*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
Lamictal (lamotrigine) may cause side effects for some patients who take it. Lamotrigine has a box warning for severe rash reactions and is commonly associated with multiple side effects, including but not limited to rash, tremors, dizziness, nausea, vomiting, diarrhea, dry mouth, insomnia, and others. Lamotrigine also has additional severe side effects.
If you are considering lamotrigine or want to discuss your current medication treatment with a provider, online psychiatry platforms, such as Talkiatry and Brightside Health are a good place to start. Their providers offer assessments and prescription consultation, and can answer any questions you have about lamotrigine side effects.
Boxed Warning: Lamotrigine (Lamictal) - Risk of serious skin rashes that can require hospitalization
Lamotrigine, the active ingredient in Lamictal, has a black box warning. This is the most serious type of warning from the Food and Drug Administration (FDA). Lamotrigine can increase the risk serious skin rashes that can require hospitaliztions and possible discontinuation of treatment. You should talk with your doctor about serious risks with lamotrigine and any other medications before starting treatment.
What Is Lamictal (Lamotrigine) & How Is it Used?
Lamictal is an anticonvulsant medication, also known as an anti-seizure drug. This medication contains the active ingredient lamotrigine and is available as a generic and under the brand name Lamictal. Both the generic lamotrigine and Lamictal are available as tablets.
Lamictal is also available in multiple forms, including Lamictal CD (tablet for an oral suspension), Lamictal ODT (orally disintegrating tablet), and Lamictal XR (extended release tablet). It is FDA-approved for the treatment of epileptic seizures in patients two years of age and older. It is also FDA-approved for the maintenance of mood episodes (e.g. manic, restless episodes) in bipolar patients.
Lamotrigine may be used off-label as a mood stabilizer. Some prescribers may use Lamotrigine to treat bipolar disorder episodes, fibromyalgia, schizophrenia, and trigeminal neuralgia. An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone. 1,2,3
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Serious Side Effects of Lamotrigine
All medications, including lamotrigine, can cause serious side effects. Though these cases are rare, it is crucial to keep them in mind because, in some cases, they can be fatal. Lamotrigine can cause dangerous allergic and hypersensitivity reactions that can cause swelling of the throat, face, and eyes and lead to breathing difficulties.1 Immediate medical care is needed if any of these or other serious side effects develop.
Serious side effects of lamotrigine include:1
- Swelling of the face, throat, tongue, lips, and eyes
- Seizures for the first time or happening more often
- High fever, rash, swollen lymph nodes, muscle pains
- Racing heartbeat, skipped or slow heartbeat, shortness of breath
*All medications, including lamotrigine, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor or pharmacist about any questions you have and to understand the potential side effects and benefits of any medication.
Common Side Effects of Lamotrigine
Lamotrigine is associated with various side effects. Users may experience side effects such as blurred vision, shaking movement, and difficulty speaking. All side effects or suspected side effects should be monitored closely, and users should discuss with their doctors if their symptoms do not go away or worsen.
Examples of common side effects of lamotrigine include:1
- Dizziness
- Tremor
- Double vision
- Nausea
- Vomiting
- Trouble with balance and coordination
- Anxiety
*All medications, including lamotrigine, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor or pharmacist about any questions you have and to understand the potential side effects and benefits of any medication.
Concerned About Medication Side Effects? Ask a Doctor
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Lamotrigine Warnings & Precautions
The FDA has issued several warnings and precautions for using lamotrigine due to the potential for serious interactions and side effects. Seek immediate medical care if you experience any of the following symptoms.1
Warnings and precautions for taking lamotrigine include:1
- Serious skin rashes: Serious skin rashes can develop, including Stevens-Johnson syndrome, which can lead to hospitalization and may become life-threatening for children. Lamotrigine has a black box warning for this risk.
- Hemophagocytic lymphohistiocytosis (HLH): This is an immune deficiency disorder where extreme inflammation can damage organs. It can occur in children and adults.
- Multi-organ hypersensitivity reactions and organ failure: Swelling in the lymph nodes, fever, and rash may be signs of multi-organ hypersensitivity. While rare, these symptoms may signal a risk of organ failure.
- Heart rhythm abnormalities: Irregular heart rhythms may develop while taking lamotrigine. This may increase risks for those with cardiac conditions, such as heart failure and coronary artery disease.
- Blood disorders: Taking lamotrigine has been associated with an increased risk of developing disorders affecting blood cells, such as anemia.
- Suicide risk: Lamotrigine increases the risk of suicidal thoughts and behaviors and may occur as soon as one week after starting the medication.
- Aseptic meningitis: This is a serious condition involving severe swelling of the linings of the brain and may develop in children and adults.
