Lamictal Side Effects & Adverse Reactions

Lamictal (Lamotrigine) is a medication that was first approved by the FDA in 1994 for the treatment of partial seizures, later in 1998 for the treatment of Lennox-Gastaut syndrome, and again 2003 for the management of bipolar disorder.  Specifically, Lamictal is used to prevent and/or treat: focal seizures, tonic-clonic seizures, and acute depressive episodes or rapid cycling of mood (in persons with bipolar disorder).

Due to its effectiveness, low cost, and safety profile, Lamictal is classified as an essential medicine by the World Health Organization (WHO).  Upon analysis of Lamictal’s pharmacodynamics, it appears as though the medication: modulates ion channels (voltage-gated sodium (Na+) and calcium (Ca+) channels); decreases excitatory neurotransmitter signaling (glutamate and aspartate); bolsters inhibitory neurotransmitter signaling (GABA); and alters 5-HT3 plus sigma receptor activation.

While these mechanisms of action facilitate therapeutic benefit for many, a subset of users may experience unwanted side effects.  If you’re using Lamictal, it is important to be cognizant of possible side effects and adverse reactions that might occur.

Lamictal Side Effects (List of Potential Reactions)

Included below is a comprehensive list of side effects that might occur as a result of Lamictal (lamotrigine) treatment.  That said, it is important to realize that side effects of Lamictal are often subject to significant interindivdiual variation.  In other words, the specific side effects that you experience might differ from those reported by another user.

Despite individual variance in side effects of Lamictal, clinical trial data reveals that certain side effects tend to occur more frequently than others, namely:  vision changes; balance and/or coordination changes; skin rash; nausea; upset stomach; headache; and dizziness.  It is estimated that approximately 10% of users will end up discontinuing Lamictal due to unwanted side effects.

