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Lamotrigine is a new antiepileptic agent approved by the US Food and Drug Administration for adjunctive therapy in the treatment of partial seizures in adults with epilepsy. Common side effects attributed to lamotrigine include headache, dizziness, somnolence, insomnia, nausea, and vomiting. Approximately 10 to 15% of patients taking lamotrigine may develop a rash, which in most of cases, is dose dependent. After reviewing the medical literature, we found three case reports indicating adverse hematologic effects associated with lamotrigine (macrocytic anemia,1 pure red cell aplasia,2 leukopenia3). We report two additional cases and review the literature.
Case reports. Case 1. A 35-year-old man with intractable epilepsy and a history of recurrent psychosis was taking valproic acid 500 mg tid, primidone 250 mg tid, haloperidol 4 mg qhs, and trihexyphenidyl 2 mg qd. The patient was started on lamotrigine 12.5 mg qd on December 11, 1995. The baseline CBC showed WBC: 10.2; Hct: 36.8; Hgb: 12.1; mean corpuscular volume: 78.8; platelets: 329. The patient was reevaluated 11 days later and was …
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