It makes me feel uncomfortable and unconfident when wearing sexy clothes.
    - You can try to use physiological salt. After bathing, apply it to the back skin and massage for 10-15 minutes, then rinse with warm water. You will recover immediately if using this back acne treatment.
    Or lemon juice is effective as well, it's simple just cut a lemon into 2 halves and rub them on your infected skin 2-3 times per week.
    Those are my tips to get rid of back acne
    If you wanna get more useful tips, you can read them here https://authorityremedies.com/home-r...for-back-acne/

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    I'm not sure whether or not it causes acne, but the rash that being referred to here is caused by Steven-Johnson Syndrome, and there's a chance you can end up developing that if you're on lamictal. Rash looks like a target basically - large spots with a darker circle in the middle, surrounded by lighter colored circle, rather than the smaller, pink colored acne spots. If you end up seeing that, you need to go to ER pretty much ASAP.

    The drug I'm on (Sodium Valproate) can supposedly cause SJS, and every time I see a rash appear I start panicking and googling it, and then compare the rash to images of it.
    I'M GONNA FIGHT 'EM ALL
    A SEVEN NATION ARMY COULDN'T HOLD ME BACK.......


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