Lamotrigine is a medication used to help manage epileptic seizures and bipolar disorder1. Side effects of lamotrigine may include reproductive, vaginal and urinary tract symptoms and are reported to occur in about four per cent of those taking the drug.
It is unclear why this happens, but when the person stops taking lamotrigine, the issues disappear. When the drug is reintroduced, symptoms return.2
Urogenital and reproductive side effects of lamotrigine3
- Vaginitis (vaginal inflammation)
- Painful, sore or itchy vagina
- Painful periods
- Changes to the menstrual cycle
- Changes to sexual desire, including an increase
- Urinary frequency
- Burning or pain during urination
Other side effects include3
- Headache
- Dizziness
- Blurred or double vision
- Lack of coordination
- Sleepiness
- Nausea,
- Vomiting
- Insomnia, oversleeping
- Tremor
- Rash
- Fever
- Abdominal pain
- Back pain
- Fatigue
- Dry mouth3
- Allergic reaction
- Skin rashes with blistering, peeling, redness
- Bloody stools, stomach upset, bloating
- Chest pain
- Extreme weakness, dizziness or fainting
- Swollen glands
- Suicidal ideation
- Aches, joint pain
- Eye twitches
- Moodiness
- Appetite changes, weight loss
- Nose bleeds
- Runny, stuffy nose
- Swelling of hands, feet, ankles, face
How does lamotrigine work?
Researchers are still not exactly sure how lamotrigine works. This makes it tricky to work out how exactly it could cause vaginal and urinary tract symptoms.
We do know lamotrigine binds to and inhibits voltage-gated sodium channels, which in turn stabilises presynaptic neuronal membranes and inhibits presynaptic glutamate and aspartate release. It is not believed that lamotrigine has significant effects on other neurotransmitters (serotonin, norepinephrine, dopamine).4
A theory put forward suggests lamotrigine may interact with voltage-activated calcium-gated channels, which in turn may have broad impacts. Lamotrigine inhibits dihydrofolate reductase, which may indicate teratogenicity. Lamotrigine has a half-life in-vitro of 29 hours.
References
- 1.Ramsay RE. Advances in the Pharmacotherapy of Epilepsy. Epilepsia. Published online November 1993:S9-S16. doi:10.1111/j.1528-1157.1993.tb05922.x
- 2.Jafferany M, Shireen F, Ibrahim A. Lamotrigine-Induced Vaginitis and Dysuria in an Adult Woman With Bipolar Depression. Prim Care Companion J Clin Psychiatry. Published online June 3, 2010. doi:10.4088/pcc.09l00881gre
- 3.Schachter SC, Leppik IE, Matsuo F, et al. Lamotrigine: A six-month, placebo-controlled, safety and tolerance study. Journal of Epilepsy. Published online August 1995:201-209. doi:10.1016/0896-6974(95)00034-b
- 4.Verrotti A, Striano P, Iapadre G, et al. The pharmacological management of Lennox-Gastaut syndrome and critical literature review. Seizure. Published online December 2018:17-25. doi:10.1016/j.seizure.2018.10.016
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