A Systematic Review on Lamotrigine Induced Skin Rashes
Lamotrigine is a newer anti-epileptic drug synthesised in 1980s and approved by USFDA in 1994. It is mainly used for treating paediatric epilepsy and one of the frequently prescribing newer anti- epileptic drugs in European countries. In English scenario, lamotrigine is suggested as monotherapy for recently identified partial seizures (localized seizure) in children as its first line drug. Lamotrigine is recommended for generalized seizures as second line drug and as add on therapy in intractable generalized epilepsy. It is a treatment option after sodium valproate and ethosuximide for petit-mal epilepsy. It can be used as either single or in combination with other anti-epileptic drugs. It has lot of adverse effects like other anti-epileptic drugs. Major adverse effect associated with lamotrigine is skin rashes in newly administered patients up to 8 weeks. About 3-10 % of the patients experience skin rashes in their therapy with lamotrigine. Lamotrigine doses should be titrated properly in combination with other anti-epileptic drugs especially with valproic acid. Other less common adverse effects with lamotrigine include dizziness, ataxia, blurred vision, headache, nausea and diplopia. Moreover, lamotrigine has a safe drug profile and effective in both children and adults for the treatment of various types of seizures. The dose escalation should be monitored regularly to avoid serious adverse reactions.
2. Wong IC, Mawer GE, Sander JW. Factors influencing the incidence of lamotrigine-related skin rash. Ann Pharmacother. 1999 Oct; 33(10):1037-42.
3. Matsuo F. Lamotrigine. Epilepsia. 1999 May; 40:s30-6.
4. Piña-Garza JE, Elterman RD, Ayala R, Corral M, Mikati MA, Piña-Garza MJ, Warnock CR, Conklin HS, Messenheimer JA. Long-term tolerability and efficacy of lamotrigine in infants 1 to 24 months old. Jchild neurol. 2008 Aug; 23(8):853-61.
5. Besag FM, Wallace SJ, Dulac O, Alving J, Spencer SC, Hosking G. Lamotrigine for the treatment of epilepsy in childhood. J pediatrics. 1995 Dec 1; 127(6):991-7.
6. Mikati MA, Fayad M, Koleilat M, Mounla N, Hussein R, Kazma A, Yunis K. Efficacy, tolerability, and kinetics of lamotrigine in infants.Jpediatrics. 2002 Jul 1; 141(1):31-5.
7. Thome-Souza S, Valente KD. Valproate and lamotrigine in pediatric patients with refractory epilepsy: after the first year. Pediatr Neurol. 2013 Jun 1; 48(6):436-42.
8. Falah R, Akhavan KS, Golestan M. Efficacy and safety of lamotrigine in lennox-Gastaut syndrome. Iranian Journal of Child Neurology, Vol. 3 No. 3 (2009).
9. Duchowny M, Gilman J, Messenheimer J, et al. Long-term tolerability and efficacy of lamotrigine in pediatric patients with epilepsy. J Child Neurol 2002; 17:278–85.
10. Egunsola O, Choonara I, Sammons HM. Safety of lamotrigine in paediatrics: a systematic review. BMJ open. 2015 Jun 1; 5(6):e007711.
11. Coppola G, Pascotto A. Lamotrigine as add-on drug in children and adolescents with refractory epilepsy and mental delay: an open trial. Brain and Development. 1997 Sep 1; 19(6):398-402.
12. Farrell K, Connolly MB, Munn R, Peng S, MacWilliam LM. Prospective, open-label, add-on study of lamotrigine in 56 children with intractable generalized epilepsy. Pediatr neurol. 1997 Apr 1; 16(3):201-5.
13. Besag FM, Dulac O, Alving J, Mullens EL. Long-term safety and efficacy of lamotrigine (Lamictal®) in paediatric patients with epilepsy. Seizure. 1997 Feb 1; 6(1):51-6.
14. Holmes GL, Frank LM, Sheth RD, Philbrook B, Wooten JD, Vuong A, Kerls S, Hammer AE, Messenheimer J. Lamotrigine monotherapy for newly diagnosed typical absence seizures in children. Epilepsy research. 2008 Dec 1; 82(2-3):124-32.
15. Mackay FJ, Wilton LV, Peace GL, Freemantle SN, Mann RD. Safety of long‐term lamotrigine in epilepsy. Epilepsia. 1997 Aug; 38(8):881-6.