- Withdrawal seizures: Patients with epilepsy are at risk of increased seizures when lamotrigine is abruptly stopped. Tapering is recommended when changing dosage or stopping the medication.
- Status epilepticus (serious seizures): There is an increased risk of serious seizures or a worsening of seizures, which is a medical emergency.
- Sudden unexplained death in epilepsy: A few sudden and unexplained deaths have been reported among patients with epilepsy who have taken lamotrigine.
- Possible interaction with birth control medication: Lamotrigine dosage may need to be adjusted in patients who are on oral birth control.
This is not a comprehensive list of the possible interactions with lamotrigine. You should talk with your healthcare provider and your pharmacist about all prescription and over-the-counter medications, herbs, and supplements you take before starting lamotrigine.
Allergic Reactions to Lamotrigine
Lamotrigine allergies can range from mild to severe. These symptoms may go away after patients have been on Lamotrigine for some time. In other cases, they can persist or worsen, but this is less common.1
Allergic reactions to lamotrigine include:
- Rash
- Fever
- Sore throat
- Difficulty breathing
If you suspect an allergic reaction to lamotrigine, seek immediate medical care.
Side Effects in Children
Use lamotrigine with caution in children. Children ages 2 to 17 years old are at higher risk of getting skin rash when they are on lamotrigine. They are also at higher risk for infectious and respiratory reactions, including bronchitis, ear infections, viral infections, nasal congestion, and cough.1
Frequently Asked Questions
How Long Do Lamotrigine Side Effects Last?
Lamotrigine side effects and duration of side effects can vary from person to person, and it is challenging to monitor them regularly. Some patients experience more and longer side effects than others. Some side effects last a few days to weeks, while others can happen randomly throughout the treatment time. Side effects tend to happen more often when patients just start lamotrigine treatment or when the dosage is adjusted.1
What Are the Long-term Side Effects of Lamotrigine?
The long-term side effects of lamotrigine are still unclear and additional research studies are needed to determine long-term side effects.1,4,5
Does Lamotrigine Have Any Rare Side Effects I Should Look For?
Yes, lamotrigine can have rare side effects. These occur less frequently but may include various blood disorders, liver problems, or aseptic meningitis. It’s important to seek medical attention if you experience any unusual or severe symptoms (e.g. abdominal pain, swelling, fever, stiff neck, photophobia) while taking lamotrigine.1 This is not a comprehensive list of rare side effects. Talk with your healthcare professional about all of the potential risks before starting lamotrigine.
Does Lamotrigine Cause Weight Gain or Weight Loss?
Lamotrigine is generally considered weight-neutral, meaning it does not commonly cause significant weight gain or weight loss. However, individual responses may vary, and some people may experience slight changes in weight while taking the medication.1
Does Lamotrigine Have Any Specific Side Effects in Children or Adolescents?
Lamotrigine may have specific side effects in children or adolescents. Common side effects seen in this age group include headache, dizziness, nausea, and fatigue. It is crucial to consult a pediatrician or child psychiatrist for accurate information regarding lamotrigine use in your child or adolescent.1
Are There Any Interactions between Lamotrigine and Other Medications That May Worsen Side Effects?
Lamotrigine can potentially interact with other medications, which may lead to worsening side effects or reduced effectiveness. Notable interactions include valproic acid, carbamazepine, phenytoin, and certain oral birth control pills. It’s important to inform your prescriber and pharmacist about all the medications, supplements, and herbal products you are taking to prevent any potential interactions.1
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How to Manage Side Effects
Side effects of lamotrigine tend to occur in patients just starting the medication, and these symptoms may disappear after a few days or several weeks. Lamotrigine can also cause dizziness and drowsiness, especially when starting or adjusting the dosage. It’s important to be cautious while driving or operating machinery until you know how the medication affects you.