• Anxiety: It is known that, on occasion, some individuals respond well to using Lamictal for anxiety such that the medication effectively counteracts anxious symptoms. That said, other individuals may not respond well to the neurochemical modulation induced by Lamictal and might experience increased anxiety or nervousness as a side effect.  According to clinical trial data, 4% to 5% of Lamictal users report anxiety as a side effect. Though it’s unclear as to why anxiety might occur as a side effect of Lamictal, it may stem from cognitive impairment and/or excess relaxation (e.g. relaxation-induced anxiety).
• Balance & coordination problems: Substantial changes in balance, coordination, and/or gait have been documented as side effects of Lamictal. During treatment, it may seem as though fine motor function is impaired as a result of Lamictal use.  It is unclear as to why Lamictal causes balance and/or coordination problems, but it is known that poor coordination (i.e. incoordination) occurs in up to 10% of users.  Moreover, in one clinical trial, “ataxia” or loss of control over bodily movement occurred in 22% of Lamictal recipients.  If you experience balance and/or coordination problems – avoid operating heavy machinery and/or motor vehicles.
• Constipation: Though Lamictal is more likely to cause diarrhea than constipation, data indicate that constipation occurs in 4% to 5% of users.  If you become constipated while under the influence of Lamictal, it may help to increase your hydration, activity level, and/or dietary fiber.  If dietary and lifestyle modifications are unsuccessful in alleviating constipation, ask your doctor about using laxative agents “as needed” for relief.
• Diarrhea: Studies suggest that between 6% and 11% of Lamictal users will experience diarrhea as a side effect – making it a relatively common gastrointestinal reaction. Diarrhea generally caused by expedited movement of food through the gastrointestinal tract.  If you’re experiencing diarrhea while taking Lamictal, discuss this reaction with a medical doctor and consider using an adjunct antidiarrheal agent (e.g. Imodium) for management.  Unmanaged diarrhea could lead to dehydration, unintentional weight loss, and/or vitamin deficiencies.
• Dizziness: Dizziness is documented as a common side effect of Lamictal treatment. Clinical trial data reveals that dizziness occurs in approximately 10% of adults using Lamictal monotherapy for the management of bipolar disorder.  That said, dizziness is significantly more common among persons using Lamictal as an adjunct (along with another medication).  Dizziness appears to be a dose-dependent side effect such that high doses of Lamictal increase the prevalence and severity of dizziness.
• Dry mouth: Dry mouth, or “xerostomia” is a side effect of Lamictal that is estimated to occur in 1% to 10% of users. One trial of Lamictal monotherapy for bipolar disorder documented xerostomia as occurring in 6% of Lamictal recipients.  If you develop dry mouth as a result of Lamictal, it is recommended to discuss it with a dental professional – as dry mouth can lead to proliferation of unhealthy oral bacteria and could expedite tooth decay.  Chewing sugar-free gum, drinking extra water, and/or using special mouthwash might help counteract this side effect.
• Double vision & blurred vision: Double vision, medically referred to as “diplopia” is a common side effect of Lamictal occurs in approximately 28% of users. Some trials reported lower incidence rates of diplopia at just 5%, whereas other trials documented high incidence rates of diplopia at 49%.  In addition, it is estimated that up to 16% of Lamictal users will experience blurred vision – irrespective of whether “double vision” occurs.  If you experience visual side effects of Lamictal, it is imperative to report these to a medical doctor and receive regular eye exams from an ophthalmologist to ensure that the medication isn’t damaging your eyes.
• Fatigue or tiredness: Approximately 14% of persons using Lamictal will experience somnolence or sleepiness as a side effect. The somnolence may be described as constant fatigue, or possibly extreme tiredness that interferes with physical and/or mental performance throughout the day.  Somnolence likely occurs as a side effect due to medication-mediated decreases in signaling from excitatory neurotransmitters (e.g. glutamate) and simultaneous increases in signaling from inhibitory transmitters (e.g. GABA).  Fatigue and tiredness tend to occur more frequently at higher doses of Lamictal compared to lower doses.
• Fever: Pyrexia (i.e. fever), or increased body temperature, can occur as a side effect of Lamictal. It is estimated that between 6% and 15% of all Lamictal users will develop a fever from the medication.  Fever may be accompanied by chills, increased sweating, and/or flu-like symptoms.  Because fever could be a sign of a serious adverse reaction to Lamictal, it should be reported to a medical doctor as soon as it is noticed.
• Headache: A relatively common side effect associated with Lamictal is headache. Research suggests that headache is more likely to occur as a side effect among persons receiving Lamictal as an adjunct (or “add on”).  In trials of adjunct Lamictal for epilepsy and bipolar disorder, approximately 29% and 25% of recipients experienced headache as a side effect.  That said, headache seems to be significantly less common among those who use Lamictal as a standalone agent (i.e. monotherapy).
• Indigestion: Up to 7% of Lamictal users may experience dyspepsia or indigestion. Indigestion may be accompanied by heartburn, stomach pain, constipation, belching, bloating, and/or flatulence.  If you experience indigestion while using Lamictal, talk to a medical doctor about ways in which you can manage it throughout treatment.  A combination of dietary adjustments, adequate hydration, over-the-counter medications, and/or increasing your physical activity level may help.
