Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

Keynote webinar | Spotlight on sleep in brain health

LIVE: Thursday 2nd May 2024, 18:00-19:30 (CEST)

Quality sleep is essential for health. But what happens to our brains when sleep patterns are disturbed? Join our experts to explore the interplay between sleep disruption and neurological diseases, and the questions that you need to be asking your patients to help you prevent the harmful effects of sleep deprivation.
ADVANCED SEARCH
Log in
Top
Annals of General Psychiatry
Published in: Annals of General Psychiatry 1/2016

Open Access 01-12-2016 | Case Report

Rhabdomyolysis after lamotrigine overdose: a case report and review of the literature

Authors: Sokratis E. Karaoulanis, Markos Syngelakis, Konstantinos Fokas

Published in: Annals of General Psychiatry | Issue 1/2016

Login to get access

Abstract

Background

Lamotrigine is an effective anticonvulsant drug that has also been demonstrated to be effective in the treatment of bipolar disorder. We report a case of rhabdomyolysis after intentional overdose in a woman aged 48.

Case presentation

A 48-year-old female presented to the emergency department after an acute ingestion of 6 g of lamotrigine. The patient suffered from bipolar disorder, and she was taking lamotrigine and olanzapine. At that point, she had a major depressive episode, and she wanted to commit suicide. Activated charcoal was administered in the emergency department. Her vital signs were still normal, and she entered the Medical clinic, where she had been there for 2 days in a good condition. The hematological and biochemical results were normal. On the fourth day, the levels of creatine phosphokinase (CPK) showed remarkable increase (2500 IU/ml). Fluid and bicarbonate intravenous administration was performed, and CPK levels returned to normal after 3 days.

