introduction

Lamotrigine is a drug that belongs to a group of drugs called anticonvulsants, which are used to treat seizures such as epilepsy. It is one of the newer aniconvulsants and is mainly used for focal seizure disorders, that is, for seizures that are limited to a certain area of ​​the brain.
Lamotrigine is characterized by its comparatively low level of harm to the liver and kidneys.

Overview

Even if lamotrigine is generally considered a well-tolerated anti-epidemic, side effects can sometimes occur. This usually occurs in the up-dose phase, i.e. when the lamotrigine dose is slowly increased. It should be emphasized that most of the side effects (with the exception of Stevens-Johnson Syndrome) are generally unpleasant, but not dangerous and disappear after a few weeks at the latest. The most common side effects are listed below.

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  • dizziness
  • a headache
  • Tiredness / drowsiness
  • skin rash
  • itching
  • Double vision
  • Sexual excitability increase
  • Cognitive limitations (e.g. forgetfulness)
  • Weight gain or loss
  • sleep disorders
  • Nausea / vomiting
  • Tremor (tremor)
  • Joint pain
  • Increased irritability
  • Allergic skin reactions up to Stevens-Johnson syndrome

Weight gain

Some epilepsy patients report weight gain while taking lamotrigine. This is based on the fact that lamotrigine intervenes in the regulation of the feeling of hunger in the brain.

In this context, it should be emphasized that weight gain with lamotrigine is a process that takes several weeks and does not occur “overnight”. If, just a few days after starting lamotrigine therapy, you suspect that you have gained weight, this is probably a misjudgment. In this case, be patient for at least two to three weeks and objectify the possible weight gain by weighing occasionally.

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If there is indeed significant weight gain after this period, consult your treating neurologist. He or she can discuss with you whether the lamotrigine should be replaced by another anti-epileptic drug or whether the weight gain is still tolerable and other measures to stabilize the weight are possible (e.g. exercise, change in diet).

Weight loss

Amazingly, a few patients respond to taking lamotrigine with weight loss. This is due to the complex regulation of the feeling of hunger in the brain and the influence of lamotrigine on the messenger substances involved.

Weight loss does not develop from one day to the next either, but takes several weeks to complete. Ideally, you should weigh yourself at least weekly to monitor the extent of weight loss. Because even if the loss of a kilo or two is quite right for some, losing weight too quickly is anything but healthy and should not be tolerated.

It is difficult to determine exact limit values ​​in this context due to the individual physical characteristics. As a rough rule of thumb, however, the following can be stated: Weight loss of more than 2 kilograms per week or 5 kilograms per month should be reported to the treating neurologist. Together with the patient, they can weigh up whether the weight loss is tolerable or whether they should switch to another anti-epileptic drug.

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In the majority of patients affected by weight loss with lamotrigine, the weight loss comes to a halt after the multi-week dose-up phase. For this reason, weight loss with lamotrigine can in most cases be accepted and therapy continued as long as the weight loss is not too dramatic.

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fatigue

One of the most common side effects of all anti-epileptic drugs, including lamotrigine, is fatigue.

This is due to the mechanism of action of antiepileptic drugs: By blocking certain ion channels that are involved in neuronal transmission in the brain, the increased brain excitability in epileptics is counteracted. While this lowers the risk of epileptic seizures, it also increases the mental fatigue of the patient.

In most cases, the tiredness occurs at the beginning of lamotrigine therapy and disappears after a few weeks, when the brain and its messenger metabolism have adjusted to the lamotrigine.

However, some people find the tiredness so annoying in their leisure time or at work that they occasionally refrain from taking lamotrigine. But skipping a single lamotrigine intake increases the risk of an epileptic seizure considerably. Before you go down this path in the hope of an improvement in your tiredness, it is better to speak to your treating neurologist and be aware that in the vast majority of cases, tiredness is only a phenomenon in the initial phase of therapy.

However, if you cannot live with the tiredness at all, be it because of a particularly severe severity or because you are working in a job that does not allow you to be tired, the neurologist can consider switching to another anti-epileptic drug with you. Because any anti-epileptic can potentially trigger fatigue. However, this does not mean that any other anti-epileptic drug will cause fatigue in a patient who is tired on lamotrigine.

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forgetfulness

Due to the fact that lamotrigine, like all anti-epileptic drugs, interferes with the neurotransmitter balance of the brain, this results in temporary cognitive impairment in some patients.

Often these express themselves in the form of forgetfulness. So if you have the impression during the lamotrigine dose increase that you are more forgetful than usual, there may well be a connection with the new drug. If forgetfulness does not restrict your leisure and work too much, it is advisable to continue lamotrigine therapy as planned.