• Insomnia: According to clinical trial data, between 6% and 10% of Lamictal users will experience insomnia as a side effect. If you experience insomnia in the early phases of Lamictal treatment, there’s a chance that it may subside with longer-term Lamictal use as your neurochemistry becomes better-adapted to the medication.  That said, if the insomnia becomes severe such that you cannot get sufficient quality sleep – talk it over with a doctor.  There may be an adjunct medication you could use with Lamictal to help counteract the side effect.
• Menstrual changes: For some women using Lamictal (5% to 7%), dysmenorrhea may occur as a side effect. Dysmenorrhea is a medical term used to describe painful periods and/or menstrual cramps.  In around 2% of women using Lamictal, amenorrhea or “missed periods” may occur as a side effect.  If you’re concerned about the effects of Lamictal on your menstrual cycle, discuss this with a medical doctor.
• Musculoskeletal pain: Up to 8% of individuals taking Lamictal will experience muscle pain as a side effect. The common regions for pain to occur throughout treatment include the back (most common) and neck (less common).  Among those who report bodily pain while using Lamictal, the pain sensation is more likely to be mild than severe.  Nevertheless, if you experience unwanted bodily pain throughout treatment, inform your doctor as soon as possible.
• Nausea: Nausea, or feeling as though you’re about to vomit, is a common Lamictal side effect. Side effect statistics suggest that nausea occurs in 7% to 19% of all Lamictal users.  Odds of nausea appear to increase when Lamictal is administered as an adjunct treatment at large doses.  In trials of adjunct Lamictal dosed at 500 mg for the management of epilepsy, approximately 54% of recipients exhibited nausea.  If you end up nauseous from Lamictal, talk to your doctor about using an adjunct antiemetic (anti-nausea) medication.
• Rhinitis: Rhinitis, or irritation and swelling of the mucous membrane within the nose, occurs as a Lamictal side effect in 7% to 14% of users. The rhinitis may be evidenced by runny nose, stuffy nose, difficulty breathing through the nose, nasal drip, or unexpected sneezing.  In some cases, rhinitis is a transient side effect that emerges in the first few weeks of Lamictal treatment and eventually dissipates with longer-term use.
• Skin rash: If you experience a skin rash while taking Lamictal, contact emergency medical services and have it evaluated. Though the rash could be benign (nothing serious), there’s also a chance it could be a sign of a life-threatening adverse reaction (e.g. Stevens-Johnson Syndrome).  In clinical trials of Lamictal, a skin rash occurred in 7% to 14% of all users.  In a small percentage of cases, the rash was accompanied by itchiness.
• Sore throat: Sore or irritated throat, medically referred to as “pharyngitis” is documented as a Lamictal side effect. Estimates suggest that pharyngitis occurs in 5% to 14% of Lamictal users.  In some cases, pharyngitis may cause itchiness, scratchiness, voice changes, difficulty swallowing, or shortness of breath.  If you develop a sore throat from Lamictal, report this reaction to your doctor.
• Stomach aches: Stomach aches occur as a side effect in 5% to 10% of Lamictal users. Stomach aches may be accompanied by irritation of the gastrointestinal tract and/or other side effects such as: indigestion, diarrhea, nausea, and/or vomiting.  More specifically, abdominal pain is the most common type of stomach discomfort reported by persons taking Lamictal.  If you’re experiencing stomach aches, it is recommended to work with a doctor to correct preexisting gastrointestinal abnormalities in effort to reduce intensity of the aches.
• Tremor or shaking: It is estimated that between 4% and 10% of Lamictal recipients experience shaking (i.e. tremor) or involuntary muscle contractions as a result of treatment. The shaking may occur intermittently (at random times) or could be constant throughout the day.  If you happen to experience involuntary muscle contractions or unexpected bodily movements while using Lamictal, be sure to report this reaction to a medical doctor as soon as possible.
• Vaginitis: Around 4% of women using Lamictal will experience vaginitis as a side effect. Vaginitis refers to inflammation of the vagina that may lead to discharge, itching, irritation, and/or unwanted pain.  Although it remains unknown as to why Lamictal causes vaginitis in a small percentage of female users, anyone who develops this reaction should report it immediately to a medical professional.
• Vomiting: Clinical trial data indicate that vomiting occurs as a side effect in 9% to 20% of Lamictal users. The incidence of vomiting appears to be dose-dependent such that high doses of Lamictal are more likely to induce vomiting compared to low doses.  What’s more, pediatric (i.e. non-adult) Lamictal users are more likely to experience vomiting than adults.  Though vomiting may be a short-term side effect such that vomiting abates with longer-term use, it may be necessary to utilize an antiemetic to get this reaction under control.
• Weight changes: Although Lamictal is unlikely to significantly alter body weight for most users, up to 12% of persons taking Lamictal will experience noticeable weight change. Weight loss is a more common side effect than weight gain (which is comparatively rare).  If you experience substantial weight change from Lamictal, share this reaction with a medical doctor.  Weight loss could be due to a combination of: nausea, vomiting, diarrhea, appetite reduction, etc. – whereas weight gain might be caused by: somnolence, decreased metabolic rate, and/or appetite increase.

