Lamictal Adverse Reactions

The undesirable effects for epilepsy and bipolar disorder indications are based on available data from controlled clinical studies and other clinical experience and are listed in the table as follows. Frequency categories are derived from controlled clinical studies (epilepsy monotherapy [identified by^†] and bipolar disorder [identified by^§]). Where frequency categories differ between clinical trial data from epilepsy and bipolar disorder the most conservative frequency is shown. However, where no controlled clinical trial data are available, frequency categories have been obtained from other clinical experience.
The following convention has been utilised for the classification of adverse events: Very common (≥ 1/10); common (≥ 1/100 to < 1/10); uncommon (≥ 1/1000 to < 1/100); rare (≥ 1/10,000 to < 1/1000); very rare (< 1/10,000), not known (cannot be estimated from the available data). (See Table 7.)

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Description of selected adverse reactions: ¹ Haematological abnormalities and lymphadenopathy may or may not be associated with the hypersensitivity syndrome (see Immune system disorders as previously mentioned in Table 7).
² Rash has also been reported as part of a hypersensitivity syndrome associated with a variable pattern of systemic symptoms including fever, lymphadenopathy, facial oedema and abnormalities of the blood and liver. The syndrome shows a wide spectrum of clinical severity and may, rarely, lead to disseminated intravascular coagulation (DIC) and multi-organ failure. It is important to note that early manifestations of hypersensitivity (e.g. fever, lymphadenopathy) may be present even though rash is not evident. If such signs and symptoms are present, the patient should be evaluated immediately and LAMICTAL discontinued if an alternative aetiology cannot be established.
³ These effects have been reported during other clinical experience.
There have been reports that LAMICTAL may worsen parkinsonian symptoms in patients with pre-existing Parkinson's disease, and isolated reports of extrapyramidal effects and choreoathetosis in patients without this underlying condition.
⁴ Hepatic dysfunction usually occurs in association with hypersensitivity reactions but isolated cases have been reported without overt signs of hypersensitivity.
⁵ In clinical trials in adults, skin rashes occurred in up to 8 - 12% of patients taking LAMICTAL and in 5 - 6% of patients taking placebo. The skin rashes led to the withdrawal of LAMICTAL treatment in 2% of patients. The rash, usually macropapular in appearance, generally appears within eight weeks of starting treatment and resolves on withdrawal of LAMICTAL (see Precautions).
Serious potentially life threatening skin rashes, including Stevens Johnson syndrome and toxic epidermal necrolysis (Lyell's syndrome) have been reported. Although the majority recover on drug withdrawal, some patients experience irreversible scarring and there have been rare cases of associated death (see Precautions).
The overall risk of rash, appears to be strongly associated with: high initial doses of LAMICTAL and exceeding the recommended dose escalation of LAMICTAL therapy (see Dosage & Administration); concomitant use of valproate (see Dosage & Administration).
Rash has also been reported as part of a hypersensitivity syndrome associated with a variable pattern of systemic symptoms (see Immune system disorders as previously mentioned in Table 7).
There have been reports of decreased bone mineral density, osteopenia, osteoporosis and fractures in patients on long-term therapy with LAMICTAL. The mechanism by which LAMICTAL affects bone metabolism has not been identified.