Does Lamictal (lamotrigine) cause hair loss?

Lamotrigine (Lamictal) and Hair Loss

Lamotrigine (Lamictal) can cause hair loss in some patients, though it is not among the most commonly reported side effects of the medication. While not extensively documented in the provided guidelines, hair loss has been observed with various psychotropic medications including mood stabilizers like lamotrigine.

Evidence for Hair Loss with Lamotrigine

• Hair loss can occur as a side effect of many psychopharmaceuticals, including mood stabilizers like lamotrigine, though it is relatively uncommon 1
• Drug-induced hair loss is usually reversible and typically results from a toxic effect of the medication on the hair follicle matrix 2, 3
• The pattern of hair loss with medications like lamotrigine typically presents as telogen effluvium (diffuse shedding) rather than permanent alopecia 3

Comparison with Other Psychiatric Medications

• Lithium causes hair loss in 12-19% of long-term users, which is more frequently reported than with lamotrigine 1
• Valproic acid/divalproex precipitates alopecia in up to 12% of patients in a dose-dependent relationship, with incidences up to 28% observed with high valproate concentrations 1
• Carbamazepine-induced alopecia occurs at or below 6% 1
• Hair loss is less commonly reported with newer generation antidepressants and antipsychotics compared to older mood stabilizers 1

Management of Medication-Induced Hair Loss

• Discontinuation of the medication or dose reduction almost always leads to complete hair regrowth 1
• When considering medication changes due to hair loss, the therapeutic benefit of lamotrigine must be weighed against the cosmetic side effect 3
• The diagnosis of drug-induced alopecia is confirmed when improvement occurs after cessation of the suspected drug 4

Risk Factors and Differential Diagnosis

• Hair loss may be triggered by factors other than medication, including fever, severe illness, stress, and hormonal changes 5
• A thorough exclusion of potential confounders is necessary before attributing hair loss solely to lamotrigine 5
• Drug-induced hair loss typically presents as diffuse non-scarring alopecia that is reversible upon withdrawal of the drug 4

Clinical Approach to Suspected Lamotrigine-Induced Hair Loss

• Evaluate timing of hair loss in relation to medication initiation 5
• Rule out other common causes of hair loss including thyroid dysfunction, nutritional deficiencies, and androgenetic alopecia 5
• Consider dose reduction if clinically appropriate, as drug-induced hair loss may be dose-dependent 1
• Monitor for improvement after medication adjustment 4
• If lamotrigine is providing significant therapeutic benefit, discuss with the patient the typically temporary nature of medication-induced hair loss 3

Hair loss from lamotrigine should be recognized as a potential side effect that may affect treatment adherence, but in most cases, it is reversible and should be weighed against the therapeutic benefits of the medication for the individual patient 4.