Lamictal Adverse Effects & Reactions (List)

Below is a list of rare or uncommon adverse reactions associated with Lamictal that occur in a small percentage of users.  Anyone who experiences an adverse reaction from Lamictal is recommended to seek emergency medical treatment.  Prior to using Lamictal, it’s generally a smart idea to familiarize yourself with all possible adverse reactions, so that if one occurs, you’ll be able to quickly recognize it and report it to a medical doctor.

• Allergic reaction: A very small percentage of individuals taking Lamictal may experience an allergic reaction to the medication. Signs of an allergic reaction to Lamictal include: bodily swelling (face, hands, feet, etc.), hives, shortness of breath, tingling sensations in the mouth, dizziness, fever, sweating, chest discomfort, heart rate changes, and fainting.
• Anticonvulsant hypersensitivity syndrome: This is a reaction characterized by a skin eruption that is morbilliform, or resembling the measles. The skin eruption is generally red with lesions that range from 2 mm to 10 mm in size.  The rash associated with anticonvulsant hypersensitivity syndrome may be due to Stevens-Johnson syndrome or toxic epidermal necrolysis.  Other signs of anticonvulsant hypersensitivity syndrome include:  hepatitis, interstitial nephritis, autoimmune thyroiditis, and/or eosinophilia.  Risk of anticonvulsant hypersensitivity syndrome is highest among persons with first-degree relatives who’ve previously experienced the condition.
• Aseptic meningitis: In 2010 the FDA issued a warning that Lamictal may cause aseptic meningitis in a subset of users. Aseptic meningitis refers to inflammation of protective membranes that encapsulate the brain and spinal cord.  Signs of aseptic meningitis include: headache, fever, neck stiffness, chills, loss of appetite, and/or body aches.
• Cognitive deficits: Multiple studies suggest that Lamictal may impair cognitive performance in a subset of users. Cognitive impairment stemming from Lamictal use might be related to decreased excitatory neurotransmission, increased inhibitory neurotransmission, and reduced CNS activation.  Research indicates that: cognitive dulling; neurodegeneration; attentional deficits; language and comprehension problems; psychomotor slowing; short-term and working memory deficits; verbal fluency decline; and IQ reduction – can occur from Lamictal treatment.
• Depression & suicidal thoughts: Though Lamictal generally helps stabilize mood, some individuals may experience depression and/or suicidal thinking as a result of treatment. Depressed mood is one of the more common adverse reactions to treatment – occurring in around 4% of users.  The depression may be accompanied by irritability (occurring in ~3% of users) and/or suicidal thoughts.
• DRESS syndrome: DRESS (drug reaction with eosinophilia and systemic symptoms) syndrome is an adverse reaction associated with Lamictal treatment. It is thought that things like: genetic deficits in detoxifying enzymes, specific human leukocyte antigens, and viral infections – may increase risk of developing DRESS syndrome while using Lamictal.  Signs of DRESS syndrome are commonly observed 2 to 8 weeks after treatment initiation and include: fever, rash, hematologic abnormalities, and hepatic dysfunction.
• Edema: Some Lamictal users may experience edema, or increased fluid accumulation in certain tissues of the body, as an adverse reaction. The edema may lead to a bloated or swollen appearance.  It is reported that edema in the facial region occurs in around 2% of persons taking Lamictal.  That said, edema can also occur in bodily regions besides the face.
• Eye and vision changes: It is understood that double vision and blurred vision are common Lamictal side effects that don’t typically cause permanent eye damage or serious ocular complications. That said, some individuals may experience medically significant eye and/or vision problems as adverse reactions to Lamictal.  For example, conjunctivitis, uveitis, visual field defects, and abnormally dry eyes could occur as a result of treatment.  To ensure that your eyes stay healthy while using Lamictal, receive evaluations from an ophthalmologist.