16. Frank LM, Enlow T, Holmes GL, Manasco P, Concannon S, Chen C, Womble G, Casale EJ. Lamictal (lamotrigine) monotherapy for typical absence seizures in children. Epilepsia. 1999 Jul; 40(7):973-9.
17. Baker GA, Jacoby A, Buck D, Stalgis C, Monnet D. Quality of life of people with epilepsy: a European study. Epilepsia. 1997 Mar; 38(3):353-62.
18. Pal AB, Prusty SK, Sahu PK, Swain TR. Drug utilization pattern of antiepileptic drugs: a pharmacoepidemiologic and pharmacovigilance study in a tertiary teaching hospital in India. Asian J Pharm Clin Res. 2011; 4(1):96-.
19. Egunsola O, Choonara I, Sammons HM. Safety of lamotrigine in paediatrics: a systematic review. BMJ open. 2015 Jun 1; 5(6):e007711.
20. Glauser TA, Cnaan A, Shinnar S, Hirtz DG, Dlugos D, Masur D, Clark PO, Capparelli EV, Adamson PC. Ethosuximide, valproic acid, and lamotrigine in childhood absence epilepsy. N Engl JMed. 2010 Mar 4; 362(9):790-9.
21. Eriksson AS, Nergårdh A, Hoppu K. The efficacy of lamotrigine in children and adolescents with refractory generalized epilepsy: a randomized, double‐blind, crossover study. Epilepsia. 1998 May; 39(5):495-501.
22. Nieto-Barrera M, Brozmanova M, Capovilla G, Christe W, Pedersen B, Kane K, O'Neill F, Lamictal vs Carbamazepine Study Group. A comparison of monotherapy with lamotrigine or carbamazepine in patients with newly diagnosed partial epilepsy. Epilepsy research. 2001 Aug 1; 46(2):145-55.
23. Anderson GD, Yau MK, Gidal BE, Harris SJ, Levy RH, Lai AA, Wolf KB, Wargin WA, Dren AT. Bidirectional interaction of valproate and lamotrigine in healthy subjects. Clinical Pharmacology & Therapeutics. 1996 Aug; 60(2):145-56.
24. Messenheimer JA, Giorgi L, Risner ME. The tolerability of lamotrigine in children. Drug Safety. 2000 Apr 1; 22(4):303-12.
25. Duchowny M, Pellock JM, Graf WD, Billard C, Gilman J, Casale E, Womble G, Risner M, Manasco P, Lamictal Pediatric Partial Seizure Study Group. A placebo-controlled trial of lamotrigine add-on therapy for partial seizures in children. Neurology. 1999 Nov 1; 53(8):1724-.
26. Hirsch LJ, Weintraub DB, Buchsbaum R, Spencer HT, Straka T, Hager M, Resor Jr SR. Predictors of lamotrigine‐associated rash. Epilepsia. 2006 Feb; 47(2):318-22.
27. Shi YW, Min FL, Liu XR, Zan LX, Gao MM, Yu MJ, Liao WP. HLA‐B alleles and lamotrigine‐induced cutaneous adverse drug reactions in the Han Chinese population. Basic & clinical pharmacology & toxicology. 2011 Jul; 109(1):42-6.
28. Trevathan E, Kerls SP, Hammer AE, Vuong A, Messenheimer JA. Lamotrigine adjunctive therapy among children and adolescents with primary generalized tonic-clonic seizures. Pediatrics. 2006 Aug 1; 118(2):e371-8.
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
Authors who publish with this journal agree to the following terms:
- Authors retain copyright and grant the journal right of first publication with the work simultaneously licensed under a Creative Commons Attribution-NonCommercial 4.0 International (CC BY-NC 4.0). that allows others to share the work with an acknowledgment of the work's authorship and initial publication in this journal.
- Authors are able to enter into separate, additional contractual arrangements for the non-exclusive distribution of the journal's published version of the work (e.g., post it to an institutional repository or publish it in a book), with an acknowledgment of its initial publication in this journal.
- Authors are permitted and encouraged to post their work online (e.g., in institutional repositories or on their website) prior to and during the submission process, as it can lead to productive exchanges, as well as earlier and greater citation of published work (See The Effect of Open Access).