Conclusion

The majority of patients exposed to lamotrigine in overdose experienced no toxic clinical effects. The most common clinical effects are drowsiness and lethargy, vomiting, nausea, ataxia, dizziness/vertigo, and tachycardia. In this case report, the patient was alert and did not have any serious complications, except for mild rhabdomyolysis, which was the main consequence of lamotrigine overdose.
Literature
1.
Wade JF, Dang CV, Nelson L, Wasserberger J. Emergent complications of the newer anticonvulsants. J Emerg Med. 2010;38(2):231–7.CrossRefPubMed
2.
Fleurat M, Smollin C. Case files of the University of California San Francisco medical toxicology fellowship: lamotrigine toxicity. J Med Toxicol. 2012;8:52–8.PubMedCentralCrossRefPubMed
3.
Lofton AL, Klein-Schwartz W. Evaluation of lamotrigine toxicity reported to poison centers. Ann Pharmacother. 2004;38(11):1811–5.CrossRefPubMed
4.
Kicka M, Klopotowski T, Picheta S, Bazylewicz A, Miskiewicz K. Massive lamotrigine poisoning-case report. Przeql Lek. 2011;68(8):543–5.
5.
Buckley NA, Whyte IM, Dawson AH. Self-poisoning with lamotrigine. Lancet. 1993;33:557–9.
6.
Nogar JN, Minns AB, Savaser DJ, Ly BT. Severe sodium channel blockade and cardiovascular collapse due to a massive lamotrigine overdose. Clin Toxicol (Phila). 2011;49(9):854–7.CrossRef
7.
8.
O’Donnell J, Bateman DN. Lamotrigine overdose in an adult. J Toxicol Clin Toxicol 2000;38(6):659–60.
9.
Oh Sum-Young , JS Kim, YH Lee, AY Lee, J Kim, JM Kim. Downbeat, position and perverted head-shaking nystagmus associated with lamotrigine toxicity. J Clin Neurology 2006;2:283–5.
10.
Moore PW, Donovan JW, Burkhart KK, Haggerty D. A case series of patients with lamotrigine toxicity at one center from 2003 to 2012. Clin Toxicol (Phila). 2013;51(7):545–9.CrossRef
11.
Pricone MG, King CV, Drummer OH, Opeskin K, McIntyre IM. Postmortem investigation of lamotrigine concentrations. J Forensic Sci. 2000;45:11–5.CrossRefPubMed
12.
French LK, McKeown NJ, Hendrickson RG. Complete heart block and death following lamotrigine overdose. Clin Toxicol (Phila). 2011;49(4):330–3.CrossRef
13.
Close BR, Banks CJ. Seizures secondary to lamotrigine toxicity in a two-year old. Ann Pharmacother. 2010;44(6):1112–5.CrossRefPubMed
14.
Thundiyil JG, Anderson IB, Stewart PJ, Olson KR. Lamotrigine-induced seizures in a child: case report and literature review. Clin Toxicol. 2007;45:169–72.CrossRef
15.
Briassoulis G, Kalabalikis P, Tamiolaki M, Hatzis T. Lamotrigine childhood overdose. Pediatr Neurol. 1998;19:239–42.CrossRefPubMed
16.
Dinnerstein E, Jobst PC, Williamson PD. Lamotrigine intoxication provoking status epilepticus in an adult with localization-related epilepsy. Arch Neurol. 2007;64(9):1344–6.CrossRefPubMed
17.
18.
Venkatraman N, O’Neil D, Hall AP. Life-threatening overdose with lamotrigine, citalopram and chlorpheniramine. J Postgrad Med. 2008;54(4):316–7.CrossRefPubMed
19.
Mylonakis E, Vittorio CC, Hollik DA, Round S. Lamotrigine overdose presenting as an anticonvulsant hypersensitivity syndrome. Ann Pharmacother. 1999;33(5):557–9.CrossRefPubMed
20.
Schwartz MD, Geller RJ. Seizures and altered mental status after lamotrigine overdose. Ther Drug Monit. 2007;29:843–4.CrossRefPubMed
21.
22.
Stopforth J. Overdose with gabapentin and lamotrigine. S Afr Med J. 1997;87:1388.PubMed
23.
Sirianni AJ, Osterhoudt KC, Calello DP, Muller AA, Waterhouse MR, Goodkin MB, Weinberg GL, Henretig FM. Use of lipid emulsion in the resuscitation of a patient with prolonged cardiovascular collapse after overdose of bupropion and lamoptrigine. Ann Emerg Med. 2008;51:412–5.CrossRefPubMed
24.
Nixon AC, Doak MW, Crozier H, Crooks DP, Waring WS. Patterns of antiepileptic drug overdose differ between men and women: admissions to the Edinburgh Poisons Unit, 2000–2007. Q J Med. 2009;102:51–5.CrossRef
25.
Dlamini N, Voermans NC, Lillis S, Stewart K, Kamsteeg EJ, Drost G, et al. Mutations in RYR1 are a common cause of exertional myalgia and rhabdomyolysis. Neuromuscul Disord. 2013;23(7):540–8.CrossRefPubMed
26.
Molenaar JP, Voermans NC, van Hoeve BJ, Kamsteeg EJ, Kluijtmans LA, Kusters B, et al. Fever-induced recurrent rhabdomyolysis due to a novel mutation in the ryanodine receptor type 1 gene. Intern Med J. 2014;44(8):819–20.CrossRefPubMed
27.
28.
Berwaerts K, Sienaert P, De Fruyt J. Teratogenic effects of lamotrigine in women with bipolar disorder. Tijdschr Psychiatr. 2009;51(10):741–50.PubMed
Metadata
Title
Rhabdomyolysis after lamotrigine overdose: a case report and review of the literature
Authors
Sokratis E. Karaoulanis
Markos Syngelakis
Konstantinos Fokas
Publication date
01-12-2016
Publisher
BioMed Central
Published in
Annals of General Psychiatry / Issue 1/2016
Electronic ISSN: 1744-859X
DOI
https://doi.org/10.1186/s12991-016-0093-3

Other articles of this Issue 1/2016

Annals of General Psychiatry 1/2016 Go to the issue

Primary research

Analysis of personality traits and their influence on the quality of life of postmenopausal women with regard to genetic factors

Primary research

Relationship between the lesion location of acute ischemic stroke and early depressive symptoms in Japanese patients

Primary research

Physician perception regarding side-effect profile at the onset of antidepressant treatment: a survey of Israeli psychiatrists and primary care physicians

Primary research

Regional cortical thinning of the orbitofrontal cortex in medication-naïve female patients with major depressive disorder is not associated with MAOA-uVNTR polymorphism

Primary research

Hyperthymic affective temperament and hypertension are independent determinants of serum brain-derived neurotrophic factor level

Primary research

Link of dysfunctional attitudes with the negative self-model