Can lamotrigine (Lamictal) cause elevated liver enzymes?/nThe question concerns a patient with bipo

Fråga: Can lamotrigine (Lamictal) cause elevated liver enzymes? The question concerns a patient with bipolar affective disorder who has developed elevated s-ALAT (1.32 ukat/L, ref <1.2), s-GT (3.31 ukat/L, ref <2.0) and s-ALP (5.2 ukat/L, ref <1.9) subsequent to initiation of therapy with lamotrigine 50 mg x2. Details concerning baseline values, temporal relations, management and outcome are not known.

Sammanfattning: Lamotrigine is a rare cause of hepatotoxicity, but severe reactions probably due to idiopathic hypersensitivity have been reported. In most patients developing asymtomatic elevation of liver function tests during lamotrigine therapy, particularly after more than 8 weeks duration, an alternative cause is more likely.

Svar: Hepatic side effects, including asymtomatic elevated liver function tests, appear to be very uncommon in lamotrigine therapy (1). Eight cases of cases of severe hepatotoxicity appearing between day 6-39 post commencing therapy, however, have been published. In five of these cases a concomitant rash is reported, and it seems plausible that the hepatotoxicity in these cases are part of a lamotrigine hypersensitivity syndrome. (2) Lamotrigine hypersensitivity, including the Stevens-Johnson syndrome, usually appears within eight weeks of initiation of lamotrigine therapy, although suspected cases presenting later have been reported (3). Generally speaking, it is very rare for hepatic side effects of a given drug to appear after more than three months of therapy (4).