From the Research
Yes, lamotrigine can cause elevations in liver function tests (LFTs). This antiepileptic medication, commonly used for seizure disorders and bipolar disorder, has been associated with mild to moderate increases in liver enzymes in approximately 5-10% of patients, as reported in various studies, including 1 and 2. These elevations are typically asymptomatic and transient, often resolving even with continued treatment. However, in rare cases (estimated at less than 0.1%), lamotrigine can cause severe hepatotoxicity or drug-induced liver injury, as documented in a case report published in 1.
Risk Factors and Mechanism
Patients taking lamotrigine should have baseline LFTs checked before starting treatment, with periodic monitoring recommended, especially during the first few months of therapy. Risk factors for lamotrigine-induced liver abnormalities include concomitant use of other hepatotoxic medications (particularly valproate), pre-existing liver disease, and rapid dose escalation, as suggested by studies such as 3 and 4. The mechanism behind lamotrigine's effect on the liver likely involves the formation of reactive metabolites that can trigger immune-mediated responses or direct hepatocellular damage.
Clinical Recommendations
If a patient develops symptoms of liver dysfunction (jaundice, abdominal pain, fatigue, nausea) while on lamotrigine, the medication should be promptly discontinued and medical evaluation sought, as advised in 5. It is also crucial for prescribers to be aware of quality control concerns about some available brands of lamotrigine, as highlighted in 5, to minimize the risk of adverse effects.
Monitoring and Management
- Baseline LFTs should be checked before starting lamotrigine.
- Periodic monitoring of LFTs is recommended, especially during the initial months of treatment.
- Patients should be educated on the signs of liver dysfunction and the importance of reporting these symptoms promptly.
- In cases of suspected lamotrigine-induced liver injury, the drug should be discontinued, and the patient should undergo a thorough medical evaluation.