• Flu-like symptoms: Up to 7% of individuals treated with Lamictal may experience flu-like symptoms such as: body aches, diarrhea, fever, chills, nausea, swollen glands, and/or vomiting. In some cases, flu-like symptoms may be a temporary adverse reaction and abate with dosage adjustments and/or longer-term treatment.  Nevertheless, flu-like symptoms can also be associated with life-threatening reactions to Lamictal.
• Fulminant hepatitis: Cases of fulminant hepatitis have been documented among Lamictal users. Fulminant hepatitis is a condition characterized by impaired hepatic function or necrosis of hepatocytes without preexisting liver disease.  If fulminant hepatitis is suspected, Lamictal will be discontinued and blood testing will be conducted to evaluate changes in liver function.
• Hepatic dysfunction: Hepatic dysfunction or impairment might occur in a subset of persons taking Lamictal. Persons with a history of hepatic dysfunction may be at greatest risk of experiencing hepatic dysfunction as a result of Lamictal treatment.  Signs of hepatic dysfunction might include: jaundice (yellowing of skin or eyes); itchiness; swelling; dark urine; and/or chronic fatigue.
• Leukopenia: Lamictal treatment may cause leukopenia or decreases in white blood cell counts. A shortage of white blood cells can increase risk of infections, and cause a variety of symptoms including: fatigue; weakness, or shortness of breath.  To ensure that you do not develop leukopenia from Lamictal, regular blood testing is recommended.
• Neuroleptic malignant syndrome: Neuroleptic malignant syndrome (NMS) is a life-threatening reaction that can occur among persons taking Lamictal. Signs of NMS include: fever; altered mental status; rigid muscles; and autonomic dysfunction (dizziness, fainting, blurred vision, tremor, etc.).
• Renal dysfunction: A rare adverse reaction to Lamictal that could occur in some individuals is renal dysfunction. Possible signs of renal dysfunction, or kidney impairment include: decreased urination, swelling, shortness of breath, nausea, and fatigue.  Persons with a history of renal dysfunction may be at greatest risk of experiencing this adverse reaction.
• Seizures: Despite the fact that Lamictal is used to treat seizures, it may cause or aggravate seizures in ~2% of users. Lamictal has been reported to provoke myoclonic jerks and tonic-clonic seizures.  In most cases, seizures tend to occur in the early stages of treatment (e.g. first 8 weeks) or after dosage adjustments.  It is thought that using moderate-to-high doses of Lamictal increases risk of seizures compared to lower doses.
• Speech changes: Up to 3% of Lamictal users may experience changes in speech. Speech may become disorganized, incoherent, or seem atypical.  Anyone experiencing significant changes in his/her speech during treatment should report this to a doctor – changes could be associated with cognitive deficits or neurodegeneration.
• Stevens-Johnson Syndrome: Stevens-Johnson syndrome (SJS) is a potentially life-threatening reaction to Lamictal that occurs in a small percentage of users. In some cases, Stevens-Johnson syndrome occurs along with toxic epidermal necrolysis (TEN), whereas other times it may occur as a standalone adverse reaction.  Signs of Stevens-Johnson syndrome include: flu-like symptoms; skin rash (red or purple); blistering and/or peeling skin; swelling in the face or tongue; skin pain; etc.
• Swollen glands: Glands in the armpits, neck, or groin may swell as an adverse reaction to Lamictal. Swollen glands may occur as a standalone reaction – or along with a more serious adverse reaction (e.g. anticonvulsant hypersensitivity syndrome).  Report any swollen glands you experience to a doctor as soon as they are noticed.
• Toxic epidermal necrolysis (TEN): This is a potentially life-threatening skin condition characterized by erythema, necrosis, and detachment of the epidermis plus mucous membranes. Those experiencing toxic epidermal necrolysis may end up with gastrointestinal hemorrhage, respiratory failure, ocular abnormalities, and genitourinary complications.  Toxic epidermal necrolysis may appear with spots, without spots, or overlap with Stevens-Johnson syndrome.
• Weakness: Physical or muscular weakness can occur as a side effect of Lamictal. Weakness could be a non-serious reaction, but might also be associated with a serious adverse reaction.  For this reason, if you experience extreme musculoskeletal weakness such that it’s difficult to engage in physical activity – report it to a medical doctor immediately.

