The antiepileptic drug Lamictal (generic: lamotrigine) has one major adverse reaction, which is a serious skin rash known as Stevens Johnson Syndrome (SJS). However, a study suggests that a large majority of patients who developed the skin rash may be given the medication again without experiencing a Lamictal rash.

The study was published in the medical journal Epilepsy Currents, a publication of the American Epilepsy Society, and was authored by Dr. Andres Kanner, professor at the Miller School of Medicine at the University of Miami. Kanner is considered one of the leading experts on epilepsy in the United States.

Kanner does not downplay the severity of Stevens Johnson Syndrome and says that it is of great concern, but is asking if the merits of Lamictal in treating epilepsy  are worth a rechallenge.

The study looked at 688 patients who were taking Lamictal and rechallenged those who had developed Stevens Johnson Syndrome with 5 mg of the medication every day or every other day for 14 days. Every 14 days the dosage was increased another 5 mg until the patient reached the daily dosage of 25 mg per day.

Of those patients, 52 developed a Lamictal rash, making up about 6 percent of patients. About 1.8 percent of those were taking the epilepsy medication for the first time. Nineteen of those who developed Stevens Johnson Syndrome were rechallenged with Lamictal and 84 percent of those patients were able to continue taking the medication with success.

According to Kanner, these results put the problem of Lamictal SJS “in a more realistic perspective.”

He explains that since Lamictal is now recommended to be prescribed at lower dosages it “has a risk comparable to that of other frequently prescribed anti-epileptic drugs that are known to cause a serious rash.”

He concludes his analysis by saying that he would recommend that “in the case of nonserious rash, a rechallenge with [Lamictal] can potentially be considered.”

What is Stevens Johnson Syndrome?

SJS is a severe skin rash that often starts out as hives. It may appear in the form of facial swelling, tongue swelling, and skin pain as well as a red or purple rash that spreads rapidly, within hours to days.

Blisters will begin to develop on the skin and mucous membranes, especially in the mouth, nose and eyes. It usually culminates in the shedding of the skin–which means that the top layer of the skin has died. SJS is incredibly painful and can make eating, urinating, and sleeping difficult. If blisters develop on the eye, it can cause blindness.

SJS is fatal in about 5 percent of patients who contract it. Lesions can develop on internal organs such as the heart, lungs, kidneys or liver, causing inflammation on those organs. It can also cause sepsis, a condition in which the bacteria from the infection enter the bloodstream. SJS can take months to recover from and can leave lasting damage.

This adverse Lamictal side effect can be severe enough to lead to death, especially if it turns into Toxic Epidermal Necrolysis.

As a result of this serious reaction to Lamictal, the epilepsy medication now comes with a black-box warning as part of the information given to the patient about the prescription.

While SJS can occur at any time after the patient has begun taking Lamictal, most develop the reaction within two to eight weeks after beginning a Lactimal regimen.