Lamictal Rash: Symptoms, Causes, and Treatment

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

Despite its widespread use, Lamictal can cause a hypersensitivity reaction marked by severe rash and inflammation, leading to a black box warning from the U.S. Food and Drug Administration (FDA).

If you experience a rash while taking Lamictal, see your doctor immediately. If it's spreading quickly, call 911 or go to the nearest emergency room.

Symptoms of Rash

Early-onset symptoms of a Lamictal reaction include:

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

More severe rash symptoms can include:

• Peeling skin
• Painful blisters
• Inflammation of the eyes
• Swollen lymph nodes
• Flu-like symptoms

Hypersensitivity Reactions to Lamictal

Lamictal can cause hypersensitivity reactions, including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), and drug reaction with eosinophilia and systemic symptoms (DRESS syndrome). These conditions manifest as severe rashes typically developing after two to eight weeks of drug use, with mortality rates ranging from 5% to 30%.

Stevens-Johnson Syndrome (SJS)

SJS can be preceded by flu-like symptoms and is characterized by a quickly spreading rash, swelling of the face and tongue, and severe blistering of the mouth, nose, and eyes. The skin rash can be painful and lead to the detachment and shedding of skin.

Toxic Epidermal Necrolysis (TEN)

TEN is a more severe form of SJS, involving the detachment of more than 30% of skin. The risk of death from TEN is four to five times greater than SJS.

DRESS Syndrome

DRESS syndrome is a drug reaction causing rash alongside severe nerve pain and inflammation of a major organ (often the liver, kidneys, lungs, heart, muscles, or pancreas).

Causes of Hypersensitivity

• Age: People under 17 are more likely to have a reaction.
• Dosage: Taking more than the recommended dose, increasing the dose too quickly, or stopping treatment and starting again at the full dose can increase the risk.
• Concurrent Medications: Taking Depakene (valproic acid) or Depakote (sodium valproate) with Lamictal can increase the risk.

Hypersensitivity can also occur when taking the drug as prescribed, with genetic factors and idiopathic causes contributing.

The risk of hypersensitivity is about three times higher with Lamictal compared to other mood stabilizers, and the risk doubles in those under 16.