Note: The above listed Lamictal side effects and adverse reactions might be incomplete.  In other words, not all Lamictal side effects may have been reported or properly documented.  If you’re aware of additional Lamictal side effects that can occur – share these side effects in the comments section.  If you are concerned about side effects of Lamictal or have further questions, seek immediate medical attention.

• Source: https://www.fda.gov/downloads/Drugs/DrugSafety/UCM152835.pdf
• Source: https://www.ncbi.nlm.nih.gov/pubmed/12940653
• Source: https://www.ncbi.nlm.nih.gov/pubmedhealth/PMHT0010856/
• Source: https://www.ncbi.nlm.nih.gov/pubmed/19077780

Variables that influence Lamictal side effects

A host of variables might influence the specific side effects and/or adverse reactions that a person endures while using Lamictal.  Variables that are likely influencers of Lamictal side effects include: Lamictal dose; length of Lamictal treatment; use of other substances throughout treatment (e.g. other medications); and individual factors (lifestyle, genetics, preexisting medical conditions, etc.).  In a majority of cases, a combination of the aforestated variables explains why certain individuals experience unwanted side effects – and others don’t.

1. Lamictal dose (Low vs. High)

The exact dose of Lamictal that you administer could influence the side effects that you experience – as well as the respective intensities of those side effects.  Upon analysis of clinical trial results, it is clear that likelihood of experiencing side effects increases at higher doses compared to lower doses.

For example, it is known that side effects like: ataxia, blurred vision, double vision, dizziness, nausea, and vomiting – are substantially more likely to occur among persons taking Lamictal at dosages of 500 mg per day – compared to persons taking Lamictal at dosages of 300 mg per day.  In addition to side effects being more common at higher doses, the severities of certain side effects may increase at higher doses.

Because higher doses of Lamictal (e.g. 500 mg per day) impact neurophysiology to a greater degree than lower doses (e.g. 300 mg per day), persons taking lower doses are at lower risk of experiencing side effects and adverse reactions.  Moreover, the side effects experienced by lower dose users are likely to be of lesser overall severity in comparison to those reported by high dose users.

2. Duration of Lamictal treatment (Short-term vs. Long-term)

The cumulative duration over which you’ve regularly administered Lamictal might impact the incidence and severities of side effects.  It is known that persons who are new users of Lamictal are likely to endure some side effects as a result of initial neurophysiologic adaptation to the medication.  In other words, some side effects occur in the early stages of treatment because the central nervous system hasn’t fully adjusted to the ongoing presence of Lamictal.

As a new or short-term Lamictal user continues his/her treatment, some side effects that occurred in the early stages of treatment will fade with longer-term Lamictal use – as a result of the central nervous system becoming more adjusted to the influence of Lamictal.  However, although certain side effects in the short-term can fade with longer-term use (as the body becomes better adjusted to Lamictal) – it’s possible that new side effects could emerge with longer-term use.

Administration of Lamictal over a long-term might induce side effects as a result of dosage increases (due to tolerance onset) and/or specific neurophysiologic adaptations that solely occur after long-term Lamictal use.  Regardless of how long you’ve used Lamictal – realize that certain side effects may be more common and/or severe over the short-term, whereas others might be more common and/or severe over the long-term.

3. Using substances with Lamictal

It is fair to suspect that concurrent use of substances while taking Lamictal could impact the side effects that you experience.  Administering medications, illicit drugs, and/or dietary supplements while using Lamictal might increase or decrease the likelihood of certain side effects.  For example, if you’re experiencing nausea as a side effect of Lamictal, but administer a concurrent antiemetic agent (i.e. anti-nausea medication) – you may experience zero nausea or significantly less debilitating nausea as a side effect than you would’ve without the concurrent antiemetic.

On the other hand, if you experience diarrhea as a side effect of Lamictal and use a concurrent prescription medication that also causes diarrhea as a side effect – your diarrhea side effect may be significantly worse as a result of a synergistic effect between Lamictal and the other substance.  Realize that certain concurrently used substances may “cancel out” or attenuate the side effects of Lamictal, whereas other concurrently used substances may exacerbate or potentiate the side effects of Lamictal.

Some concurrently used substances will interact with Lamictal pharmacokinetically – such that they either increase or decrease plasma concentrations of Lamictal.  For example, the medication carbamazepine is known to decrease Lamictal concentrations by nearly 40% – which should decrease the neurophysiologic effect of Lamictal, and ultimately the side effects attributable to Lamictal.  On the other hand, the medication Valproate can increase Lamictal concentrations by nearly 2-fold – which should increase the neurophysiologic effect of Lamictal and side effects attributable to Lamictal.

Other concurrently used substances might interact with Lamictal pharmacodynamically as a result of synergistic or antagonistic neurochemical modulation.  For example, a psychostimulant medication may increase excitatory neurotransmission and cancel out the side effect of somnolence or fatigue, whereas a benzodiazepine may synergistically act with Lamictal on GABA to cause a worsening of motor impairment and/or cognitive dysfunction.

