Rash While Taking Lamictal Is a Rare but Serious Side Effect (2022)

Lamictal (lamotrigine) is an anticonvulsive drug frequently used as a mood stabilizer for people living with bipolar disorder. It works by moderating extreme variations in mood and is particularly helpful in treating severe depression.

The medication has enjoyed widespread use since its introduction in 1994. Today, it is on the World Health Organization's List of Essential Medications.

Despite its proven benefits, Lamictal has its downsides. In some individuals, Lamictal has been known to cause a hypersensitivity reaction marked by severe rash and inflammation. This finding led the U.S. Food and Drug Administration (FDA) to issue a black box warning advising consumers about this rare but potentially deadly reaction.

If you experience a rash while taking Lamictal, see your doctor immediately. If it is spreading quickly, call 911 or go to your nearest emergency room. It is far better to be safe than sorry, no matter how​ low the risk may be.

Symptoms

There are a number of early-onset symptoms that might indicate that you are having a reaction to Lamictal. Some of these include:

  • Feeling poorly
  • Fever
  • Itching skin
  • Hives
  • Red blisters on areas of the body, which may include the face or mouth

Symptoms of a more serious rash can include peeling skin, painful blisters, inflammation of the eyes, swollen lymph nodes, and flu-like symptoms.

The symptoms can range from benign to potentially fatal. However, there is no way to gauge the potential outcome based on the symptoms. If you experience any signs of a rash when taking Lamictal, even if it seems mild, you need to contact your doctor immediately.

Hypersensitivity Reactions

The FDA warns that a number of hypersensitivity reactions may occur in people who take Lamictal.

What Is a Hypersensitive Reaction?

A hypersensitive reaction is one in which a condition or drug causes the immune system to overreact, resulting in an allergy or adverse autoimmune response.

With Lamictal, these can include reactions known as Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS syndrome).

Each of these conditions manifests with a severe (some say "angry") rash which typically develops after two to eight weeks of drug use. Mortality rates are significant, ranging from 5% to as high as 30%.

Stevens-Johnson Syndrome (SJS)

Stevens-Johnson Syndrom can often be preceded by flu-like symptoms such as:

  • Cough
  • Diarrhea
  • Fever
  • Headache
  • Sore throat
  • Vomiting

This can be followed by an all-body reaction characterized by a quickly spreading rash, swelling of the face and tongue, and the severe blistering of the mucous membranes of the mouth, nose, and eyes.

The skin rash can be incredibly painful and, in some cases, lead to the detachment and shedding of skin.

(Video) Lamictal Side Effects - What You Need To Know Plus 1 Serious Warning

Toxic Epidermal Necrolysis (TEN)

Toxic epidermal necrolysis is essentially SJS but worse. TEN is defined as the detachment of more than 30% of skin as opposed to SJS which involves less than 10%. Moreover, the risk of death from TEN is between four and five times greater than SJS.

DRESS Syndrome

DRESS syndrome is a drug reaction that can also cause rash alongside other characteristic symptoms including severe nerve pain and inflammation of at least one major organ (most often the liver, kidneys, lungs, heart, muscles, or pancreas).

Causes of Hypersensitivity

By and large, people under 17 are more likely to have a reaction to Lamictal than adults. In addition, there are a number of factors that can increase the likelihood of an adverse response:

  • Taking more than the recommended dose when starting therapy
  • Increasing the dose too quickly when starting instead of ramping up gradually
  • Stopping treatment and starting again at the normal full dose
  • Taking the medications Depakene (valproic acid) or Depakote (sodium valproate) in conjunction with Lamictal

It should be pointed out, however, that hypersensitivity can sometimes occur even if you are taking the drug as prescribed. While genetic factors appear to play a part, the causes are sometimes idiopathic (meaning that we simply don't know the reason).

According to the FDA's research, there is about a three-fold increase in risk if you take Lamictal as compared to other mood stabilizers. If you are under 16, the risk will further double.

It is important to note, however, that not all hypersensitivity reactions will end up with SJS. Putting it all into perspective, there is really only a 0.1% chance of such an event occurring.

In the end, it was the severity of the reaction, as well as the availability of other mood-stabilizing drugs, that informed the FDA decision as much as the statistical risk itself.

Treatment for Lamictal Rash

Treatment involves the immediate discontinuation of Lamictal and the use of supportive therapies to treat the pain, prevent infection, and ensure that the person remains properly hydrated.

