Lamotrigine's Impact on Vaginal Health

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