From the Guidelines
If a patient on lamotrigine develops oral ulcers, the medication should be immediately discontinued and the patient should seek urgent medical attention. Oral ulcers can be an early sign of Stevens-Johnson syndrome or toxic epidermal necrolysis, which are rare but potentially life-threatening skin reactions associated with lamotrigine 1. While awaiting medical evaluation, the patient can use topical oral pain relievers like benzocaine or lidocaine for comfort and maintain good oral hygiene with gentle saltwater rinses. The healthcare provider will evaluate the severity of the reaction and determine appropriate next steps, which may include hospitalization in severe cases. These serious skin reactions typically occur within the first 8 weeks of treatment or following a dosage increase, which is why lamotrigine is typically started at a low dose and gradually increased. The risk is also higher when lamotrigine is combined with valproate or when the recommended initial dosing and titration schedule is not followed. However, the provided evidence does not directly address the management of oral ulcers in patients taking lamotrigine, but rather focuses on the management of various other conditions, including Behçet's disease 1, ulcerative colitis 1, and peptic ulcer disease 1. In the context of Behçet's disease, topical measures such as local corticosteroids are recommended as the first line of treatment for isolated oral and genital ulcers 1. But in the case of lamotrigine-induced oral ulcers, the primary concern is the potential for a severe skin reaction, and thus the medication should be discontinued and medical attention sought promptly. It's also worth noting that the evidence provided does not specifically address the use of lamotrigine or the management of oral ulcers in the context of this medication, so the recommendation is based on general principles of managing potential severe skin reactions associated with lamotrigine. In general, when managing oral ulcers, it's essential to consider the underlying cause and tailor treatment accordingly, which may include topical therapies, systemic medications, or a combination of both, as seen in the management of Behçet's disease 1 or ulcerative colitis 1. However, the immediate discontinuation of lamotrigine and seeking medical attention is the priority in this scenario.
From the Research
Lamotrigine-Induced Oral Ulcers
- Oral ulcers can occur in patients taking lamotrigine, especially after the discontinuation or dosage decrease of inducers such as oxcarbazepine or carbamazepine 2.
- The development of oral ulcers may be a sign of lamotrigine toxicity, which can occur several weeks after the discontinuation or dosage decrease of inducers 2.
- Drug-induced oral ulcerations can be caused by direct contact between the drug and the oral mucosa, or as part of a complex reaction with cutaneous or systemic manifestations 3.
- Solitary oral ulcerations usually appear after a few weeks of treatment and may resist conventional treatments, with rapid healing following the suppression of the responsible drug 3.
Management of Lamotrigine-Induced Oral Ulcers
- If a patient on lamotrigine develops oral ulcers, the medication should be discontinued or the dosage adjusted to prevent further toxicity 2, 4.
- Dental medicine professionals should be aware of the risks involved with using lamotrigine and recognize the population at risk among patients suffering from epilepsy, bipolar, and neurologic disorders 4.
- Exfoliative cytology can be performed to reassure the patient that the oral ulcer is not a sign of oral cancer, and to confirm the presence of a nonspecific inflammatory reaction 5.
Importance of Monitoring and Cooperation
- Hospital psychiatrists and dental medicine professionals should be aware of the potential for lamotrigine-induced oral ulcers and monitor patients closely for signs of toxicity 2, 4.
- Cooperation between clinicians and dentists is essential to adjust the prescribed medication and resolve symptoms 5.
- Patients taking lamotrigine should be informed of the potential risks and monitored regularly for signs of oral ulcers or other adverse effects 6.