Lamotrigine rash: Signs, risks, and when to seek help

In this article:

• What does a lamotrigine rash look like?
• How serious is a lamotrigine rash?
• How do you treat a lamotrigine rash?

In this article

• What does a lamotrigine rash look like?
• How serious is a lamotrigine rash?
• How do you treat a lamotrigine rash?

Lamotrigine is the generic version of Lamictal, a medication that’s FDA-approved to treat seizures as well as bipolar I disorder. Lamotrigine is sometimes prescribed off-label to treat schizophrenia, fibromyalgia, and trigeminal neuralgia.

In some cases, lamotrigine can cause a rash (Lamictal rash), which can be either mild or more severe. Some severe lamotrigine rashes can be life-threatening. According to a 2015 meta-analysis, about 10% of people get a lamotrigine rash. If you notice any type of rash while taking lamotrigine, you should contact your healthcare provider right away for medical attention.

What does a lamotrigine rash look like?

Lamotrigine rashes can vary in appearance and how they feel, according to Dr. Soma Mandal, MD, internist at Summit Health. “Typically, these rashes may present as red, itchy patches on the skin,” she explains. “Some patients describe them as uncomfortable, with varying degrees of itchiness. In more severe cases, the rash can lead to blistering or peeling of the skin, which can feel painful,” Dr. Mandal shares.

Mild lamotrigine rashes may also produce small bumps on the skin, which can look like red blotches, according to Dr. Sean Ormond, MD, dual board-certified physician in anesthesiology and interventional pain management at Atlas Pain Specialists. “Mild rashes are more annoying than anything, but if the rash gets worse—becoming painful, blistered, or peeling—it could be a sign of a serious reaction,” he says. Severe symptoms should be taken seriously and reported right away to your healthcare provider.

How long does it take to get a rash?

According to MedlinePlus, it can take anywhere from two to eight weeks to develop a lamotrigine rash. It’s also possible to develop a rash from the medication before or after this timeframe. That’s why it’s vital to share any new rashes with your healthcare provider if you are taking lamotrigine.

While anyone can get a lamotrigine rash, certain risk factors may make you more likely to experience one. Dr. Ormond explains that you are more likely to get a lamotrigine rash if you start at a dose that’s too high or if the dose is increased too quickly after you start taking it.

Additionally, if you’re taking valproic acid (Depakote), another medication used to treat seizures, your risk of a lamotrigine rash increases. This is because valproic acid slows down how your body metabolizes lamotrigine.

Other factors that may increase your chances of developing a lamotrigine rash are genetics, allergies, and certain health conditions, like liver disease, according to Dr. Erika Gray, PharmD, founder and chief medical officer at MyToolBox Genomics.

“An individual’s sensitivity or allergic reaction to the medication may also play a role,” adds Dr. Mandal.

How serious is a lamotrigine rash?

According to Dr. Gray, there are two main types of rashes that can develop after taking lamotrigine: a regular rash and a much more serious rash. The more serious version of the rash is called Stevens-Johnson syndrome, which is very rare, impacting less than 1% of people.

How can you tell the difference between the two? Here’s what to know:

Regular (mild) lamotrigine rash symptoms

“A regular rash will present as small, flat or slightly raised, red or pinkish spots,” says Dr. Gray. “It can either be patchy or consistent across the body and is most commonly found on the torso, arms, or face.” While this rash may feel itchy or uncomfortable, it isn’t typically painful.

Stevens-Johnson syndrome symptoms

This is the more severe version of a lamotrigine rash, and usually first starts with rash symptoms around the mouth, throat, or genitals, Dr. Gray describes. “At first, people typically feel flu-like symptoms, and it will rapidly progress to a painful, blistering rash,” she says. Stevens-Johnson syndrome is extremely serious and can be life-threatening for some people, Dr. Gray emphasizes. 

How do you treat a lamotrigine rash?

If you have any type of lamotrigine rash, you should take action right away. This includes calling your healthcare provider for medical advice and to discuss the best course of action. Your provider can also help you distinguish between a mild lamotrigine rash vs. a more serious one.

How you treat a lamotrigine rash depends on which type of rash you have. If you have severe symptoms—flu-like symptoms, pain around your mouth and genitals—you should contact your healthcare provider right away. Although it may not be Stevens-Johnson syndrome, you should have your provider rule this out, as Stevens-Johnson syndrome can be fatal if not treated right away. 

“If you start noticing any unexplained peeling or blistering in or around your mouth, or if the rash on your body is starting to peel or cause pain, immediately stop taking lamotrigine and go to the emergency room,” Dr Gray advises. “Make sure you tell the people working in the emergency room that you have been taking lamotrigine so they can efficiently diagnose you, start you on a different medication for your condition, and start treatment if necessary.”

Regular, milder lamotrigine rash may be treated in a number of ways, says Dr. Ormond, including:

• Stopping the medication for a few days
• Lowering the dose
• Taking an antihistamine, like Benadryl, to help with itching
• Drinking plenty of water
• Avoiding hot showers
• Avoiding harsh soaps

The bottom line? While lamotrigine rash isn’t always serious, you should take it seriously and never ignore it. “Even if it seems minor, check in with your doctor to be safe,” Dr. Ormond emphasizes. “Catching a reaction early can prevent serious complications.”