4. Individual factors

There are many individual factors that could influence the side effects that a specific Lamictal user experiences.  Individual factors that might impact side effect prevalence and/or severities include: administration details; age and sex; genetics; lifestyle; and preexisting medical conditions.

• Administration details: The specific format of Lamictal that you’re using – standard tablet or extended-release – could influence side effects.  For example, someone might find that he/she experiences fewer side effects with the extended-release Lamictal than the standard release; or vice-versa.  Additionally, some users may find that certain side effects (e.g. gastrointestinal) tend to be more prevalent when taking Lamictal after eating a meal versus on an empty stomach; or vice-versa.  Moreover, some individuals might report that side effects are more debilitating when taking Lamictal in the morning compared to the evening; or vice-versa.
• Age & sex: A person’s age and sex could determine the side effects resulting from Lamictal treatment. For example, pediatric Lamictal users may be at greater risk of experiencing certain side effects and/or long-term complications from treatment due to lack of CNS and brain development.  Oppositely, an elderly Lamictal user may be at greater risk of experiencing hepatic or renal complications during treatment due to age-related decline in organ function.  Additionally, some research suggests that side effects associated with Lamictal may be more common in women than men.
• Genetics: The genetic and/or epigenetic expression of a Lamictal user could influence medication tolerability. Though genes implicated in hepatic metabolism are relatively irrelevant with regard to influencing side effects of Lamictal, genes that encode for specific neurotransmitter systems might determine how well the medication works, as well as the side effects that occur.  Because Lamictal interacts with voltage-gated sodium and calcium channels, 5-HT3 receptors, sigma receptors, and GABA neurotransmission – variants of genes that mediate activation of these neurotransmitter systems could dictate Lamictal side effects.
• Lifestyle: A person’s lifestyle while taking Lamictal might impact side effects experienced throughout treatment. For example, someone who lives a healthy lifestyle by managing stress, eating a nutritious diet, maintaining a sleep schedule, exercising consistently, etc. – might experience few unwanted side effects from the medication – or reduce the severities of side effects as a result of healthy lifestyle choices.  On the other hand, someone who makes unhealthy lifestyle choices might experience intense and/or unwanted side effects throughout treatment partly attributable to lifestyle.
• Medical conditions: Preexisting medical condition(s) being managed with Lamictal, and additional medical diagnoses – could influence the side effects and/or adverse reactions that occur during treatment. For example, someone with preexisting renal dysfunction may be more likely to experience an adverse reaction than someone with healthy renal function.  Assuming you don’t have medical conditions in addition to the condition for which Lamictal was prescribed, you may be at a lower risk of side effects.

Lamictal (Lamotrigine): Do the benefits outweigh the side effects?

If you’re undergoing treatment with Lamictal, it is probably a good idea to evaluate whether the therapeutic effects facilitated by the medication outweigh any unwanted side effects that you’re experiencing.  Based on clinical trial data, it is understood that a majority of individuals who use Lamictal will find the medication to be effective and tolerable for the management of medical symptoms.

In other words, most people will find that the therapeutic benefits derived from treatment significantly outweighs any unwanted side effects.  Although a few unwanted side effects may be inevitable, these side effects generally aren’t severe and/or will be possible to manage with assistance from a medical doctor.

Nevertheless, some individuals may find that the side effects associated with Lamictal significantly impair cognitive performance and/or compromise general health.  If side effects from Lamictal become so problematic that they’re impairing your performance or endangering your health, a medical doctor will likely recommend ceasing Lamictal use – regardless of whether the medication was effectively managing your medical symptoms.

In the event that you aren’t exactly sure whether the benefits you’re reaping from Lamictal are outweighing the side effects that you’re enduring – it may be smart to maintain a daily journal during treatment.  Journaling on a regular basis (e.g. daily) can help you reflect upon: how well Lamictal is managing your symptoms; the specific side effects that you’re experiencing; the severities of those side effects; and whether tolerability or efficacy change over time.

Possible ways to reduce Lamictal side effects

Listed below are some tactics that could help counteract or minimize the side effects that a person experiences while using Lamictal.  Keep in mind that the effectiveness of these side effect attenuation tactics will be subject to interindividual variation among Lamictal users – some may benefit from them, whereas others may find them to be useless.  Prior to implementing any of these tactics and/or modifying aspects of Lamictal treatment, discuss a medical doctor to confirm safety.

