When it comes to your children’s medication, have you done your research? Exhaustive laundry lists of side effects often accompany prescription medications. This reality makes it crucial to know as much as you can about any new prescription medication that your child could be ingesting and its potential effects. Failing to do so may result in unexpected negative health effects that can change your child’s life — at least it did for Mary Shomon and her son.
A Mother and Son’s Experience with Lamictal
Mary Shomon is a NY Times Bestselling author and a thyroid and hormonal health patient advocate whose twelve-year-old son required medication for depression and mood. The psychiatrist recommended that he take Lamictal and assured them that it is a relatively low-risk option, the risk being a mild “Lamictal rash.”
It wasn’t until three weeks later that Shomon and her son developed what they thought was pink eye which they treated with eye drops. It seemed like a simple enough fix. But in the days that followed, her son’s “eyes looked worse, he felt achy and feverish, and he developed what appeared to be a cold sore on his mouth.”
What she thought was a cold sore were lesions that spread over his lips, in his mouth, and down his throat. Severe rashes also began to form on his face, chest, hands, and feet. By this time Shomon had called the psychiatrist, taken him off Lamictal, and received a confirmation from the ER doctor that her son has Stevens-Johnson Syndrome (SJS).
What is Stevens-Johnson Syndrome?
Stevens-Johnson syndrome usually starts with flu-like symptoms, followed by a painful red or purplish rash that spreads and blisters. Then the top layer of the affected skin dies and sheds.Certain drugs trigger SJS – in this case, Lamictal – and can be life-threatening. The disease affects both internal and external mucous membranes and can affect your corneas. These terrible health effects can cause severe skin lesions or blindness.
The unfortunate news is that Stevens-Johnson syndrome is a rare and often very unpredictable reaction. Certain drugs and types of infection have been known to trigger SJS.
Drugs that may cause Stevens-Johnson syndrome include:
- Anti-gout medications, such as allopurinol
- Pain relievers such as acetaminophen (Tylenol, others), ibuprofen (Advil, Motrin IB, others) and naproxen sodium (Aleve)
- Medications to fight infection, such as penicillin
- Medications to treat seizures or mental illness (anticonvulsants and antipsychotics)
- Radiation therapy
Infections that may cause Stevens-Johnson syndrome include:
- Herpes (herpes simplex or herpes zoster)
What are the risk factors of Stevens-Johnson Syndrome?
Although it can be very difficult to predict SJS, there are some associated risk factors that may increase you or your child’s chances of contracting SJS including:
- Viral infections. Having an infection caused by a virus, such as herpes, viral pneumonia, HIV or hepatitis.
- Weakened immune system. If you have a weakened immune system, you may have an increased risk of Stevens-Johnson syndrome. Your immune system can be affected by an organ transplant, HIV/AIDS and autoimmune diseases, such as lupus.
- A history of Stevens-Johnson syndrome. If you’ve had a medication-related form of this condition, you are at risk of a recurrence if you use that drug again.
- A family history of Stevens-Johnson syndrome. If an immediate family member has had Stevens-Johnson syndrome or a related condition called toxic epidermal necrolysis, you may be more susceptible to developing Stevens-Johnson syndrome too.
- Having a certain gene. If you have a gene called HLA-B 1502, you have an increased risk of Stevens-Johnson syndrome, particularly if you take certain drugs for seizures or mental illness. Families of Chinese, Southeast Asian or Indian descent are more likely to carry this gene.
If any of the above apply to you or your child and you are considering new prescription medication, you can have an open conversation with your health care provider when deciding which treatment option is best.
What is Lamictal and What is it Prescribed For?
Although many people may blame Lamictal in Mary Shomon’s son’s terrible episode of SJS, the truth is Lamictal isn’t solely to blame. As we’ve learned, SJS can be triggered by a variety of prescription medications and certain diseases.
Lamictal Lamotrigine, commonly known as Lamictal, is an FDA-approved drug that treats both children and adults with epilepsy or other seizures. Adults with bipolar disorder also use this drug to delay mood episodes.[3,4] You’ll often find psychiatrists and doctors prescribing Lamictal in combination with other medications.
There are two forms of Lamictal: One offers immediate-release of the medication while the other offers an extended-release.
Who Can Take Lamictal?
Immediate-release Lamictal (in combination with other drugs) is used in kids as young as two if they suffer from seizures. Although, doctors advise against teenagers aged sixteen and under using this form of Lamictal. Further, extended-release Lamictal is reserved only for adults and children no younger than thirteen.
Regarding Lamictal, the FDA-approved prescribing instructions are clear: “Children and Adolescents (less than 18 years of age): Safety and effectiveness of Lamictal in patients below the age of 18 years with mood disorders have not been established.”
Furthermore, the “black box warning” – a part of the label designed to call attention to serious or life-threatening risks – for Lamictal may make you think twice about allowing your child to take it.
Here’s a “black box” excerpt:
“Lamictal can cause serious rashes requiring hospitalization and discontinuation of treatment…Discontinuation of treatment may not prevent a rash from becoming life-threatening or permanently disabling or disfiguring.”
Lamictal is Off-Label
Off-label means that while professionals are prescribing a certain drug, they do so for a reason that isn’t included on the FDA-approved label or insert.The FDA does not regulate drug prescribing – only drug approval.
In fact, “doctors are free to prescribe any drug for any [reason] they think is medically appropriate,” according to medical ethics advocate and University of Chicago assistant professor G. Caleb Alexander. “Off-label use is so common, that virtually every drug is used off-label in some circumstances.”
So in the case of Shomon and her son, the Lamictal packaging did not specify that it can treat depression and mood issues. However, the psychiatrist used it with this intent – a practice that is common and legal.
This Consumer Reports document includes a list of drugs that professionals commonly prescribe off-label. While many of these FDA-approved drugs can treat more than one problem, they often come with a list of known and unknown side effects. The severity of these effects can vary, so it’s truly up to you to do as much research into a drug and ask as many questions as possible.
- Severe or life-threatening skin rashes (especially in children and with high doses)
- Swollen glands
- Painful sores around your eyes or mouth
- Difficulty breathing
- Sore throat
- Swelling in your face or tongue
- Burning in your eyes
- Skin pain that leads to blistering and peeling
- Thoughts about self-harm or suicide
Reading these side effects alongside the “black box warning” can be eye-opening, angering, frightening, and rightly so. These are medications that can cause serious harm, and while some may be effective, not all of them work. Although many people who suffer from mood disorders require prescription medication to manage symptoms, you should know that you don’t have to limit yourself to only pharmaceutical options:
- Sometimes physical activity, healthy eating, being social, experiencing nature, and getting better sleep are the best natural ways to combat depression.
- You may not be into yoga, but even doctors are backing its mental and physical health benefits.
- Scientists know that Turmeric and sauerkraut may help treat anxiety and depression – why not get better and eat better?
Disclaimer: This information is not intended to be a substitute for professional medical advice, diagnosis or treatment and is for information only. Always seek the advice of your physician or another qualified health provider with any questions about your medical condition and current medication. Do not disregard professional medical advice or delay seeking advice or treatment because of something you have read here.