Lorberg Boris, Youssef Nagy A, Bhagwagar Zubin
Department of Psychiatry, Yale University School of Medicine, CT 06519-1187, USA.
Int J Neuropsychopharmacol. 2009 Mar;12(2):257-65. doi: 10.1017/S1461145708009504. Epub 2008 Oct 10.
The major burden of illness in bipolar disorder (BD) is in the depressive pole. Lamotrigine has been shown to be useful in the long-term prophylaxis of depressive episodes in BD. Current guidelines recommend discontinuing lamotrigine in patients who develop rash. Our objective in this paper is to review literature to identify possible predictors of serious vs. benign rash that might help guide clinical decision-making and recommend titration strategy for re-introduction of lamotrigine, if indicated. We performed a search of the literature between 1966 and July 2008 to investigate the phenomenon of lamotrigine-induced rash and rechallenge procedures. The search identified six reports, and we were able to identify another case series from reviewing the bibliography of all of the above papers. We reviewed all the papers of lamotrigine rash rechallenge that resulted from the literature search. These papers describe 44 cases of lamotrigine rechallenge. Currently, there are 39 reported cases in the literature of successful lamotrigine rechallenge after a rash and five cases with rash recurrence. There are some characteristics of the rash that can help identify serious cases from benign ones. In addition, very slow titration of lamotrigine is crucial to the reduction of rash recurrence rate. Several cases that develop benign rash on lamotrigine can be rechallenged without adverse consequences. We believe that lamotrigine rechallenge in bipolar depression is an under-utilized option in our clinical armamentarium, and further studies are needed to guide us in this area.
双相情感障碍（BD）的主要疾病负担在于抑郁发作期。拉莫三嗪已被证明对BD抑郁发作的长期预防有效。目前的指南建议，出现皮疹的患者应停用拉莫三嗪。本文的目的是回顾文献，以确定严重皮疹与良性皮疹的可能预测因素，这可能有助于指导临床决策，并在必要时推荐重新引入拉莫三嗪的滴定策略。我们检索了1966年至2008年7月间的文献，以研究拉莫三嗪诱发皮疹及再次用药的情况。检索共找到6篇报告，通过查阅上述所有论文的参考文献，我们又确定了另一个病例系列。我们回顾了文献检索中所有关于拉莫三嗪皮疹再次用药的论文。这些论文描述了44例拉莫三嗪再次用药的病例。目前，文献中报道有39例皮疹后成功再次使用拉莫三嗪的病例，以及5例皮疹复发的病例。皮疹的一些特征有助于区分严重病例和良性病例。此外，拉莫三嗪滴定速度极慢对于降低皮疹复发率至关重要。几例使用拉莫三嗪后出现良性皮疹的病例再次用药时未出现不良后果。我们认为，双相抑郁中再次使用拉莫三嗪是我们临床手段中一个未得到充分利用的选择，需要进一步研究来指导我们在这一领域的工作。