However, if forgetfulness is too pronounced, consult your treating neurologist instead of skipping lamotrigine intake of your own accord. The latter is not a recommended solution, since skipping the intake once increases the risk of an epileptic fit. Instead, you should weigh up with the neurologist whether another anti-epileptic is an option for you, even if unfortunately all anti-epileptic drugs can at least theoretically cause forgetfulness.

skin rash

Some people with epilepsy who take lamotrigine develop a rash. In the vast majority of cases, this occurs right at the beginning of lamotrigine therapy. The rash usually starts on the trunk and face and, in more severe cases, can spread to the whole body. It initially manifests itself as reddening of the skin and itching, later blistering and peeling of the skin can follow.
If you develop a rash after taking lamotrigine, please consult your neurologist or family doctor as soon as possible. In the vast majority of those affected, the rash is limited to a circumscribed area and redness and itching, but it can also be a harbinger of the life-threatening, severe form of the disease, Stevens-Johnson syndrome.

Read more on the subject below Medication rash.

Hair loss

Even if there have been isolated reports of hair loss after taking lamotrigine, no proven statistical or biological relationship is known.

If you experience hair loss beyond the usual extent during therapy with lamotrigine, consult your family doctor. They can analyze whether you have another, more common cause of hair loss. Especially if the hair loss only occurs after prolonged use of lamotrigine and not in the high dose phase, a connection with the active ingredient is far less likely than other potential triggers. The latter include iron deficiency or hormonal changes.

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Are you suffering from hair loss? Read more on the subject at: Hair loss

libido

Some people with epilepsy suffer from impaired sexual function, usually in the form of a decreased libido.

Many anti-epileptic drugs are said to aggravate this decrease in libido. Lamotrigine is an exception in this context: a clinical study was able to show that lamotrigine increases libido. This effect is explained by the authors of the study with the mood stabilized by the lamotrigine.

Even if many patients benefit from this effect, as it counteracts the decrease in libido caused by epilepsy, some sufferers also find it uncomfortable. In this case, it can be decided together with the neurologist whether you should switch to another anti-epileptic drug. Most of the time, however, the influence of lamotrigine on libido is put into perspective by itself after a few weeks.

Side effects on the eyes

Occasionally double vision may occur during treatment with lamotrigine. This can lead to other symptoms such as headaches and nausea. For most people, this side effect only occurs during the first few days and weeks after starting lamotrigine. However, especially in professions in which such impairment of visual perception cannot be tolerated, it may be necessary to discontinue lamotrigine therapy and switch to another anti-epileptic drug.

Nystagmus, i.e. involuntary repetitive jerky movements of the eyes in the horizontal plane, is one of the most common symptoms of an acute overdose of lamotrigine. In most cases, this results from accidentally taking lamotrigine twice. If you notice any of these symptoms, see your neurologist or family doctor. He can get an impression of the extent of the overdose and, if necessary, initiate countermeasures.

You can find more information on the subject of nystagmus here: Nystagmus

a headache

A relatively large number of epilepsy patients experience headaches in the first few weeks after starting lamotrigine therapy.
The exact mechanism is not yet known, but a connection with the intervention of lamotrigine in neuronal transmission in the brain is obvious.

As a rule, the headache is dull and bilateral. The headache usually disappears after a few weeks, when the neurotransmitter balance of the brain has adjusted to the lamotrigine.

If the symptoms are too severe and stressful, contact your treating neurologist. This can analyze whether there is actually a connection with the lamotrigine therapy or whether there is another cause of the headache. In the former case, you can switch to another anti-epileptic if necessary.

Read more about headache on the following page: a headache

Increase in liver values

Particularly in the initial phase of lamotrigine therapy, some patients have an increase in liver values.

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Liver values ​​are specific liver-specific enzymes whose concentration in the blood can be determined with the help of a blood sample. An increased concentration suggests damage to the liver tissue.

The fact that increased liver values ​​can occur at the beginning of a lamotrigine intake is due to the fact that the lamotrigine is excreted via the liver and the organ is in a way overwhelmed with this task at the beginning. Since the liver cells show a considerable training effect, much like muscles, the liver values ​​mostly normalize after a few weeks.

Nevertheless, one or more blood samples should be taken to monitor liver function during the dosing phase. Based on the values ​​determined in it, the doctor can estimate the extent of the liver damage and decide whether the lamotrigine therapy can be continued. If not, the patient is switched to an anti-epileptic that is not excreted via the liver but the kidneys (e.g. gabapentin, levetiracetam).

You can find more information about liver values ​​here: Liver values

Side effects on the heart

Some patients report occasional palpitations on lamotrigine therapy. Even if no study on statistical or biological relationships is available so far, it is at least conceivable that lamotrigine can trigger such a side effect in the heart by influencing the circulatory center in the brain.

