From the Research
Yes, lamotrigine can cause liver function tests (LFTs) to increase, though this is relatively uncommon. Lamotrigine-induced liver injury typically presents as mild to moderate elevations in liver enzymes such as ALT and AST, usually occurring within the first 6 months of treatment. Most cases are asymptomatic and resolve with dose reduction or discontinuation of the medication. Severe hepatotoxicity is rare but has been reported, as seen in a case report of fatal progressive hepatic necrosis associated with lamotrigine treatment 1. The mechanism appears to be an idiosyncratic immune-mediated reaction rather than direct liver toxicity.
Some key points to consider:
- Patients taking lamotrigine should have baseline LFTs checked before starting treatment, with periodic monitoring recommended, especially during dose adjustments 2.
- Risk factors for liver enzyme elevation include concomitant use of other hepatotoxic medications, particularly valproate which can increase lamotrigine levels.
- If a patient develops symptoms such as jaundice, right upper quadrant pain, fatigue, or nausea while on lamotrigine, prompt evaluation of liver function is warranted.
- For most patients, the benefits of lamotrigine therapy outweigh this potential risk, but careful monitoring is necessary to minimize the risk of adverse effects.
It's worth noting that the most recent study available, from 2021, discusses the effects of ursodeoxycholic acid on liver function and atherosclerosis, but does not directly address lamotrigine-induced liver injury 3. However, the study that is most relevant to the question of lamotrigine-induced liver injury is the one from 2008, which reports a case of reversible severe hepatitis associated with lamotrigine 2.
In terms of management, baseline LFTs should be checked before starting lamotrigine, and periodic monitoring is recommended, especially during dose adjustments. If liver enzyme elevations occur, the medication should be discontinued or the dose reduced, and the patient should be closely monitored for signs of liver failure. Overall, while lamotrigine can cause liver function tests to increase, the risk is relatively low, and with proper monitoring and management, the benefits of the medication can outweigh the risks.