The skin damage is treated in a similar manner to a thermal burn. Corticosteroids are commonly used to reduce inflammation.

  • For mild rashes, a healthcare professional might recommend monitoring the symptoms and using topical creams and ibuprofen to minimize pain, reduce inflammation, and prevent infection.
  • Stevens-Johnson syndrome treatment involves hospitalization and supportive care to manage symptoms.
  • Toxic epidermal necrolysis also requires hospitalization and may require the administration of fluids, intravenous antibiotics, and/or immune therapy.
  • DRESS syndrome may require hospitalization, depending on the severity of the condition. Other treatments may be needed if they experience other complications such as liver or kidney failure.

If a person has to stop taking Lamictal, their doctor may recommend a different mood stabilizer such as Depakote (divalproex sodium, sodiumvalproate, and valproic acid), lithium, or Topamax (topiramate). Research also suggests that Zyprexa (olanzapine) can be helpful for managing symptoms of bipolar disorder.

Learn More About Lamictal as a Mood Stabilizer

Frequently Asked Questions

  • How can I avoid a Lamictal rash?

    (Video) LA teenager’s skin 'melts’ off in severe reaction to prescription medication with strict FDA warning

    Two strategies that can prevent serious Lamictal rashes include titration (which involves starting at a low dose and gradually increasing the amount) and stopping the medication if any symptoms of skin rashes appear within the first two months of treatment.

  • What does the beginning of a Lamictal rash look like?

    The rash is characterized by red blisters, often around the mouth or face, but also on other areas of the body. People may also notice itching, hives, or a general feeling of unwellness.

  • How long does it take for a Lamictal rash to go away?

    A Lamictal rash typically appears within five days to eight weeks of initiating treatment and usually disappears within a few days after stopping the medication.

8 Sources

(Video) Medication That Almost Killed Me! Lamictal (Lamotrigine)

Verywell Mind uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.

  1. GlaxoSmithKline. Lamictal (lamotrigine): Highlights of Prescribing Information. Triangle Park, North Carolina.

  2. Wang XQ, Lv B, Wang HF, et al. Lamotrigine-induced severe cutaneous adverse reaction: Update data from 1999-2014. J Clin Neurosci. 2015;22(6):1005-11. doi:10.1016/j.jocn.2015.01.016

  3. Lerch M, Mainetti C, Terziroli beretta-piccoli B, Harr T. Current Perspectives on Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. Clin Rev Allergy Immunol. 2018;54(1):147-176. doi:10.1007/s12016-017-8654-z

  4. Wang XQ, Lv B, Wang HF, et al. Lamotrigine induced DIHS/DRESS: Manifestations, treatment, and outcome in 57 patients. Clin Neurol Neurosurg. 2015;138:1-7. doi:10.1016/j.clineuro.2015.07.008

  5. Provenzani A, Labbozzetta M, Notarbartolo M, et al. Rash and multiorgan dysfunction following lamotrigine: could genetic be involved?. Int J Clin Pharm. 2015;37(5):682-6. doi:10.1007/s11096-015-0158-4

  6. Pan PY, Lee MS, Lo MC, Yang EL, Yeh CB. Olanzapine is superior to lamotrigine in the prevention of bipolar depression: a naturalistic observational study.BMC Psychiatry. 2014;14:145. doi:10.1186/1471-244X-14-145

  7. Aiken C. How to minimize lamotrigine’s adverse effects. Psychiatric Times.

  8. Kverno K, Beauvois L, Dudley-Brown S. Lamotrigine rash: Benign allergy or severe adverse reaction? The Nurse Practitioner. 2018;43(3):48-51. doi:10.1097/01.NPR.0000530211.32278.96

By Marcia Purse
Marcia Purse is a mental health writer and bipolar disorder advocate who brings strong research skills and personal experiences to her writing.

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(Video) How to use Lamotrigine? (Lamictal) - Doctor Explains

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FAQs

How serious is Lamictal rash? ›

Most skin rashes are not serious. Stevens-Johnson syndrome is a rare side effect of lamotrigine. It causes flu-like symptoms, followed by a red or purple rash that spreads and forms blisters. The affected skin eventually dies and peels off.

Is Lamictal rash rare? ›

The risk of getting a serious rash from Lamictal is low. According to the Epilepsy Foundation, clinical trials showed that the risk is only 0.3 percent for adults and 1 percent in children under 16 years of age. It's still important to know the symptoms because a serious rash from Lamictal can be fatal.

