Risks associated with lamotrigine prescription: a review and personal observations

To detail some serious lamotrigine side effects and their management, and raise awareness about the possible lack of quality control of some brands of lamotrigine. A literature review is provided and some personal observations added. While most psychiatrists are aware of the risks of Stevens–Johnson syndrome (SJS), awareness of two other serious side effects – toxic epidermal necrosis (TEN) and drug-related eosinophilia and systemic symptoms (DRESS) – is seemingly lower. Awareness that failure to respond to lamotrigine and that the prevalence of serious side effects may reflect poor quality control of some preparations is also less well recognized. While lamotrigine may be retrialled at a lower dose escalation rate following some skin reactions, it should not be recommenced following a SJS, TEN or DRESS reaction. Prescribers should be aware of quality control concerns about some available brands of lamotrigine