Does lamotrigine cause hair loss? This is a question raised by many people prescribed this widely used anticonvulsant and mood stabiliser for epilepsy or bipolar disorder. Hair loss — known medically as alopecia — is listed as an uncommon adverse reaction in the UK Summary of Product Characteristics (SmPC) for lamotrigine, affecting between 1 in 1,000 and 1 in 100 people. This article explains what the evidence says, how drug-induced hair loss occurs, what steps to take if you notice shedding, and how to discuss your options safely with your healthcare team.
Summary: Lamotrigine can cause hair loss, but it is classified as an uncommon side effect, affecting between 1 in 1,000 and 1 in 100 people according to the UK Summary of Product Characteristics.
- Alopecia is listed as an uncommon adverse reaction to lamotrigine in the UK SmPC and BNF, occurring in 1 in 1,000 to 1 in 100 patients.
- The pattern is typically diffuse hair thinning or increased shedding, consistent with telogen effluvium, though the precise mechanism is not confirmed.
- Do not stop lamotrigine without medical advice — abrupt withdrawal carries serious risks including breakthrough seizures or mood relapse.
- Other causes of hair loss, including thyroid dysfunction, iron deficiency, and concurrent medications such as sodium valproate, must be ruled out.
- Serious skin reactions such as Stevens-Johnson syndrome are a more urgent safety concern with lamotrigine and require immediate medical attention.
- Suspected side effects, including hair loss, can be reported to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk.
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Can Lamotrigine Cause Hair Loss?
Yes, lamotrigine can cause hair loss; the UK SmPC classifies alopecia as an uncommon adverse reaction, affecting 1 in 1,000 to 1 in 100 people. The pattern is typically diffuse shedding, possibly consistent with telogen effluvium.
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Lamotrigine is an anticonvulsant and mood-stabilising medicine widely prescribed in the UK for epilepsy and bipolar disorder. It works by stabilising electrical activity in the brain, primarily by blocking voltage-gated sodium channels and reducing the release of excitatory neurotransmitters such as glutamate.
Hair loss — medically referred to as alopecia — is a recognised adverse effect of lamotrigine, though it is not among the most commonly reported side effects. The UK Summary of Product Characteristics (SmPC) for lamotrigine, available via the Electronic Medicines Compendium (emc), lists alopecia as an uncommon adverse reaction, defined as occurring in between 1 in 1,000 and 1 in 100 people taking the medicine. This classification is consistent with the BNF monograph for lamotrigine and the NHS Medicines A–Z entry for this drug.
Hair loss associated with lamotrigine is often reported as diffuse hair thinning or increased shedding, based on pharmacovigilance data and published case reports. This pattern may be consistent with telogen effluvium — a condition in which a physiological or pharmacological stressor causes a larger-than-normal proportion of hair follicles to enter the resting (telogen) phase simultaneously, leading to noticeable shedding several weeks later. However, this mechanistic link has not been confirmed in controlled clinical studies, and the precise way in which lamotrigine may affect hair follicles is not yet fully understood. Not everyone taking the medication will experience this effect.
| Side Effect | Frequency | Severity | Management |
|---|---|---|---|
| Alopecia (diffuse hair thinning/shedding) | Uncommon: 1 in 1,000 to 1 in 100 (SmPC, BNF) | Mild to moderate; often reversible | Discuss with GP; rule out other causes (ferritin, TSH, FBC); do not stop lamotrigine abruptly |
| Headache | Common (more frequent than alopecia) | Mild to moderate | Symptomatic relief; review with prescriber if persistent |
| Dizziness | Common | Mild to moderate | Advise caution when driving; review dose with prescriber |
| Skin rash (non-serious) | Common | Mild; monitor closely | Report to prescriber promptly; assess for signs of serious reaction |
| Stevens-Johnson syndrome / toxic epidermal necrolysis | Rare; highest risk in first 8 weeks and during dose escalation | Severe; potentially life-threatening | Stop lamotrigine immediately; seek urgent medical attention; MHRA Yellow Card report |
| Telogen effluvium (drug-induced hair cycle disruption) | Uncommon; onset typically 2–4 months after starting or increasing dose | Mild to moderate; usually reversible | Ensure adequate nutrition; avoid harsh hair treatments; GP review; NHS dermatology referral if severe |
| Mood relapse / breakthrough seizures (on abrupt withdrawal) | Risk increases with sudden discontinuation | Severe | Never stop lamotrigine without medical supervision; follow NICE NG217 / CG185 |
How Common Is Hair Loss With This Medication?
