Open Journal of Internal Medicine
Vol.3 No.2(2013), Article ID:32420,3 pages DOI:10.4236/ojim.2013.32016

Lamotrigine overdose cause skin rash and angioedema*

Mohammad Alkayem1#, Hussein Assallum2

Department of Internal Medicine, Lincoln Medical and Mental Health Center, New York, USA


Copyright © 2013 Mohammad Alkayem, Hussein Assallum. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received 9 April 2013; revised 9 May 2013; accepted 16 May 2013

Keywords: Lamotrigine; Over Dose; Angioedema


A 23 years old female presented to Lincoln Medical and Mental Health center with skin rash and angioedema after she received 20 pills of lamotrigine 25 mg, and the patient used to take this medication before two tables a day for many months, after she received the appropriate management she improved. After reviewing MEDLINE we found a few cases reported life threatening complications related to lamotrigine intoxication and sudden increase the dose, so we should be aware about these complications before prescribing this medication.


To describe the physical manifestations of lamotrigine toxicity presenting as skin rash and angioedema.


A 23 years old Hispanic female presented to Lincoln Medical and Mental Health Center with itchy rash affecting her face, body, and swelling of her eyelids and lower lip, after taking approximately 20 pills of lamotrigine in an apparent suicide attempt. She denies SOB, cough, fever, palpitation, headache or blurry vision. She has history of bipolar disorder and used to be on lamotrigine 25 mg bid for many months. No other significant medical history. No history of allergies. Patient uses Alcohol daily and Marijuana sometimes. Physical exam show mild edema in eyes lids, few erythematous edematous papules on cheeks, bilateral upper extremities (Figures 1 and 2), lower extremities, chest, abdomen and back. The rest of physical exam was normal. Blood work normal, urine toxicology was positive for Marijuana. EKG showed prolonged QT interval (Figure 3). Steroids and anti-histamine started which improved her symptoms.

Dermatology assessment: Urticarial with angioedema, may be related to lamotrigine overdose.


In our case, the patient developed mild angioedema and urticaria, 12 - 24 hours, after she took approximately 500 mg of lamotrigine. Lamotrigine is a new antiepileptic medication approved by the US Food and Drug Administration as adjunctive treatment of partial seizures in adults and children, as well as for adjunctive therapy for primary generalized tonic-clonic seizures and Lennox-Gastaut syndrome [1,2]. It is also used as first line medication for bipolar disorder maintenance treatment [3]. Common side effects of lamotrigine at regular dose include nausea, vomiting, chest pain, peripheral edema, insomnia, somnolence, impaired coordination, dizziness, ataxia, irritability, rash, dermatitis, dysmenorrhea, increased libido, dyspepsia, nystagmus, abnormal vision, and in rare cases have been reported to cause multiorgan hypersensitivity reactions, life-threatening skin rashes, CNS depression, aseptic meningitis [4-7]. Overdose of lamotrigine usually causes drowsiness, lethargy, nausea, vomiting, ataxia, dizziness, tachycardia, coma, respiratory depression. There is report of a case in which lamotrigine caused anticonvulsant hypersensitivity syndrome [8,9]. The incidence of urticaria, periorbital and lip edema, immediately after Lamotrigine overdose in our patient, made us suspect overdose as the cause of the symptoms.


Lamotrigine overdose may manifest as angioedema, and

Figure 1. EKG show sinus tachycardia with prolong QT intervals.

Figure 2. Rashes in the patient trunk.

Figure 3. Rashes in medial aspect of left lower extremity.

urticaria. Health care providers should be aware about these complications and able to medically optimize the patient as needed.


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*Guarantor of Submission: The corresponding author is the guarantor of submission.

Author’s Contributions: Mohammad Alkayem, MD: first author, wrote whole the case, took the consent and the Images, prepared the article for publication and sent it to OJIM. Hussein Assallum, MD: second author, reviewed and revised the article.

Conflict of Interest: Null.

#Corresponding author.