How do you approach the management of patients on lamotrigine who develop a minor rash?

Lamictal rash can be dangerous but if we stop or switch lamictal for any rash during treatment we can run out of options soon.

Get a good history and pictures, if possible. How long have they been on lamictal and was there a recent dose change or did the pharmacy change their generic brand? Have any enzyme-inhibiting drugs like depakote been added?

Lamictal is one of the few meds that still has some benefit especially patients who do not tolerate switching of generic brands by going to brand na...

When mild rash occurs during the initial titration phase, I have had success in slowing down the titration rate. Upon initial notice of the rash, I have the patient return to the previous dose in the titration protocol. If the rash worsens or fails to improve, I would be likely at this point to discontinue lamotrigine. If the rash improves on the lower dose, from there, I increase the dose every 4 weeks by 25mg instead of every 2 weeks - essentially taking 2x as long to reach the desired therape...

We have so many choices with AED's, it's best in the patient's safety to stop Lamictal.

If it’s a minor rash with no other problems (skin rash only and non-confluent or wide spread) I slow down and monitor daily with phone calls and or Telemed med weekly. I like LTG and there usually is a reason these days for choosing it with the availability of other AED so I feel comfortable with monitoring it. I have extensive experience with it.