Rechallenge of lamotrigine after development of rash

Lamotrigine (LTG) is associated with the potential for a life-threatening rash (eg, Stevens-Johnson syndrome or toxic epidermal necrolysis). The incidence has been linked to rapid titration and an interaction with valproic acid that can increase the level of LTG. Providers often have difficulty discriminating between serious versus benign rashes, and the package insert recommends discontinuing the medication at the first sign of a rash. Therefore, many patients end up being taken off LTG when it may have been effective for them. We present a case where LTG is reintroduced with a faster initial titration than what is noted in the literature after development of a rash. This case is also unique in that the patient had been on LTG for years prior to emergence of the rash and demonstrates that retrials can be successful.