When should I worry about Lamictal rash? ›

If you experience a rash while taking Lamictal, see your doctor immediately. If it is spreading quickly, call 911 or go to your nearest emergency room. It is far better to be safe than sorry, no matter how​ low the risk may be.

How many people get the Lamictal rash? ›

Furthermore, in clinical trials of bipolar and other mood disorders that followed the new dosing regimens, the rate of serious rash was 0.08% in adults treated with LTG monotherapy and 0.13% when used as adjunctive therapy—well below previous rates.

When does lamotrigine rash start? ›

Lamotrigine rashes are typically allergic in nature, presenting as simple, benign morbilliform rashes with onset between 5 days and 8 weeks after treatment initiation; the rashes tend to disappear within a few days after the medication is stopped.

When does Lamictal rash start? ›

Serious rashes usually develop during the first 2 to 8 weeks of treatment with lamotrigine, but can develop at any time during treatment.

What is a good substitute for Lamictal? ›

  • Seroquel.
  • Abilify.
  • Topiramate.
  • Vraylar.
  • Lithium.
  • Lurasidone.

How do I stop Lamictal rash? ›

Preventing rashes on lamotrigine

There are two ways to prevent serious rashes on lamotrigine: titrate slowly and stop the medicine if there is any significant skin eruption within the first 2 months of treatment. With those precautions, the risk of Stevens Johnson Syndrome drops from 1% to 0.1-0.01%.

Is Lamictal a high risk medication? ›

Lamotrigine (Lamictal) has been associated with a rare, but serious and life-threatening adverse reaction called hemophagocytic lymphohistiocytosis (HLH), which can lead to multi-organ failure resulting in hospitalization or death, particularly if diagnosis and treatment are delayed.

How quickly does Stevens-Johnson syndrome start? ›

One to three days before a rash develops, you may show early signs of Stevens-Johnson syndrome, including: Fever. A sore mouth and throat. Fatigue.

What does Steven Johnson Syndrome look like in the beginning? ›

Stevens-Johnson syndrome can start with flu-like symptoms, such as a high temperature, sore throat, cough and joint pain. A rash appears a few days later. It's made up of circular patches that are darker in the middle and lighter around the outside.

What are the serious side effects of lamotrigine? ›

Lamotrigine may cause serious allergic reactions affecting multiple body organs (eg, liver or kidney). Check with your doctor right away if you or your child have the following symptoms: fever, dark urine, headache, hives, muscle pain or stiffness, stomach pain, unusual tiredness, or yellow eyes or skin.

What should I avoid while taking lamoTRIgine? ›

lamoTRIgine food

You should avoid or limit the use of alcohol while being treated with lamoTRIgine. Do not use more than the recommended dose of lamoTRIgine, and avoid activities requiring mental alertness such as driving or operating hazardous machinery until you know how the medication affects you.

Is it better to take lamotrigine at night or morning? ›

You may have to take lamotrigine once or twice a day. It doesn't matter what time you take it each day – choose a time that you can always remember. This could be at mealtimes, or when you brush your teeth. You can take it before or after food.

What does Lamictal do to the brain? ›

How does Lamictal work? Lamotrigine works by inhibiting cell pathways in the brain called sodium channels, which reduces the emission of chemicals called glutamate and aspartate, two of the most important excitatory neurotransmitters in the brain.

What is the newest medication for bipolar? ›

Caplyta Now Approved for Bipolar Depression in Adults
  • In December 2021, the FDA approved Caplyta (lumateperone) to treat depressive episodes in bipolar 1 or 2 disorder in adults. ...
  • Caplyta is an oral capsule that you take once a day with or without food. ...
  • There are many ways to save on Caplyta.
24 Jan 2022

What is the safest mood stabilizer? ›

The safest and most efficacious mood stabilizer combinations appear to be the mixtures of anticonvulsants and lithium, particularly valproate plus lithium.

Is Lamictal hard to get off of? ›

However, reports from people who have taken it and then stopped indicate that some individuals may experience difficult symptoms when discontinuing Lamictal. All medications have the potential to cause both uncommon side effects and uncommon withdrawal symptoms.

How common is SJS with Lamictal? ›

Adverse skin reactions occur in 8.3% of patients taking lamotrigine, with 0.04% of patients developing SJS/TEN. This rate of SJS/TEN is far greater than that reported for other well-known trigger medications including phenobarbital (0.02%), nitrofurantoin (0.007%) and sulfamethoxazole with trimethoprim (0.003%).

