Lamotrigine and side effects

For approximately 65 million people in the world with epilepsy, antiepileptic drugs (AEDs) are the mainstay of treatment.¹ Lamotrigine (LTG) is a nonenzyme inducing AED with favorable pharmacokinetics, approved for use by the Food and Drug Administration (FDA) in epilepsy as well as bipolar disorder. From May 2009 to April 2010, approximately 9 million prescriptions were dispensed from outpatient pharmacies.² In epilepsy, it has proven to be effective in a wide variety of seizure types and patient groups (2 years of age and older), with clinical applicability in focal seizures and in generalized seizures associated with both genetic epilepsy and the Lennox-Gastaut syndrome. Both the efficacy and safety profile of LTG have been defined by numerous clinical studies.³ Compared with other first-line AEDs, LTG is well tolerated with little sedation or cognitive impairment, weight neutrality, and a favorable psychotropic profile. A recent large randomized comparative effectiveness trial found LTG as the drug of first choice for patients with presumed partial (focal) epilepsy.⁴ Since efficacy among AEDs does not differ for common epilepsy syndromes, tolerability becomes a critical factor in drug selection.³

Adverse effects have long been recognized with all AEDs.⁵ Upon its release in 1994, rash hampered the use of LTG. A black box warning in the prescribing information reflected the possibility of serious rash …