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 Johnsons 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:
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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.
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from:
http://en.wikipedia.org/wiki/Lamotrigine
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 and **** regions. Those in the mouth are usually extremely painful and reduce the patient's ability to eat or drink.
I take lamotrigine as a mood stabilizer. It has been very effective for me. Besides the rash, lamtotrigine 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.
As a beginner, a link to lamotrigine acne:
http://www.skindermatology.com/lamictal-acne/
Here is a meta-anylasis of lamotrigine and skin rashes ( 2011, accepted 2012) The authors have no conflict of interest to declare.
http://www.elsevier.es/sites/default...12)00091-X.pdf
One of the key points in these studies is the potential for developing a rash or other dermatological conditions. It increases by going off and then back on the medication, not keeping a regular daily dosing schedule and titrating up to fast.
This link is to the publication-
Bi-Polar Pschopharmaclogy
(second edition, 2011)
-Chapter 4 is on the psychopharmacology and use of lamtotrigine
http://books.google.com/books?hl=en&...page&q&f=false
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