Potential hepatotoxicity of lamotrigine

Lamotrigine is a new antiepileptic drug that is effective for a broad range of seizures in adults and children. Three children with seizures of differ ent causes who were treated with lamotrigine and developed reversible hepat otoxicity are reported. In one child, this therapy led to relatively severe hepatic failure that required and responded to aggressive therapy. Unlike most of the previously reported six patients with similar severe hepatic in volvement, this patient's liver function and blood hepatic enzymes became n ormal. All three patients were on multiple drugs, and two were in epilepsia partialis continua secondary to encephalitis, Two of the patients had rela tively rapid medication titration schedules. The close time relationship be tween the initiation of the lamotrigine therapy and the reversal of the liv er abnormalities with lamotrigine discontinuation argues against a cause ot her than the lamotrigine; however, because of the complexity of the reporte d cases, the causality remains an assumption. Review of the literature reve aled six other previously reported patients (five adults and one child) who had hepatotoxicity during lamotrigine therapy, with or without associated multisystem failure, and similar patient profiles. Lamotrigine is generally a safe and effective medication; however, it should be used with caution i n patients on polytherapy and in those with complicated acute systemic and central nervous system conditions, such as fever, status epilepticus, epile psia partialis, and encephalitis. (C) 2000 by Elsevier Science Inc. All rig hts reserved.