Lamotrigine

Medically Reviewed by Dr. Harshi Dhingra, M.D.

Last Reviewed: Aug 02, 2023

Warnings

Lamotrigine Risks, Warnings, and Complications

Lamotrigine can cause or worsen health problems in some people. Talk to your doctor or pharmacist about other treatments for your condition if you are at an increased risk of adverse reactions or complications from this medication. Some of the risks of taking lamotrigine include:

SERIOUS RASHES: Lamotrigine can cause serious skin reactions, which can be life-threatening and even fatal. The risk of serious rashes requiring hospitalization is higher in people on adjunctive therapy with other similar medications (antiepileptic drugs), for example, those taking valproic acid or divalproex (Depakote). The risk is also greater in people on high doses of lamotrigine and whose dose of lamotrigine is increased too fast. Pediatric patients are at a greater risk of developing a serious rash than adults. Severe skin reactions are most likely to occur in the first 2-8 weeks of starting lamotrigine therapy but can happen at any time.
Get immediate medical care if you develop a skin rash, blistering, peeling, painful sores, swelling, or difficulty breathing while on lamotrigine. Sometimes, the early signs of an allergic reaction include fever and swollen lymph nodes before a rash appears. Seek emergency medical help if you notice fever, chills, mouth sores, swollen glands, or body aches.
SUICIDE RISK: Lamotrigine use can increase the risk of suicidal thoughts and behaviors. These changes in mental health can happen within a week of starting the medicine. The risk is higher in people who have a history of suicidal ideation. Your friends and family members should know about this risk and watch for any signs of worsening depression. They should know how to contact your provider if they notice any suicidal thoughts or actions or unusual moods or behaviors in case you are unable to seek care for yourself.

Precautions Before Starting Lamotrigine

Tell your doctor if you have ever had an allergic reaction to lamotrigine, any of the active or inactive ingredients in lamotrigine formulations, other antiepileptic drugs, or any other medications. Your pharmacy can give you a list of ingredients.

Give your doctor and pharmacist a complete list of your medications, including prescription medications, over-the-counter medicines, vitamins, nutritional supplements, and herbal products. This can help avoid possible drug interactions between lamotrigine and your other medicines.

Be sure to tell your doctor if you are taking oral contraceptives, other forms of hormonal contraception such as patches, rings, implants, injections, or intrauterine devices, or hormone replacement therapy (HRT). Consult your doctor before starting or stopping estrogen-containing hormonal medicines while on lamotrigine. Inform your doctor if you have bleeding between menstrual periods while on these medicines.

Lamotrigine may not be right for people with certain medical conditions. Give your doctor a complete medical history, including autoimmune conditions such as lupus, blood disorders, unipolar depression, mood problems, mental illness, a history of suicidal thoughts or behaviors, heart disease including irregular heart rhythm or heart failure, renal impairment (kidney disease), liver disease, or ascites (abdominal swelling due to fluid buildup).

Tell your health care professional if you are pregnant, could be pregnant, plan to get pregnant, or are nursing an infant with breast milk.

Precautions During Use of Lamotrigine

Keep all your healthcare appointments during lamotrigine therapy. Your doctor will start you on a low dose and gradually increase the dose. Follow your doctor’s instructions for dose adjustment carefully. Tell your doctor if your seizures are not well controlled. Do not increase the dose yourself without your doctor’s approval.

Taking lamotrigine can make you drowsy and dizzy. Do not drive or participate in any activity that requires your full alertness until you know how this medicine affects you. Alcohol can make these side effects worse. Avoid drinking while on lamotrigine.

Call your doctor right away if you develop any changes in mood or behavior, including suicidal thoughts and behaviors.

Tell your doctor if you become pregnant while on this medication. Breastfed infants can get some lamotrigine from the mother. Watch your baby for signs of unusual sleepiness, poor sucking, or slow breathing if you are nursing while on lamotrigine.

Tell all your healthcare providers you are on lamotrigine, especially before any procedure, including dental procedures.

Lamotrigine Drug Interactions

Other drugs can affect how lamotrigine works. Possible interactions with certain medications can increase the risk of severe adverse effects such as a life-threatening skin rash. Some of the medications that can have interactions with lamotrigine include:

Antiepileptic drugs such as divalproex (Depakote), valproic acid, phenobarbital (Luminal, Solfoton), phenytoin (Dilantin, Phenytek), oxcarbazepine (Oxtellar XR, Trileptal), carbamazepine (Epitol, Tegretol, others), and primidone (Mysoline)
Estrogen-containing oral contraceptives, other hormonal contraceptives, and hormone replacement therapy
Antiviral medications such as atazanavir with ritonavir (Reyataz with Norvir) and lopinavir with ritonavir (Kaletra)
Medications used to treat heart rhythm abnormalities, such as disopyramide (Norpace), quinidine (in Nuedexta), and procainamide
Cancer drugs such as methotrexate (Rasuvo, Trexall)
Anti-parasitics such as pyrimethamine (Daraprim)
Antibiotics such as rifampin (Rifadin, Rimactane, Rifater, in Rifamate) and trimethoprim (Septra, Primsol, in Bactrim)

Give your doctor or pharmacist a complete list of your medications, including prescription drugs, nonprescription drugs, dietary supplements, and herbal remedies. Also, tell your healthcare professional if you smoke, drink alcohol, or use recreational or illegal drugs because some of these substances can cause serious health complications when used with prescription medications.

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