title: Dermatology precautions and slower titration yield low incidence of lamotrigine treatment-emergent rash.
abstract: OBJECTIVE
  To assess treatment-emergent rash incidence when using dermatology precautions (limited antigen exposure) and slower titration during lamotrigine initiation.
  
  
  METHODS
  We assessed rash incidence in 100 patients with DSM-IV bipolar disorder instructed, for their first 3 months taking lamotrigine, to avoid other new medicines and new foods, cosmetics, conditioners, deodorants, detergents, and fabric softeners, as well as sunburn and exposure to poison ivy/oak. Lamotrigine was not started within 2 weeks of a rash, viral syndrome, or vaccination. In addition, lamotrigine was titrated more slowly than in the prescribing information. Patients were monitored for rash and clinical phenomena using the Systematic Treatment Enhancement Program for Bipolar Disorder Clinical Monitoring Form. Descriptive statistics were compiled.
  
  
  RESULTS
  No patient had serious rash. Benign rash occurred in 5 patients (5%) and resolved uneventfully in 3 patients discontinuing and 2 patients continuing lamotrigine. Two patients with rash were found to be not adherent to dermatology precautions. Therefore, among the remaining patients, only 3/98 (3.1%) had benign rashes.
  
  
  CONCLUSIONS
  The observed rate of benign rash was lower than the 10% incidence in other clinical studies. The design of this study confounds efforts to determine the relative contributions of slower titration versus dermatology precautions to the low rate of rash. Systematic studies are needed to confirm these preliminary findings, which suggest that adhering to dermatology precautions with slower titration may yield a low incidence of rash with lamotrigine.
authors.affiliation: Stanford University School of Medicine, 401 Quarry Road, Stanford, CA 94305, USA. tketter@stanford.edu
authors.forename: Terence A
authors.initials: TA
authors.lastname: Ketter
authors.forename: Po W
authors.initials: PW
authors.lastname: Wang
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Chandler
authors.forename: Andrea M
authors.initials: AM
authors.lastname: Alarcon
authors.forename: Olga V
authors.initials: OV
authors.lastname: Becker
authors.forename: Cecylia
authors.initials: C
authors.lastname: Nowakowska
authors.forename: Colette M
authors.initials: CM
authors.lastname: O'Keeffe
authors.forename: Matthew R
authors.initials: MR
authors.lastname: Schumacher
mesh_terms: D000328:Adult; D000553:Ambulatory Care; D000927:Anticonvulsants / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use; D001714:Bipolar Disorder / Q000188:drug therapy*; D015331:Cohort Studies; D004334:Drug Administration Schedule; D003875:Drug Eruptions / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D016903:Drug Monitoring; D004359:Drug Therapy, Combination; D005076:Exanthema / Q000139:chemically induced / Q000453:epidemiology / Q000517:prevention & control*; D005260:Female; D006801:Humans; D015994:Incidence; D000077213:Lamotrigine; D008297:Male; D010349:Patient Compliance; D011619:Psychotropic Drugs / Q000627:therapeutic use; D012648:Self Care / Q000379:methods; D017592:Skin Care / Q000379:methods; D016896:Treatment Outcome; D014227:Triazines / Q000008:administration & dosage* / Q000009:adverse effects* / Q000627:therapeutic use
chemical_list: D000927:Anticonvulsants; D011619:Psychotropic Drugs; D014227:Triazines; D000077213:Lamotrigine