What are the side effects of lamotrigine (Lamictal) and aripiprazole (Abilify), and how long after starting these medications do they usually appear?

Medical Advisory BoardAll articles are reviewed for accuracy by our Medical Advisory Board
Educational purpose only • Exercise caution as content is pending human review
Article Review Status
Submitted
Under Review
Approved

Last updated: November 5, 2026 • View editorial policy

Have a follow-up question?

Our Medical A.I. is used by practicing medical doctors at top research institutions around the world. Ask any follow up question and get world-class guideline-backed answers instantly.

Ask Question

Side Effects of Lamotrigine (Lamictal) and Aripiprazole (Abilify)

Both medications have distinct side effect profiles that typically emerge within the first 30 days of treatment, with lamotrigine requiring particular vigilance for rash (10-17% incidence) and aripiprazole commonly causing akathisia and sedation in the early treatment period.

Lamotrigine (Lamictal) Side Effects

Most Common Side Effects

The five most frequent adverse events include 1:

  • Ataxia (unsteadiness)
  • Dizziness
  • Diplopia (double vision)
  • Somnolence (sleepiness)
  • Headache

Critical Safety Concern: Rash

  • Incidence: 10-17% of patients on lamotrigine versus 6-10% on placebo 1
  • This is the most important side effect to monitor given the risk of serious dermatologic reactions
  • Slower titration significantly reduces rash risk

Less Common but Notable Side Effects

  • Psychiatric symptoms: Affective switches, acute psychotic episodes, hallucinations, anxiety, emotional lability, and irritability 2
  • Manic induction: Particularly in bipolar I patients, those with manic predominant polarity, or history of antidepressant-induced mania 3
  • Movement abnormalities: Eye movement abnormalities, tremor, chorea, involuntary movements 4
  • End-of-dose withdrawal symptoms: Anxiety, emotional lability, irritability occurring 1-2 hours before next dose, even on stable dosing 5

Discontinuation Rates

  • 1-5% discontinuation due to adverse events in clinical trials 1

Aripiprazole (Abilify) Side Effects

Most Common Side Effects (FDA Label Data)

In adults with schizophrenia/bipolar disorder 6:

  • Akathisia (25% in depression augmentation studies)
  • Somnolence/sedation (6-23% depending on indication)
  • Extrapyramidal symptoms (5-20%)
  • Restlessness (12% in depression studies)
  • Insomnia (8%)
  • Constipation (5%)
  • Fatigue (8-11%)
  • Nausea (11%)

In pediatric patients 6:

  • Sedation (13-21%)
  • Somnolence (10-13%)
  • Extrapyramidal disorder (6-20%)
  • Fatigue (8-17%)
  • Weight gain (3%)
  • Tremor (9-10%)
  • Akathisia (6-10%)

Critical Safety Concerns

Impulsive-compulsive behaviors 7:

  • Gambling disorder
  • Hypersexuality
  • Obsessive-compulsive symptoms
  • Problem eating, shopping, kleptomania
  • Mean onset: within 30 days of starting aripiprazole
  • Mean dose associated: 11.63 mg/day
  • Resolution: typically within 30 days of discontinuation or dose reduction

Elderly patients with dementia 6:

  • Increased mortality risk
  • Lethargy (5%)
  • Somnolence/sedation (8%)
  • Urinary incontinence (5%)
  • Excessive salivation (4%)
  • Lightheadedness (4%)

Discontinuation Rates

  • 6-10% in adults 6
  • 7-10% in pediatric populations 6

Timeline of Side Effect Emergence

Lamotrigine

  • Rash: Can occur at any point during titration but risk is highest during the first 8 weeks
  • Neurological side effects (dizziness, ataxia, diplopia): Typically emerge during titration phase
  • Psychiatric symptoms: Can occur within weeks of initiation or dose increases 2
  • End-of-dose symptoms: Develop after stable dosing is achieved, occurring 1-2 hours before next dose 5

Aripiprazole

  • Akathisia and extrapyramidal symptoms: Often emerge within the first 1-4 weeks 6
  • Sedation/somnolence: Typically appears early in treatment (first 2-4 weeks)
  • Impulsive-compulsive behaviors: Majority appear within 30 days of starting treatment 7
  • Metabolic effects: Can develop over weeks to months

Critical Clinical Pitfalls

For Lamotrigine

  1. Rapid titration increases rash risk: Slower titration (25-50 mg increments every 1-2 weeks) significantly reduces adverse events 1
  2. Drug interactions matter: Valproate doubles lamotrigine levels—use half the standard dose 1
  3. Manic switch risk: Avoid in bipolar I patients with manic predominance without adequate antimanic coverage 3
  4. Withdrawal symptoms: Even on stable doses, patients may experience end-of-dose symptoms requiring dose redistribution 5

For Aripiprazole

  1. Monitor for impulsive behaviors: Specifically ask about gambling, sexual behavior, shopping, and eating patterns at every visit during the first 2 months 7
  2. Akathisia is dose-related: Consider starting at lower doses (2-5 mg) in sensitive patients 6
  3. Educate patients and families: About impulsive-compulsive behaviors before starting treatment 7
  4. Elderly patients: Avoid in dementia-related psychosis due to increased mortality risk 6

References

4
Research

Unusual side effects of lamotrigine therapy.

Journal of child neurology, 2003

Related Questions

Are there any medications similar to quetiapine fumarate that are effective for bipolar disorder?
Can lamotrigine (Lamictal) cause a feeling of euphoria?
Is it safe to increase risperidone from 4 mg to 9 mg nightly and lamotrigine from 50 mg to 200 mg daily in a 65‑year‑old patient with bipolar disorder currently in a severe depressive episode with psychotic features, generalized anxiety disorder, chronic insomnia, and recurrent major depressive disorder?
A patient increased lamotrigine from 25 mg to 50 mg and experienced dissociation; what management advice should be given?
Can lanreotide (Somatostatin analogue) cause mood swings?
What renal stone size is considered concerning and warrants urologic evaluation?
Can trimethoprim‑sulfamethoxazole (Bactrim) tablets be crushed?
Can benzodiazepines be used to treat acute mania, or are they only short‑term adjuncts for agitation while mood‑stabilizing or antipsychotic therapy is initiated?
In a patient with multivessel coronary artery disease characterized by a 30% left main ostial stenosis, a 95% heavily calcified mid left anterior descending artery lesion, a 90% calcified proximal left circumflex lesion, and a 100% occluded proximal right coronary artery with TIMI (Thrombolysis In Myocardial Infarction) flow 0 and collateral circulation, what is the preferred revascularization strategy?
Can a patient with vasculitis safely receive the annual inactivated influenza vaccine, and how should timing be adjusted for disease stability and immunosuppressive therapy?
In a patient with systemic lupus erythematosus being monitored for renal involvement and electrolyte disturbances, what is the significance of elevated monocytes, lymphocytes, and eosinophils and how should this be evaluated?

Professional Medical Disclaimer

This information is intended for healthcare professionals. Any medical decision-making should rely on clinical judgment and independently verified information. The content provided herein does not replace professional discretion and should be considered supplementary to established clinical guidelines. Healthcare providers should verify all information against primary literature and current practice standards before application in patient care. Dr.Oracle assumes no liability for clinical decisions based on this content.