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Synergistic risks: Lamotrigine induced rash potentiating lithium toxicity
Shalini Kumari1, Venkata Lakshmi Narasimha2, Santanu Nath1
1Department of Psychiatry, All India Institute of Medical Sciences, Deoghar, Jharkhand, India.
Psychiatria Danubina
|January 22, 2026
Summary
This case report highlights a patient experiencing lithium toxicity and acute kidney injury due to lamotrigine-induced rash. Close monitoring is crucial when combining these mood stabilizers to prevent severe adverse events.
Area of Science:
- Pharmacology
- Nephrology
- Psychiatry
Background:
- Lithium and lamotrigine are common mood stabilizers for bipolar disorder.
- Lithium has a narrow therapeutic index, making its plasma levels sensitive to renal function and physiological changes.
- Lamotrigine can cause severe rash, potentially leading to fluid and electrolyte imbalances.
Purpose of the Study:
- To report a case of lithium toxicity and acute kidney injury.
- To emphasize the risks associated with combining lamotrigine and lithium.
- To highlight the importance of close patient monitoring during combination therapy.
Main Methods:
- Case report presentation.
- Review of patient's medication history and clinical presentation.
- Analysis of the interaction between lamotrigine and lithium.
Main Results:
- A patient developed a rash from lamotrigine, resulting in impaired alimentation and fluid/electrolyte imbalance.
- This imbalance led to increased lithium reabsorption and subsequent lithium toxicity.
- The patient also experienced acute kidney injury as a consequence.
Conclusions:
- Combination therapy with lamotrigine and lithium poses a risk of severe adverse events.
- Lamotrigine-induced rash can precipitate lithium toxicity and acute kidney injury.
- Vigilant monitoring of patients on combined lamotrigine and lithium therapy is essential.
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