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Hair Loss and Lamotrigine

09/01/2005

Question:

I read in one of your q and a`s about a relationship between lamictal and hair loss. I am currently on lamictal for bipolar spectrum disorder and am experiencing massive hair loss. My prescribing NP INSISTS that lamictal does NOT cause hair loss. That said, my question is when the medication is discontinued (if lamictal is the culprit) will the hair immediately stop falling out. Will the hair regrow and thicken up? I am quite frightened especially since it will take a few weeks (I presume) to get off the medication safely and I am female! Thank you.

Answer:

There are many possible causes for hair loss. While hair loss is often considered to be mainly a problem in men, by the age of fifty, most people have noticeable hair loss. Normal hair loss in women may be masked somewhat by hair styling choices. A search for information about this topic (alopecia) on Netwellness returned 45 responses. Reading these responses may provide additional information.

Another name for Lamictal®, is lamotrigine. It is a medication used to treat epilepsy either alone or in combination with other antiepileptic drugs. It may also be used to treat seizures associated with Lennox-Gastaut Syndrome and bipolar disorder.

Lamotrigine is generally well tolerated, but is associated a number of side effects, including: nausea (14% incidence), insomnia (10%), drowsiness (9%), back pain (8%), fatigue (8%), rhinitis (7%), non-serious rash (7%), abdominal pain (6%), dry mouth (6%), constipation (5%), vomiting (5%), worsening of cough (5%), and pharyngitis (5%). In patients receiving other psychotropic medications, side effects associated with dose increases of lamotrigine may include: headache (25%), rash (11%), dizziness (10%), diarrhea (8%), unusual dreams (6%), and itching (6%). In addition, the official labeling for Lamictal® (lamotrigine -Glaxo Smith Kline) contains a black box warning about the risk of a serious rash which may require hospital admission. This potentially severe adverse reaction may occur in 3 and 7 per 1000 adult and pediatric patients respectively.

The incidence of hair loss associated with lamotrigine is <1%. This is a relatively low incidence compared to some other medicines used treat psychiatric disorders. For example, lithium, carbamazepine, and valproic acid have all been associated with increased hair loss. Lithium may cause hair loss in 12-19% of patients. Worsening hair loss has been reported in 12% of patients taking carbamazepine and less than 6% of patients taking valproic acid or divalproex sodium

In most cases, hair growth returns to normal after stopping or reducing the dose of lamotrigine. While cosmetic side effects like hair loss may tempt some patients to stop using their medicines it is important to avoid stopping lamotrigine abruptly. This can lead to a reoccurrence of the symptoms for which it was prescribed. It is important to discuss any concerns you may have about your drug therapy with your physician. The doctor can explore alternate causes of the hair loss or consider other therapeutic options.

This response was prepared in part by Lauren Barton, a PharmD candidate 2006, NetWellness.org

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Go to the Pharmacy and Medications health topic.