From the Guidelines
Lamictal can cause mild, transient nausea, as well as frequent and serious rashes, which are a major concern, particularly in patients with a history of rash or intolerance 1. When considering the side effects of Lamictal, it is essential to prioritize the risk of severe skin rashes, such as Stevens-Johnson syndrome or toxic epidermal necrolysis, which can be life-threatening. According to the study published in the Annals of Emergency Medicine 1, the loading dose of Lamictal should be approached with caution, especially in patients with a history of rash or intolerance. The study highlights that loading with Lamictal is not recommended if the patient has a history of rash or has not been previously on the medication.
Some key points to consider when evaluating the side effects of Lamictal include:
- Mild, transient nausea is a common side effect 1
- Frequent and serious rashes are a major concern, particularly in patients with a history of rash or intolerance 1
- The risk of severe skin rashes is highest during the first 2-8 weeks of treatment
- Loading with Lamictal should be approached with caution, especially in patients with a history of rash or intolerance 1
It is crucial to weigh the benefits and risks of Lamictal and closely monitor patients for any signs of adverse effects, particularly during the initial treatment period. By prioritizing the risk of severe skin rashes and taking a cautious approach to loading with Lamictal, healthcare providers can minimize the risk of morbidity and mortality associated with this medication 1.
From the Research
Side Effects of Lamictal
- Lamictal, also known as lamotrigine, can cause severe cutaneous adverse effects such as Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis 2, 3, 4, 5.
- SJS is a rare but life-threatening acute mucocutaneous hypersensitivity reaction, usually related to drugs 2, 3, 4, 5.
- The concomitant use of lamotrigine and valproic acid can increase the risk of SJS 2, 5.
- Patients who undergo therapy with antiepileptic drugs, particularly new users of these agents, should be informed of and monitored for possible systemic and cutaneous adverse effects of AEDs 2.
- Polytherapy should be avoided for as long as possible as this increases the frequency of adverse effects, and treatment should be discontinued if any rash appears 2.
- The Federal Food and Drug Administration recommends testing HLA subtypes for those associated with SJS prior to starting lamotrigine 3.
- Valproic acid can cause inhibition of epoxide hydrolase enzymes and/or depletion of glutathione levels leading to adverse cutaneous reactions 5.
Risk Factors
- Certain HLA genotypes, such as HLAB15:02, HLAB31:01, and HLA-B*44:03, can increase susceptibility to lamotrigine-induced SJS in certain ethnic groups 3.
- Patients of Chinese and Southeast Asian origin with HLAB15:02, Japanese origin with HLAB31:01, and Koreans with HLA-B*44:03 are at increased risk of SJS after receiving lamotrigine 3.
Prevention and Treatment
- Immediate withdrawal of the offending medication, providing symptomatic relief, and offering supportive care can decrease mortality seen with severe cutaneous adverse drug reactions 6.
- A strict re-challenge dosing regimen can facilitate successful reintroduction of lamotrigine in patients who have previously experienced SJS 3.