Introduction
Lamotrigine is a drug that belongs to the group of so-called anticonvulsants used to treat convulsive disorders such as epilepsy. It belongs to the newer anticonvulsants and is used mainly for focal seizure disorders, i.e. seizures that are restricted to a certain area of the brain. Lamotrigine is characterized by its comparatively low harmfulness to liver and kidney.
Overview
Although lamotrigine is generally considered to be a well-tolerated anti-epileptic, side effects may occasionally occur. This usually occurs in the dosage phase, i.e. when the Lamotrigine dose is slowly increased. It should be emphasized that most side effects (except for Stevens-Johnson syndrome) are usually unpleasant but not dangerous and disappear after a few weeks at the latest.
The most common side effects are listed below.
- Swindle
- Headaches
- FatigueDrowsiness
- Skin rash
- Itching
- Double images
- Sexual excitability increase
- Cognitive limitations (e.g. forgetfulness)
- Weight gain or loss
- Insomnia
- NauseaE Vomiting
- Trembling (Tremor)
- Joint Pain
- Increased irritability
- Allergic skin reactions up to Stevens-Johnson syndrome
Some epilepsy patients report weight gain when taking Lamotrigine. This is due to the fact that lamotrigine interferes with the regulation of the feeling of hunger in the brain.
In this context, it should be emphasized that weight gain with lamotrigine is a process that takes several weeks and does not occur “overnight”. So if you suspect that you have developed weight gain just a few days after starting Lamotrigine therapy, this is probably an incorrect assessment. In this case you should wait at least two to three weeks and objectify the possible weight gain best by weighing yourself occasionally.
If significant weight gain is actually observed after this period, consult your treating neurologist. He or she can discuss with you whether the lamotrigine should be replaced by another antiepileptic drug or whether the weight gain is still tolerable and other measures to stabilize the weight can be considered (e.g. exercise, change of diet). Surprisingly, a few patients react to the use of Lamotrigine by losing weight.
This is due to the complex regulation of the feeling of hunger in the brain and the influence of Lamotrigine on the messenger substances involved. Also the weight loss does not develop from one day to the other, but takes several weeks. Ideally, you should weigh yourself at least once a week in order to monitor the extent of the weight loss.
Even if some people are happy to lose a few kilos, losing weight too quickly is anything but healthy and should not be tolerated. It is difficult to define exact limits in this context because of the individual differences in physical characteristics. But as a rough rule of thumb can be stated: A weight loss of more than 2 kilograms per week or 5 kilograms per month should be reported to the treating neurologist.
Together with the patient, the neurologist can decide whether the weight loss is tolerable or whether the patient should switch to another anti-epileptic drug. In the majority of patients affected by weight loss under lamotrigine, the weight loss comes to a halt after the dosage phase of several weeks. For this reason, weight loss under Lamotrigine can be accepted in most cases and therapy can be continued as long as the weight loss is not too dramatic.
One of the most common side effects of all antiepileptic drugs, including Lamotrigine, is fatigue. This is due to the mechanism of action of antiepileptic drugs: By blocking certain ion channels that are involved in neuronal transmission in the brain, the increased brain excitability in epileptics is counteracted. While this reduces the risk of epileptic seizures, it also increases the mental fatigue of patients.
In most cases, fatigue occurs at the beginning of Lamotrigine Therapy and disappears after a few weeks when the brain and its messenger metabolism have adjusted to the Lamotrigine.However, some affected persons feel the tiredness as so disturbing in spare time or occupation that they renounce occasionally the Lamotrigin income. But even the single omission of a Lamotrigin income increases the risk for an epileptic seizure substantially. So before you go down this road in the hope of an improvement in fatigue, it is better to talk to your treating neurologist and make yourself aware that in the vast majority of cases fatigue is only a phenomenon of the initial phase of therapy.
However, if you cannot live with the fatigue at all, either because it is particularly pronounced or because you work in a profession that does not allow for any fatigue at all, the neurologist can consider switching to another anti-epileptic drug together with you. This is because, potentially, any anti-epileptic drug can cause fatigue. However, this does not mean that a patient who suffers from fatigue when taking lamotrigine will also be tired when taking any other antiepileptic.
Due to the fact that lamotrigine, like all anti-epileptic drugs, interferes with the brain’s neurotransmitter system, some patients experience temporary cognitive impairment. These often manifest themselves in the form of forgetfulness. So if you have the impression during the lamotrigine dosage phase that you are more forgetful than usual, there may well be a connection with the new drug.
