From the Research
Yes, Lamictal (lamotrigine) can cause elevated liver function tests (LFTs), though this is relatively uncommon. Most cases of LFT elevations with lamotrigine are mild and transient, occurring in approximately 1-10% of patients 1. Severe liver injury is rare but has been reported, particularly as part of serious hypersensitivity reactions that typically occur within the first 8 weeks of treatment.
Key Points to Consider
- Patients taking lamotrigine should have baseline LFTs checked before starting treatment, with periodic monitoring recommended, especially during the initial months of therapy.
- Risk factors for lamotrigine-induced liver abnormalities include rapid dose escalation, concurrent use of valproate (which inhibits lamotrigine metabolism), and a history of liver disease.
- The mechanism behind lamotrigine's effect on the liver likely involves the formation of reactive metabolites that can trigger immune-mediated responses in susceptible individuals 2.
- If a patient on lamotrigine develops symptoms such as jaundice, right upper quadrant pain, fatigue, or nausea, prompt medical evaluation is necessary, and the medication may need to be discontinued if significant liver abnormalities are confirmed.
Monitoring and Management
- Monitoring the hepatic function in patients who have just been initiated on lamotrigine is crucial, especially if they develop jaundice 2.
- In advanced liver disease, drugs with predominant hepatic metabolism and/or excretion, particularly those with a narrow therapeutic index, should be used with caution 3.
- Prescribing practices may need altering in the presence of decompensated cirrhosis 3.