Lamotrigine

Meet the patient

A 29-year-old with bipolar disorder has been well for two years on lamotrigine 200 mg daily. She is admitted with a manic relapse, misses five days of tablets in the chaos of transfer, and is restarted on her usual dose. Sodium valproate is added the same afternoon for the mania.^[9][10]

On day ten she has a spreading rash across her trunk, and there is an erosion on her lower lip.^[8][14]

Two errors, both invisible on the drug chart. She was restarted at maintenance after a multi-day gap instead of re-titrating, and valproate was added without switching her to the co-therapy schedule. Both are documented risk amplifiers for serious cutaneous reactions — and the lip tells you which pathway you are now on.^{[8][9][10][14]}

References18ShowHide

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