While lamotrigine can help stabilize mood, it may also cause mood changes or emotional alterations in some individuals. If you notice any significant changes in your mood or emotional well-being (usually a negative change) while taking lamotrigine, it’s crucial to discuss them with your prescriber and pharmacist. If side effects continue or get worse, patients should speak with their healthcare providers.1
Skin Rash
Rash and itchiness are common side effects of lamotrigine. Some individuals experience a very mild rash, and it goes away after a few days, while others may experience a more severe rash and hives. It’s important to remember that lamotrigine has a black box warning for serious rashes that can be fatal. If you suspect a rash appearing with lamotrigine treatment, contact your prescriber or pharmacist immediately.1
Dizziness
Take your time when standing up or changing positions to prevent sudden drops in blood pressure. Avoid rapid head movements or sudden changes in body position. Stay hydrated and maintain a healthy blood sugar level. If dizziness worsens, consult your prescriber and pharmacist.1
Tremors
Reduce caffeine and stimulant intake as they can exacerbate tremors. Consider relaxation techniques such as deep breathing exercises or meditation. Use assistive devices or adaptive strategies to manage daily tasks if necessary. If the tremor becomes severe or significantly affects your quality of life, consult you prescriber or pharmacist for possible solutions.1
Double Vision
Avoid activities such as driving or operating machinery if double vision is present. Cover one eye or wear an eye patch to help alleviate the double vision. Inform your healthcare provider promptly about double vision, as it may require adjustment of your medication or additional evaluation.1
Nausea and Vomiting
Take lamotrigine with food or a light snack to help reduce stomach irritation. Avoid triggers such as strong odors of certain foods that may worsen nausea. Consider over-the-counter remedies like ginger or antacids after consulting with your prescriber or pharmacist. If your nausea and vomiting become severe or persistent, consult your healthcare providers for further guidance.1
Anxiety
Practice relaxation techniques, such as deep breathing exercises, mindfulness, or meditation. Engage in regular physical activity if possible and maintain a healthy lifestyle. Seek support from a therapist or counselor to help manage anxiety symptoms. If anxiety becomes overwhelming or significantly affects your daily functioning, consult your prescriber or pharmacist for additional support.1
Trouble With Balance & Coordination
Use assistive devices such as canes or walkers, if needed, to improve stability. Modify your environment to minimize fall risks by removing trip hazards and improving lighting. Engage in exercises that promote balance and coordination, such as yoga or tai chi, if possible. Consult your prescriber or pharmacist for further evaluation and guidance if balance and coordination issues persist or worsen.1
Questions to Ask Your Healthcare Provider About Lamictal (Lamotrigine) Side Effects
Patients should have a conversation with their doctor or pharmacist prior to starting lamotrigine. Here are several topics and questions to discuss when considering lamotrigine as a treatment.
Questions to ask your care team about Lamictal side effects:
- What are some expected side effects of lamotrigine?
- How long do Lamictal side effects usually last?
- What should I do if these Lamictal side effects don’t go away?
- Will I experience more side effects with lamotrigine if I’m taking other medications?
- What time of day should I take lamotrigine?
- Can I use alcohol with lamotrigine?
- What are substances I should avoid taking while on lamotrigine?
- Do you need to adjust the dosage of my other medications while I’m on lamotrigine?
In My Experience
In my experience, despite being an effective treatment for bipolar disorder symptoms, lamotrigine’s various side effects can interfere with a patient’s quality of life. The most common mild effects I see in practice include drowsiness, mild itchiness, and nausea. These side effects can go away after a few weeks after the body gets used to lamotrigine.
Do not stop lamotrigine when you start experiencing side effects. Your doctor needs to slowly decrease your dose of lamotrigine to prevent worsening side effects if you abruptly stop the medication. Your provider’s goal will be to find the optimal dose for maximum effectiveness with a minimal risk of side effects.
ChoosingTherapy.com strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.
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National Institutes of Health. (2023). DailyMed – AMICTAL- lamotrigine tablet, LAMICTAL- lamotrigine tablet, for suspension, LAMICTAL ODT- lamotrigine tablet, orally disintegrating, LAMICTAL- lamotrigine kit U.S. National Library of Medicine. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm
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Geddes, J. R., Calabrese, J. R., & Goodwin, G. M. (2009). Lamotrigine for treatment of bipolar depression: independent meta-analysis and meta-regression of individual patient data from five randomised trials. The British journal of psychiatry : the journal of mental science, 194(1), 4–9. Retrieved from https://doi.org/10.1192/bjp.bp.107.048504
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Bendtsen, L., Zakrzewska, J. M., Abbott, J., Braschinsky, M., Di Stefano, G., Donnet, A., Eide, P. K., Leal, P. R. L., Maarbjerg, S., May, A., Nurmikko, T., Obermann, M., Jensen, T. S., & Cruccu, G. (2019). European Academy of Neurology guideline on trigeminal neuralgia. European journal of neurology, 26(6), 831–849. Retrieved from https://doi.org/10.1111/ene.13950
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Meador, K. J., & Loring, D. W. (2016). Developmental effects of antiepileptic drugs and the need for improved regulations. Neurology, 86(3), 297–306. Retrieved from https://doi.org/10.1212/WNL.0000000000002119
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Ramaratnam, S., Panebianco, M., & Marson, A. G. (2016). Lamotrigine add-on for drug-resistant partial epilepsy. The Cochrane database of systematic reviews, 2016(6), CD001909. Retrieved from https://doi.org/10.1002/14651858.CD001909.pub2
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