Since palpitations are often harmless, but can be very dangerous under certain circumstances, you should consult your neurologist or family doctor if you experience such symptoms. They can examine whether the lamotrigine is actually the most likely cause of the racing heart or whether there are other causes (e.g. heart or thyroid disease).

Read more about racing heart on the following page: Racing heart

itching

If an epilepsy patient itches while taking lamotrigine, this is usually accompanied by a rash on the itchy area. In this case, a doctor should be consulted, as the rash is usually harmless and temporary, but can also be a harbinger of a life-threatening form, the Stevens-Johnson syndrome.

If the itching occurs alone, i.e. without a rash, a different cause is more likely to be assumed (especially liver and gallbladder diseases). In this case, too, you should see a doctor in order to identify and treat the actual cause.

You can find more causes of itching here: itching

sweat

To date, there is no known statistical or biological association between lamotrigine and excessive sweating, although isolated patient reports indicate this. In particular, if sweating only occurs after prolonged use of lamotrigine and not already in the dosage phase, other causes are much more likely. Your GP can get to the bottom of this and investigate the most common causes of increased sweating. These primarily include hormonal and thyroid diseases.

Word finding disorders

Due to their intervention in the neuronal transmission of the brain, cognitive functional impairments can occur, especially in the increased dosage phase.

In addition to forgetfulness, word finding disorders are one of the most common manifestations: those affected do not want to think of common terms. Since this can lead to uncomfortable situations in private as well as at work, there is sometimes considerable suffering.

However, occasionally skipping lamotrigine intake is not a recommended solution, as skipping it once increases the risk of an epileptic fit. So if the word-finding disorders are no longer tolerable, talk to your neurologist about trying another anti-epileptic drug.

Difficulty concentrating

Concentration disorders represent a further form of the cognitive impairment that can occur during therapy with lamotrigine, especially in the initial phase. They usually only last a few days or weeks and disappear after the end of the dose.

However, if they persist for a long time or are so severe that they have a decisive impact on your private or professional life, your neurologist can arrange for you to switch to another anti-epileptic drug. It should be remembered, however, that theoretically every anti-epileptic can cause concentration disorders.

Pimples

There are individual patient reports that suggest a connection between lamotrigine intake and the development of pimples. So far, however, there has been no biological explanation or statistical confirmation for this connection. Especially if the pimples only appear after prolonged use of lamotrigine and not at the beginning of lamotrigine therapy, another cause is much more likely (especially hormonal changes). Therefore, in this case, going to the dermatologist is recommended.

Tremor (tremor)

Occasionally, people with epilepsy who take lamotrigine experience shaking, which when more than usual is called tremor.

The exact mechanism by which lamotrigine causes tremor has so far been reversed, but a connection with the influence on neuronal transmission in the brain is obvious. As a rule, the tremor subsides by itself after the end of the dosing phase. Accordingly, there is usually no need for therapy.

It only becomes a cause for concern if you work in an occupation in which tremor cannot be tolerated or if the tremor is so severe that it significantly restricts your quality of life. In these cases, a neurologist can discuss whether to stop lamotrigine therapy and choose another anti-epileptic drug.

You can find more information about tremors here: tremor

sleep disorders

Paradoxically, the more common side effects of lamotrigine include not only increased mental fatigue, but also insomnia. One explanation for this may be that the tiredness triggered by lamotrigine means that the person concerned is gentle on themselves and reducing their physical strain. However, since the increased fatigue only relates to the mind and not to the body, the latter is practically not “busy” at the end of the day and therefore not in the mood to go to sleep.

Persistent sleep disorders can become a significant burden for the well-being of the person concerned and reduce the quality of life. Therefore, in this case, it is advisable to consult your family doctor or neurologist. Together with the patient, the doctor can consider whether the insomnia is still tolerable and other measures can be taken (e.g. herbal or synthetic sleeping pills, exercise) or whether a switch to another anti-epileptic is necessary.

Joint pain

Some people taking lamotrigine complain of musculoskeletal pain, mostly affecting the joints. The biological mechanism is so far unclear. Other causes are much more likely, especially if the joint pain does not occur during the dosing phase but only after prolonged use of lamotrigine.
These include rheumatic or infectious diseases. The family doctor can make an initial sounding out of the most likely cause of the joint pain and, if necessary, refer you to a specialist. If no other cause can be found and lamotrigine is identified as the most likely cause of joint pain through a process of elimination, you should talk to the neurologist about switching to another anti-epileptic drug.

Read more about rheumatism at: Rheumatoid arthritis


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