Successful re-introduction of lamotrigine after initial rash

Abstract

The aim of this study was to determine whether lamotrigine can be re-introduced safely and with a benefit in young people who previously had a mild rash associated with the first introduction of this drug. In the first 150 young people (5-19 years old) treated with lamotrigine in a special centre for epilepsy, seven developed a mild rash soon after starting the drug. In none of these cases was the rash severe, nor was there any mucous membrane involvement. The lamotrigine was stopped immediately when the rash was identified and was subsequently re-introduced, using a special very-low-dose-escalation regime, starting with 0.1 mg /day total daily dose, after periods ranging from 47 to 236 days. It was possible to re-introduce the lamotrigine without recurrence of persistent rash and without any adverse effects in all seven cases. The re-introduction of lamotrigine was associated with improvement in five of the seven cases. It is recommended that lamotrigine is stopped as soon as any rash attributable to the drug develops but it may be possible to re-introduce the drug after mild rash using a very-slow-dose-escalation regime, with a benefit in at least some cases.