How long do stress rashes last? ›

Stress rash treatment

Fortunately, most stress-induced rashes go away on their own within a few days; however, they can come back. Some may persist for as long as six weeks. Avoid scratching the rash, which can make it worse and may even spread bacteria through tiny scrapes in the skin.

What happens when you suddenly stop lamotrigine? ›

Stopping lamotrigine

If you're taking lamotrigine for epilepsy, stopping it suddenly can cause seizures. Coming off lamotrigine should be done very slowly and might take a few months. If you're taking lamotrigine for bipolar disorder, it's usually safe to stop taking it without having to reduce your dose first.

Does Lamictal affect memory? ›

Does Lamotrigine affect memory? Lamotrigine has a good cognitive profile. It does not cause a lot of memory-related side effects. In some cases, it leads to difficulty reading words.

Can Lamictal cause blood clots? ›

Common symptoms include fever, rash, and enlarged lymph nodes, liver, and spleen. They also include decreased blood cell counts, decreased liver function, and blood clotting problems.

What type of bipolar does Lamictal treat? ›

Lamotrigine (Lamictal) for Bipolar Disorder

It has been found to help delay bouts of depression, mania, hypomania (a milder form of mania), and mixed episodes in those being treated with standard therapy. It is especially effective in the prevention of bipolar depression.

Is Stevens-Johnson syndrome fatal? ›

Serious complications can include pneumonia, overwhelming bacterial infections (sepsis ), shock, multiple organ failure, and death. About 10 percent of people with Stevens-Johnson syndrome die from the disease, while the condition is fatal in up to 50 percent of those with toxic epidermal necrolysis.

Is there a blood test for Stevens-Johnson syndrome? ›

A complete blood count (CBC) may reveal a normal white blood cell (WBC) count or a nonspecific leukocytosis. A severely elevated WBC count indicates the possibility of a superimposed bacterial infection. Electrolytes and other chemistries may be needed to help manage related problems.

Which drug is most likely to cause Stevens-Johnson syndrome? ›

What drugs are most likely to cause Stevens-Johnson syndrome?
  • Antibacterial sulfa drugs.
  • Anti-epileptic drugs, including phenytoin (Dilantin®), carbamazepine (Tegretol®), lamotrigine (Lamictal®), and phenobarbital (Luminal®).
  • Allopurinol (Aloprim®, Zyloprim®), a drug used to treat gout and kidney stones.
18 Dec 2020

How fast does Lamictal rash spread? ›

Serious rashes typically develop within 5 days to 8 weeks of starting Lamictal.

What does toxic epidermal necrolysis look like? ›

Toxic epidermal necrolysis signs and symptoms include: Widespread skin pain. A spreading rash covering more than 30% of the body. Blisters and large areas of peeling skin.

What does a drug rash look like? ›

Drug rashes can appear as a variety of skin rashes, including pink to red bumps, hives, blisters, red patches, pus-filled bumps (pustules), or sensitivity to sunlight. Drug rashes may involve the entire skin surface, or they may be limited to one or a few body parts. Itching is common in many drug rashes.

Can lamotrigine cause a toxic rash? ›

There are adverse effects with lamotrigine such as a headache, blurred vision, diplopia, somnolence, ataxia, dizziness, rash, Stevens–Johnson syndrome (SJS), and toxic epidermal necrolysis. SJS is a life-threatening, blistering mucocutaneous disease.

Why does Lamictal cause a rash? ›

In some cases, Lamictal can cause a serious rash that may require hospitalization. This includes a rash as a result of Stevens-Johnson syndrome or toxic epidermal necrolysis, which are rare but serious side effects of Lamictal.

How long does it take for Lamictal to leave the body? ›

With a half-life of about 25 hours, Lamictal takes about 100 to 125 hours to leave your system. That's about 4 to 5 days. Your medical professional can help answer other questions about how Lamictal works or how long it stays in your body.

Can you take vitamin D with lamotrigine? ›

Interactions between your drugs

No interactions were found between lamotrigine and Vitamin D3.

Can I take Benadryl with lamotrigine? ›

Interactions between your drugs

Using diphenhydrAMINE together with lamoTRIgine may increase side effects such as dizziness, drowsiness, confusion, and difficulty concentrating. Some people, especially the elderly, may also experience impairment in thinking, judgment, and motor coordination.

What is the best antidepressant to take with lamotrigine? ›

Pilot studies have reported the augmentation therapy of lamotrigine with SSRI's (fluoxetine and paroxetine) to be well tolerated and far more superior in efficacy than that of SSRI monotherapy (Normann et al., 2002; Barbosa et al., 2003).

