Lamotrigine-associated rash: Risk benefit considerations in adults and children

Purpose: Lamotrigine (LTG) is an antiepileptic drug (AED) recently released in several countries. It is effective for a variety of seizure types in ad ults and children both as an add-on agent and in monotherapy, and is genera lly well tolerated. This report reviews the apparent risk factors for rash associated with LTG to determine whether and how the risk of serious rash c an be minimized in practice. Methods: The panel of experts reviewed all published and unpublished data r elated to the incidence and risk factors for serious rash with LTG. Results: An allergic skin reaction occurs in similar to 10% of patients, us ually in the first 8 weeks. Rashes leading to hospitalization, including St evens-Johnson syndrome and hypersensitivity syndrome, occurred in approxima tely one of 300 adults and one of 100 children in clinical trials and appea red to be increased with overrapid titration when starting therapy and with concurrent valproate (VPA). Conclusions: Recommendations are made for both minimizing the likelihood of serious rash and for management of rash in patients taking LTG. Risk of se rious rash may possibly be lessened by strict adherence to manufacturer's d osing guidelines, particularly in patients who are at higher risk: those on concurrent VPA and in the pediatric population.