Hair loss with lamotrigine is uncommon, affecting between 1 in 1,000 and 1 in 100 patients according to the SmPC and BNF. It is far less frequent than common side effects such as headache, dizziness, and skin rash.
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According to the lamotrigine SmPC (emc) and the BNF, alopecia is classified as an uncommon adverse reaction, meaning it may affect between 1 in 1,000 and 1 in 100 patients. This places it well below the threshold of common adverse effects such as headache, dizziness, and skin rash, which are reported far more frequently.
Serious skin reactions — a more urgent concern A more clinically significant safety concern with lamotrigine is the risk of serious skin reactions, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). These are rare but potentially life-threatening. If you develop a widespread rash — particularly one accompanied by fever, blistering, mucosal involvement (such as sores in the mouth or eyes), or feeling generally unwell — stop taking lamotrigine and seek urgent medical attention immediately. Do not wait for a routine appointment. This risk is greatest during dose escalation and in the first eight weeks of treatment, as noted in NHS and MHRA guidance.
Regarding hair loss specifically, real-world prevalence is difficult to establish precisely. Patients and clinicians may attribute hair changes to other factors — such as stress, nutritional deficiencies, thyroid dysfunction, or concurrent medications — rather than to lamotrigine directly. This is a recognised limitation of pharmacovigilance data rather than a confirmed finding of systematic under-reporting.
Many conditions for which lamotrigine is prescribed, including epilepsy and bipolar disorder, can themselves be associated with physiological stress that may independently contribute to hair changes. Additionally, other medicines commonly used alongside lamotrigine — such as sodium valproate, which has a well-established and more frequent association with alopecia — may complicate attribution. If you are taking multiple medicines and notice hair thinning, discuss this with your prescribing clinician before drawing conclusions.
Reporting suspected side effects If you think you are experiencing a side effect from lamotrigine, including hair loss, you can report it directly to the MHRA via the Yellow Card scheme at yellowcard.mhra.gov.uk or through the Yellow Card app. Reporting helps the MHRA monitor the safety of medicines in real-world use.
Why Some Medicines Affect Hair Growth
Medicines can disrupt the hair growth cycle, shifting follicles prematurely into the telogen (resting) phase and causing diffuse shedding two to four months later. With lamotrigine, the exact mechanism is unconfirmed and based primarily on pharmacovigilance data.
To understand why certain medications can cause hair loss, it helps to appreciate the normal hair growth cycle. Hair follicles cycle through three phases: anagen (active growth), catagen (transition), and telogen (resting and shedding). At any given time, the majority of scalp hairs are in the anagen phase, with a smaller proportion in telogen. Disruption to this cycle — whether by illness, nutritional deficiency, hormonal change, or medication — can shift a greater proportion of follicles into the telogen phase, resulting in diffuse shedding typically noticed two to four months after the triggering event. This timeline and pattern are described in NICE CKS guidance on alopecia and by the Primary Care Dermatology Society (PCDS).
Drug-induced hair loss generally falls into two categories:
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Telogen effluvium — the more common form with anticonvulsants, involving diffuse shedding due to premature entry into the resting phase. This is often reversible once the causative factor is addressed, though recovery may take several months.
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Anagen effluvium — less common with anticonvulsants; more typically associated with chemotherapy agents, where actively growing hairs are directly damaged.