What to do if you get a rash from Lamictal? ›

A rash that occurs in the first five days of taking lamotrigine is probably nondrug related but regardless, the patient should stop taking the drug and contact their doctor or psychiatrist as it may still represent a lamotrigine (hypersensitivity-type) reaction with potential internal organ involvement.

How quickly does Stevens-Johnson syndrome start? ›

One to three days before a rash develops, you may show early signs of Stevens-Johnson syndrome, including: Fever. A sore mouth and throat. Fatigue.

How do I stop Lamictal rash? ›

Preventing rashes on lamotrigine

There are two ways to prevent serious rashes on lamotrigine: titrate slowly and stop the medicine if there is any significant skin eruption within the first 2 months of treatment. With those precautions, the risk of Stevens Johnson Syndrome drops from 1% to 0.1-0.01%.

What does Steven Johnson Syndrome look like in the beginning? ›

Stevens-Johnson syndrome can start with flu-like symptoms, such as a high temperature, sore throat, cough and joint pain. A rash appears a few days later. It's made up of circular patches that are darker in the middle and lighter around the outside.

What does a mild Lamictal rash look like? ›

If your Lamictal rash occurs as a symptom of Stevens-Johnson syndrome or toxic epidermal necrolysis, the early stage or first stage of the rash is a red or purple rash. This appears as blemishes that have a “target” or “bull's-eye” appearance.

What is a good substitute for Lamictal? ›

  • Seroquel.
  • Abilify.
  • Topiramate.
  • Vraylar.
  • Lithium.
  • Lurasidone.

Is Lamictal a high risk medication? ›

Lamotrigine (Lamictal) has been associated with a rare, but serious and life-threatening adverse reaction called hemophagocytic lymphohistiocytosis (HLH), which can lead to multi-organ failure resulting in hospitalization or death, particularly if diagnosis and treatment are delayed.

Is Stevens-Johnson syndrome fatal? ›

Serious complications can include pneumonia, overwhelming bacterial infections (sepsis ), shock, multiple organ failure, and death. About 10 percent of people with Stevens-Johnson syndrome die from the disease, while the condition is fatal in up to 50 percent of those with toxic epidermal necrolysis.

Is there a blood test for Stevens-Johnson syndrome? ›

A complete blood count (CBC) may reveal a normal white blood cell (WBC) count or a nonspecific leukocytosis. A severely elevated WBC count indicates the possibility of a superimposed bacterial infection. Electrolytes and other chemistries may be needed to help manage related problems.

Which drug is most likely to cause Stevens-Johnson syndrome? ›

What drugs are most likely to cause Stevens-Johnson syndrome?
  • Antibacterial sulfa drugs.
  • Anti-epileptic drugs, including phenytoin (Dilantin®), carbamazepine (Tegretol®), lamotrigine (Lamictal®), and phenobarbital (Luminal®).
  • Allopurinol (Aloprim®, Zyloprim®), a drug used to treat gout and kidney stones.
18 Dec 2020

What are the serious side effects of lamotrigine? ›

Lamotrigine may cause serious allergic reactions affecting multiple body organs (eg, liver or kidney). Check with your doctor right away if you or your child have the following symptoms: fever, dark urine, headache, hives, muscle pain or stiffness, stomach pain, unusual tiredness, or yellow eyes or skin.

How common is SJS with Lamictal? ›

Adverse skin reactions occur in 8.3% of patients taking lamotrigine, with 0.04% of patients developing SJS/TEN. This rate of SJS/TEN is far greater than that reported for other well-known trigger medications including phenobarbital (0.02%), nitrofurantoin (0.007%) and sulfamethoxazole with trimethoprim (0.003%).

How fast does Lamictal rash spread? ›

Serious rashes typically develop within 5 days to 8 weeks of starting Lamictal.

What does toxic epidermal necrolysis look like? ›

Toxic epidermal necrolysis signs and symptoms include: Widespread skin pain. A spreading rash covering more than 30% of the body. Blisters and large areas of peeling skin.

What does a drug rash look like? ›

Drug rashes can appear as a variety of skin rashes, including pink to red bumps, hives, blisters, red patches, pus-filled bumps (pustules), or sensitivity to sunlight. Drug rashes may involve the entire skin surface, or they may be limited to one or a few body parts. Itching is common in many drug rashes.

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