1. Lamictal dose and/or format adjustment: Data from clinical trials indicate that high doses of Lamictal are more likely to cause side effects than lower doses. Knowing that high doses of Lamictal increase likelihood of side effects, it may be possible to counteract side effects via dosage adjustments.  For example, slightly decreasing your Lamictal dose may reduce a troubling side effect that you’re experiencing – while still providing therapeutic effect.  It is recommended to take the “minimal effective dose” or lowest quantity of Lamictal necessary to manage symptoms – as this will help decrease side effect occurrence.  Adjusting the format of Lamictal being administered may also help certain individuals (e.g. transitioning from standard tablets to extended-release; or vice-versa).
2. Concurrent substances: Some individuals may benefit from administering substances to strategically counteract specific side effects resulting from Lamictal. For example, if Lamictal is causing diarrhea, then concurrent administration of an over-the-counter agent like Imodium might help reverse the diarrheal effect and make treatment more tolerable.  It is recommended to talk with a medical doctor about your most problematic side effects on Lamictal, and ask whether any concurrent substances can be safely administered to attenuate or reduce those side effects.
3. Administration modification: Occasionally, it may help some individuals to alter the details associated with Lamictal administration. Specifically, altering the time of day at which Lamictal is administered and/or whether its administered with food – might influence side effect occurrence.  If you’re currently administering Lamictal with food and experience gastrointestinal irritation, you may want to try taking it on an empty stomach to determine whether the GI irritation improves.  If you’re taking Lamictal regularly in the early morning, you could try taking it in the late morning or early afternoon instead – to determine if side effects are easier to manage.
4. Discontinue unnecessary agents: If you’re using concurrent substances with Lamictal (prescription or OTC medications; illicit drugs; dietary supplements) – evaluate whether these agents are medically necessary. If a medical doctor doesn’t consider a concurrent substance that you’re taking to be medically necessary (based upon your current medical status) – you may want to discontinue using it.  Discontinuation of medically unnecessary agents should minimize odds of interaction effects or side effects caused by those other agents.
5. Longer-term Lamictal use: As was discussed, some individuals may experience side effects in the early stages of Lamictal treatment for multiple reasons: lack of neurophysiologic adaptation to the medication and ongoing dosage adjustments. If you’re a short-term Lamictal user and are dissatisfied with the side effects that you’re experiencing, you may want to continue treatment for a longer-term.  Sometimes side effects that occur over a short-term will fade with longer-term Lamictal administration.

Note: If you’re experiencing debilitating side effects from Lamictal, and none of the aforementioned management strategies seem to help reduce the intensities of those side effects, speak with a medical doctor.  For certain individuals with severe side effects, Lamictal withdrawal plus transitioning to another medication may be necessary.

Have you experienced Lamictal side effects?

If you’re currently using Lamictal (or have previously used it), share whether you’ve experienced side effects in the comments section.  Discuss the specific side effects that you’ve endured throughout treatment, and report the severities of those side effects (e.g. on a scale from 1 to 10 – with 10 being “most severe”).  Which side effects do you consider most severe and/or debilitating?

To help others who read this article best understand your specific situation, provide some additional information in your comment such as: the dose and format of Lamictal that you use (e.g. 300 mg, extended-release); your age and sex; the total duration over which you’ve used Lamictal (e.g. 2 years); and whether you use other substances along with it (e.g. medications, supplements, etc.).  If you use other substances with Lamictal, are you sure that the side effects you’re experiencing aren’t totally attributable to the other substance(s) – or some sort of interaction effect (between Lamictal and the other agent)?

If your side effects from Lamictal have been debilitating, have you tested any side effect attenuation strategies outlined in this article?  Are there any tactics you’ve successfully employed to reduce the intensities of certain Lamictal side effects?

Overall, it is important to recognize that no anticonvulsant/mood stabilizer is perfectly tolerated – every medication, including Lamictal has side effects.  Some people will find Lamictal to be extremely tolerable, whereas others may struggle to function while under its influence.  If you cannot tolerate Lamictal, talk to a medical doctor about different treatment options.

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