If the forgetfulness does not restrict you too much in your leisure time and at work, it is advisable to continue the Lamotrigine Therapy as planned. However, if the forgetfulness is too pronounced, you should consult your treating neurologist instead of skipping Lamotrigine intake of your own accord. The latter is not a recommended solution, since even a single missed dose increases the risk of an epileptic seizure.
Instead, it is better to discuss with your neurologist whether another antiepileptic drug is suitable for you, even though unfortunately all antiepileptic drugs can at least theoretically cause forgetfulness. Some epileptic patients who take lamotrigine develop a skin rash. In most cases this rash appears right at the beginning of the Lamotrigine therapy.
The rash usually originates from the trunk of the body and the face, and in more severe cases it can extend to the whole body. It initially manifests itself by reddening and itching of the skin, later on blistering and skin detachment may follow. If you develop a skin rash after taking Lamotrigine, please consult your neurologist or family doctor as soon as possible.
Although in most cases the rash remains limited to a defined area and to redness and itching, it can also be a harbinger of the life-threatening severe form of the disease, the Stevens-Johnson syndrome. Although there are isolated reports of hair loss after lamotrigine supplementation, no proven statistical or biological connection is yet known. If you experience hair loss beyond the usual extent under Lamotrigine therapy, please consult your family doctor.
He can analyze whether there is another, more common cause for your hair loss. Especially if the hair loss occurs only after a longer period of Lamotrigine intake and not in the dosage phase, a connection with the active ingredient is much less likely than other potential triggers. The latter include iron deficiency or hormonal changes.
Do you suffer from hair loss? Some people with epilepsy suffer from a disturbed sexual function, usually in the form of a reduced libido. Many anti-epileptic drugs are said to make this libido reduction even worse.
Lamotrigine is an exception in this context: a clinical study has shown that lamotrigine increases libido. This effect is explained by the authors of the study with the mood stabilized by lamotrigine. Even though many patients find this effect beneficial because it counteracts the libido reduction caused by epilepsy, some patients also find it unpleasant.
In this case, a decision can be made together with the neurologist whether to switch to another anti-epileptic drug. However, in most cases the influence of lamotrigine on the libido is relativized after a few weeks anyway. Occasionally, double images may be perceived during therapy with lamotrigine.
This can lead to further complaints such as headaches and nausea. For most of those affected, this side effect only occurs in the first days and weeks after starting Lamotrigine therapy.However, especially in professions where such an impairment of visual perception is not tolerable, it may be necessary to discontinue Lamotrigine therapy and switch to another anti-epileptic drug. Nystagmus, i.e. involuntary repeated jerky movements of the eyes in the horizontal plane, is one of the most common symptoms of an acute overdose of Lamotrigine.
In most cases this results from an accidental double intake of lamotrigine. If you experience such symptoms, consult your neurologist or family doctor. Your neurologist or family doctor can get an impression of the extent of the overdose and take countermeasures if necessary.
You can find more information about nystagmus here: NystagmusRelatively many epilepsy patients suffer from headaches in the first weeks after starting lamotrigine therapy. Although the exact mechanism is not yet known, a connection with the intervention of lamotrigine in the neuronal transmission in the brain is obvious. As a rule, headaches are dull and bilateral.
Usually the headaches disappear after a few weeks, when the brain’s messenger substance balance has adjusted to the lamotrigine. If the symptoms are too severe and stressful, contact your treating neurologist. Your neurologist can analyze whether there is a real connection with Lamotrigine Therapy or whether there is another cause for the headaches.
In the former case, a switch to another antiepileptic drug may be necessary. Especially in the initial phase of Lamotrigine Therapy, some patients experience an increase in liver values. Liver values are certain liver-specific enzymes, the concentration of which in the blood can be determined by taking a blood sample.
An increased concentration indicates damage to the liver tissue. The fact that increased liver values can occur at the beginning of lamotrigine intake is due to the fact that lamotrigine is excreted via the liver and the organ is to a certain extent overtaxed with this task at the beginning. However, since the liver cells, just like muscles, show a considerable training effect, the liver values usually normalize after a few weeks.
Nevertheless, one or better several blood samples should be taken during the dosage phase to monitor liver function. On the basis of the values determined therein, the physician can estimate the extent of the liver damage and decide whether the Lamotrigin therapy can be continued. If not, the switch to an antiepileptic drug that is not excreted via the liver but via the kidneys (e.g. gabapentin, levetiracetam) is made.
You can find more information about liver values here: Liver valuesSome patients report occasional heart palpitations under lamotrigine therapy. Even though there is no study on statistical or biological correlations to date, it is at least conceivable that lamotrigine can trigger such a side effect on the heart by influencing the circulatory center in the brain. Since tachycardia is often harmless, but under certain circumstances can be very dangerous, you should consult your neurologist or family doctor if you experience such symptoms.
