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 (
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 [
Lamotrigine overdose may manifest as angioedema, and
urticaria. Health care providers should be aware about these complications and able to medically optimize the patient as needed.