The majority of patients who take Lamictal (lamotrigine) have no side effects or mild side effects that are temporary or can be easily treated. However, more serious reactions do occur very rarely. The most important is a serious rash that may need to be treated in the hospital. Some patients develop a rash called Stevens-Johnson syndrome, which can be fatal.

Here's a list of symptoms that may be the start of a serious problem. If you notice any of these symptoms, call your doctor right away:

• Rash or hives
• Fever and swollen lymph glands
• Painful sores in the mouth or around the eyes
• Swelling of lips or tongue

A serious rash while taking Lamictal has been reported in about 0.3% of adults (3 in 1000) and 1% of children (1 in 100, up to age 16). The risk may be greater if Lamictal is taken in combination with Depakote, or if the dosage is rapidly increased when it is first given. Be sure to follow your doctor's instructions about dosage—it's important to start with a low dose and increase it gradually to avoid serious reactions. Call your doctor immediately at the first sign of a rash so he or she can decide whether you should stop taking Lamictal. Do not stop taking Lamictal or any other seizure medicine unless your doctor advises you to.

A complete list of all reactions to Lamictal can be found in the package insert, but it is important to remember that only a tiny number of people who take it have any of these serious problems.

On July 10, 2008, an advisory panel was convened by the Food and Drug Administration (FDA) to review data that the FDA had previously collected from drug studies showing an association between many of the antiepileptic drugs (AEDs) and suicidal ideation and behavior, which together are called suicidality. According to the FDA’s Alert, among the patients with epilepsy in these drug studies, 1 out of 1000 people taking the placebo (inactive substance) showed suicidality compared to approximately 3.5 out of 1000 people who took an AED. The FDA advisory panel voted to accept the FDA's data at its meeting on July 10. The FDA has provided the following information for patients, family members, and caregivers at www.fda.gov/cder/drug/InfoSheets/HCP/antiepilepticsHCP.htm.

• Taking antiepileptic medicines may increase the risk of having suicidal thoughts or actions;
• Do not make any changes to the medication regimen without first talking with the responsible healthcare professional;
• Pay close attention to any day-to-day changes in mood, behavior and actions. These changes can happen very quickly so it is important to be mindful of any sudden differences.
• Be aware of common warning signs that might be a signal for risk of suicide. Some of these are:
  • Talking or thinking about wanting to hurt yourself or end your life
  • Withdrawing from friends and family
  • Becoming depressed or having your depression get worse
  • Becoming preoccupied with death and dying
  • Giving away prized possessions

We again urge patients and families to contact their doctor before stopping an epilepsy medication because this may possibly lead to seizures and worsening of mood.

Reviewed July 2008 by Steven C. Schachter, MD, epilepsy.com Editorial Board.