Your neurologist or family doctor can investigate whether lamotrigine is indeed the most likely cause of tachycardia or whether there are other causes (e.g. heart or thyroid disease). If an epilepsy patient suffering from lamotrigine develops itching, this is usually accompanied by a rash at the itching site. In this case, a doctor should be consulted, since although the rash is usually harmless and temporary, it can also be the harbinger of a life-threatening form of the disease, Stevens-Johnson syndrome.
If the itching occurs on its own, i.e. without a rash, it is more likely to have another cause (especially liver and bile diseases). In this case, too, a doctor should be consulted in order to identify and treat the actual cause. Further causes of itching can be found here: ItchingUntil now there is no known statistical or biological correlation between lamotrigine and excessive sweating, even if isolated patient reports indicate it.
Especially if sweating occurs only after prolonged lamotrigine intake and not already in the dosage phase, other causes are much more likely. Your family doctor can get to the bottom of this and investigate the most common causes of increased sweating. These include primarily hormonal and thyroid gland disorders.
Due to their intervention in the neuronal transmission of the brain, cognitive function can be impaired, especially in the dosage phase.In addition to forgetfulness, word finding disorders are among the most common manifestations: The affected persons do not want to think of common terms. Since this can lead to unpleasant situations in both private and professional life, there is sometimes considerable pressure to suffer. However, skipping the Lamotrigine intake occasionally is not a recommended solution, since even a single omission significantly increases the risk of an epileptic seizure.
Therefore, if the difficulty in finding words is no longer tolerable, talk to your neurologist and possibly try another anti-epileptic drug. Concentration disorders are another form of cognitive impairment that can occur under therapy with lamotrigine, especially in the initial phase. They usually last only a few days to weeks and disappear after the end of the dosage.
However, if they last longer or are so severe that they significantly affect your personal or professional life, your neurologist can arrange for you to switch to another anti-epileptic drug. However, it should be remembered that theoretically any antiepileptic drug can cause concentration problems. Occasionally, there are patient reports that suggest a connection between lamotrigine intake and the development of pimples.
So far, however, both a biological explanation and statistical confirmation of this connection are missing. Especially if the pimples appear only after a longer period of Lamotrigine intake and not at the beginning of Lamotrigine Therapy, another cause is much more likely (especially hormonal changes). In this case, it is therefore recommended to consult a dermatologist.
Occasionally epilepsy patients suffering from epilepsy experience tremors when taking Lamotrigine, which, if it exceeds the usual extent, is called tremor. The exact mechanism by which lamotrigine leads to tremor has so far been reversed, but a connection with the influence on neuronal transmission in the brain is obvious. Usually, the tremor subsides of its own accord after the end of the dosage phase.
Accordingly, there is usually no need for therapy. It is only of concern if you work in a profession where tremor is intolerable or if the tremor is so severe that it significantly reduces your quality of life. In these cases, it can be considered together with the neurologist whether the Lamotrigine therapy should be discontinued and another anti-epileptic drug should be selected.
More information about tremor can be found here: TremorParadoxically, the more frequent side effects of Lamotrigine include not only increased mental fatigue, but also sleep disorders. One explanation for this may be that the fatigue triggered by Lamotrigine causes the affected person to take it easy on himself and reduce his physical strain. Since the increased tiredness refers however only to the spirit and not to the body, the latter is at the end of the day quasi not “loaded” and consequently not in the mood to lay down to sleep.
Permanent sleep disturbances can become a considerable stress factor for the well-being of the person concerned and limit the quality of life. In this case, it is therefore advisable to consult your family doctor or neurologist. Together with the patient, the physician can consider whether the sleep disturbances are still tolerable and whether other measures can be taken (e.g. herbal or synthetic sleeping pills, exercise) or whether it is necessary to switch to another anti-epileptic drug.
Some patients taking Lamotrigine complain of pain in the musculoskeletal system, mostly affecting the joints. The biological mechanism is still unclear. Especially if the joint pain does not occur in the dosage phase but only after a longer period of Lamotrigine intake, other causes are much more likely.
These include rheumatic or infectious diseases. The family doctor can make a first sounding regarding the most probable cause for the joint pain and refer you to a specialist if necessary. If no other cause should be found and the Lamotrigin should be identified quasi by exclusion procedure as the most probable release of the joint pain, one should speak with the neurologist about a conversion to another anti-epileptic drug.
