Lamotrigine (marketed as Lamictal) is primarily prescribed to manage epilepsy and bipolar disorder. It acts as an anticonvulsant, stabilizing electrical activity to prevent seizures, and as a mood stabilizer to manage extreme mood swings. Patients often inquire about potential side effects, including hair loss. This article addresses whether lamotrigine can cause hair thinning and outlines what is understood about this uncommon side effect. This information is for educational purposes only; consult your healthcare provider before making any changes to your medication or treatment plan.
Prevalence and Appearance of Hair Loss
Hair loss (alopecia) is a recognized side effect of lamotrigine, though it is uncommon in clinical practice. Lamotrigine is not typically listed among the most frequent causes of drug-induced hair shedding. Post-marketing surveillance indicates that hair loss is a possibility, but the reported prevalence is low, affecting less than 1% of users.
Hair loss associated with lamotrigine usually presents as diffuse thinning across the entire scalp, rather than distinct, patchy bald spots. This pattern is non-scarring alopecia, meaning the hair follicle is not permanently damaged. Because the shedding is widespread, patients often notice a reduction in hair volume and an increase in hairs collected on brushes or in the shower drain.
This type of shedding is temporary and reversible. If hair loss is attributed to the medication, hair regrowth typically begins once the drug is discontinued or the dosage is adjusted. The reversibility and non-scarring nature distinguish this drug-induced alopecia from other more permanent forms of hair loss.
Biological Explanation for Drug-Induced Alopecia
The mechanism behind lamotrigine-associated hair loss is primarily attributed to Telogen Effluvium (TE). Hair growth cycles through three phases: anagen (active growth), catagen (transition), and telogen (resting and shedding). TE occurs when a stressor, such as a new medication, prematurely pushes a high number of hair follicles into the resting phase.
Normally, only 10 to 15% of hairs are in the telogen phase, but this drug-induced shock can cause up to 70% of hairs to enter this phase simultaneously. Because the hair follicle detaches during the resting phase, the resulting shedding is often delayed. Shedding typically begins two to four months after starting the medication or a dose increase, corresponding to the natural length of the hair cycle.
A secondary mechanism involves the medication’s impact on nutrient metabolism, specifically folate (a B vitamin). Folate is an important co-factor in the rapid cell division required for healthy hair growth. Some anticonvulsant medications can interfere with folate pathways, potentially contributing to follicular distress and subsequent shedding. This disruption of metabolic processes can exacerbate the effects of Telogen Effluvium.
Actionable Steps for Management
The first step for anyone concerned about hair thinning while taking lamotrigine is to consult the prescribing physician. Do not stop the medication suddenly, as this is medically unsafe, especially when treating epilepsy or bipolar disorder. The provider must confirm that lamotrigine is the likely cause, as many other factors can trigger hair loss, including stress, thyroid dysfunction, or nutritional deficiencies.
Diagnostic testing may involve blood work to check hormone levels, iron stores, and vitamin levels, which helps rule out non-medication-related causes. If hair loss is confirmed to be drug-induced, the physician may discuss a managed reduction in the lamotrigine dose or a switch to an alternative medication. Adjusting the dose is often the initial strategy, as this can halt shedding without compromising treatment efficacy.
Supportive care measures can be implemented alongside medical review to encourage regrowth and minimize stress on the hair. Checking and supplementing for nutritional deficiencies, particularly B vitamins, zinc, and selenium, supports the cellular health of the hair follicles. These micronutrients play roles in protein synthesis and antioxidant defense, necessary for the hair growth cycle.
Using gentle hair care practices can minimize mechanical breakage and stress on vulnerable follicles. This includes avoiding harsh chemical treatments, excessive heat styling, and tight hairstyles. If a dose adjustment is successful, patients should expect a gradual recovery, with noticeable hair regrowth often beginning three to six months later as the hair cycle normalizes.