PMID- 10448828
OWN - NLM
STAT- MEDLINE
DCOM- 19990819
LR  - 20190813
IS  - 0013-9580 (Print)
IS  - 0013-9580 (Linking)
VI  - 40
IP  - 8
DP  - 1999 Aug
TI  - Adding lamotrigine to valproate: incidence of rash and other adverse effects. 
      Postmarketing Antiepileptic Drug Survey (PADS) Group.
PG  - 1135-40
AB  - PURPOSE: Valproate (VPA) triples the half-life of lamotrigine (LTG), and combined 
      use may be difficult. The adverse effect (AE) profile of this combination needs 
      clarification. METHODS: We prospectively recorded our experience in adding LTG to 
      VPA-containing regimens in 108 patients. Data collected included medications, 
      seizure types and syndromes, and AEs. Patients were followed up to 27 months, 
      until a stable dose was reached, or until LTG was discontinued. Patient 
      management was not altered by this study. There were 60 patients with 
      partial-onset seizures, 30 with generalized onset, and 12 with the Lennox-Gastaut 
      syndrome. In 37, LTG was added to VPA monotherapy, and in 71, to VPA and other 
      drugs. The median starting dose of LTG in our adult patients was 20.8 mg/day. 
      RESULTS: LTG was added successfully in 86 (80%) patients. It was discontinued in 
      22 (20%): seven because of rash, seven for other AEs, and nine for other reasons. 
      Rash occurred in 14 (13%) but caused discontinuation of LTG in only seven. We 
      found a rash rate of 14.2% and a discontinuation rate because of rash of 8.7% 
      among 310 patients in whom LTG was added to drug regimens not including VPA. 
      Other AEs included fatigue (12%), gastrointestinal (GI) symptoms (9%), dizziness, 
      headache, and insomnia (3% each). Serious AEs were hallucinations (two patients), 
      hepatic enzyme elevations (two patients), irritability (one patient), and low 
      white blood cell count (one patient). Whether LTG was added to VPA monotherapy or 
      polytherapy made no difference in overall AE rate. CONCLUSIONS: LTG can be added 
      to VPA with an acceptable incidence of side effects. LTG-induced rashes are no 
      more common with VPA than with other drugs when LTG is added at very low initial 
      dosages. Rashes are potentially serious and should be evaluated promptly.
FAU - Faught, E
AU  - Faught E
AD  - University of Alabama, Birmingham 35294-0021, USA.
FAU - Morris, G
AU  - Morris G
FAU - Jacobson, M
AU  - Jacobson M
FAU - French, J
AU  - French J
FAU - Harden, C
AU  - Harden C
FAU - Montouris, G
AU  - Montouris G
FAU - Rosenfeld, W
AU  - Rosenfeld W
LA  - eng
PT  - Clinical Trial
PT  - Clinical Trial, Phase IV
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PL  - United States
TA  - Epilepsia
JT  - Epilepsia
JID - 2983306R
RN  - 0 (Triazines)
RN  - 614OI1Z5WI (Valproic Acid)
RN  - U3H27498KS (Lamotrigine)
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Child
MH  - Dizziness/chemically induced/epidemiology
MH  - Drug Eruptions/*epidemiology/etiology
MH  - Drug Hypersensitivity/epidemiology/etiology
MH  - Drug Therapy, Combination
MH  - Female
MH  - Follow-Up Studies
MH  - Gastrointestinal Diseases/chemically induced/epidemiology
MH  - Hallucinations/chemically induced/epidemiology
MH  - Headache/chemically induced/epidemiology
MH  - Humans
MH  - Incidence
MH  - Lamotrigine
MH  - Male
MH  - Middle Aged
MH  - Product Surveillance, Postmarketing
MH  - Prospective Studies
MH  - Sleep Initiation and Maintenance Disorders/chemically induced/epidemiology
MH  - Triazines/*adverse effects/therapeutic use
MH  - Valproic Acid/*adverse effects/therapeutic use
EDAT- 1999/08/17 00:00
MHDA- 1999/08/17 00:01
CRDT- 1999/08/17 00:00
PHST- 1999/08/17 00:00 [pubmed]
PHST- 1999/08/17 00:01 [medline]
PHST- 1999/08/17 00:00 [entrez]
AID - 10.1111/j.1528-1157.1999.tb00831.x [doi]
PST - ppublish
SO  - Epilepsia. 1999 Aug;40(8):1135-40. doi: 10.1111/j.1528-1157.1999.tb00831.x.