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When taking lamotrigine (Lamictal), it is crucial to be aware of several safety concerns and warnings to ensure safe use. Below is a summary of potential risks and necessary precautions:

• Severe Skin Reactions and Allergic Reactions: Lamotrigine may cause serious skin rashes and allergic reactions, particularly if used in conjunction with medications like divalproex (Depakote) or valproic acid, or if the dosage is too high or increased too quickly. Serious rashes are more common in children and often develop within 2 to 8 weeks of starting treatment. Seek immediate medical attention if you experience any rash, blistering, peeling skin, painful sores, swelling, or difficulty breathing.

• Overactive Immune System: Rarely, an overactive immune response known as hemophagocytic lymphohistiocytosis (HLH) may occur, typically between 8 and 24 days after starting the medication. Symptoms include fever, rash, abdominal pain, brown urine, and yellowing of the skin or eyes. Immediate medical care is necessary if these symptoms arise.

• Irregular Heartbeat: Lamotrigine can potentially cause irregular heartbeats, especially in individuals with heart disease or those taking other medications affecting heart rhythm. Discuss any history of heart conditions with your healthcare provider before starting treatment.

• Suicidal Behavior and Thoughts: Like many antiseizure medications, lamotrigine may increase the risk of suicidal thoughts or actions, particularly if you have a history of depression or suicidal behavior. Inform friends and family to monitor for mood changes, and contact your healthcare provider if suicidal thoughts or actions occur.

• Meningitis: Lamotrigine can increase the risk of meningitis, a serious brain inflammation. Symptoms such as headache, stiff neck, fever, rash, and sensitivity to light can appear from 1 to 45 days after starting the medication. Seek immediate medical assistance if these symptoms develop.

• Withdrawal Seizures: Stopping lamotrigine abruptly can lead to withdrawal seizures. Never discontinue use suddenly without consulting your healthcare provider, who can guide you on how to taper the dosage safely.

• Possible Eye Problems: Long-term use of lamotrigine may be associated with eye issues due to its interaction with melanin. Notify your healthcare provider if you notice any changes in vision, as they may recommend an eye examination.

• Interactions with Other Medications: Some medications may alter how lamotrigine is processed in the body, affecting its efficacy and the likelihood of side effects. Likewise, lamotrigine may impact the effectiveness and side effects of other drugs. Discuss all medications you are taking with your healthcare provider to avoid potential interactions.

For any concerns or more detailed information, consult your healthcare provider. If you experience an overdose, contact emergency services immediately.

Common side effects:

• dizziness
• headache
• drowsiness
• upset stomach
• nausea
• vomiting
• blurred or double vision
• loss of coordination
• sleepiness
• stuffy nose
• sore throat
• rash

Less common but important to monitor:

• tremors
• tiredness
• diarrhea
• indigestion
• constipation
• dry mouth
• flu-like symptoms
• cough
• trouble sleeping

Serious side effects:

• fainting
• irregular heartbeat
• easy bruising or bleeding
• stiff neck
• vision problems
• muscle pain
• signs of kidney issues like changes in urine output
• worsening seizures
• anxiety
• unusual changes in mood, thoughts, or behavior
• signs of depression
• suicidal thoughts

Interactions with high risk of serious adverse effects and should be avoided:

• Dofetilide
• Orlistat

Interactions with moderate risk that may require dose adjustment, closer monitoring, or timing changes:

• Hormonal birth control (pills, patches)
• Estrogens
• Phenobarbital
• Primidone
• Valproic Acid
• Rifampin
• Ritonavir
• Escitalopram
• Sertraline
• Alcohol
• Cannabis
• Antihistamines (Cetirizine, diphenhydramine)
• Sleep or anxiety medications (Alprazolam, Diazepam, Zolpidem)
• Muscle relaxants
• Opioid pain relievers (codeine)