For anticonvulsants and mood stabilisers, the exact mechanism of hair follicle disruption is not fully established. In the case of sodium valproate, there is evidence of micronutrient depletion — including zinc and selenium — which are important for hair follicle health; this mechanism does not apply to lamotrigine. With lamotrigine specifically, there is no confirmed mechanistic explanation, and the association is based primarily on pharmacovigilance data and case reports rather than controlled clinical evidence, as reflected in the lamotrigine SmPC and BNF.
What to Do If You Notice Hair Thinning or Shedding
Do not stop lamotrigine without medical advice, as abrupt withdrawal risks breakthrough seizures or mood relapse. See your GP to investigate other causes and discuss the timing of hair changes in relation to your lamotrigine dose.
If you are taking lamotrigine and begin to notice increased hair shedding, thinning, or a change in hair texture, it is important not to stop taking your medication without first speaking to your GP or specialist. Abruptly discontinuing lamotrigine — particularly in people with epilepsy — carries serious risks, including breakthrough seizures. In people with bipolar disorder, abrupt withdrawal may also increase the risk of mood relapse. Any changes to your treatment must be managed under medical supervision, in line with NICE guideline NG217 (Epilepsies in children, young people and adults) and NICE guideline CG185 (Bipolar disorder: assessment and management).
When to seek urgent advice Seek urgent medical attention if you notice patchy hair loss, scalp inflammation, scarring, or rapidly progressive shedding, as these may indicate a separate condition requiring prompt assessment. As noted above, any new widespread rash — especially with systemic symptoms — requires immediate medical review.
Steps to take if you notice hair changes:
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Book an appointment with your GP to discuss the timing and pattern of hair loss in relation to when you started or changed your lamotrigine dose.
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Rule out other causes — your GP will typically arrange first-line blood tests including full blood count (FBC), serum ferritin, and thyroid function (TSH), as deficiencies and thyroid disorders are common and treatable causes of hair thinning. Further tests such as vitamin B12, vitamin D, or zinc levels may be considered if there is a specific clinical reason, in line with NICE CKS guidance on alopecia.
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Keep a record of when shedding began, how much hair is being lost, and any other new symptoms, as this information will help your clinician assess the likely cause.
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Discuss your full medication list with your prescriber, as polypharmacy is common in people with epilepsy or bipolar disorder, and another agent may be contributing.
In many cases, hair loss associated with lamotrigine may improve over time, even without changing the medication, though this cannot be guaranteed for every individual. Your clinician will weigh the benefits of seizure or mood control against the impact of this side effect on your quality of life before recommending any changes. If shedding began two to four months after starting or increasing lamotrigine, this timeline is consistent with telogen effluvium, and improvement — if the drug is the cause — may take several further months to become apparent.
Alternatives and Managing Side Effects Safely
If lamotrigine is confirmed as the likely cause of significant hair loss, a neurologist or psychiatrist may consider a dose adjustment or alternative agent, guided by NICE guidelines NG217 or CG185. Sodium valproate has a higher documented association with hair loss and is not a straightforward alternative.
If investigations confirm that lamotrigine is the most likely cause of your hair loss and the effect is significantly affecting your wellbeing, your neurologist or psychiatrist may consider adjusting your dose or switching to an alternative agent. This decision must always be made on an individual basis, balancing the risk of destabilising seizure control or mood against the tolerability concern.
For epilepsy, NICE guideline NG217 outlines a range of alternative antiepileptic drugs depending on seizure type and individual patient factors. For bipolar disorder, NICE guideline CG185 provides guidance on alternatives such as lithium or quetiapine, though each carries its own side-effect profile and suitability will depend on the phase of illness and individual circumstances. It is worth noting that sodium valproate has a considerably higher and more well-documented association with hair loss than lamotrigine, and is also subject to significant prescribing restrictions for people who could become pregnant, under the MHRA's Valproate Pregnancy Prevention Programme (details available at gov.uk/mhra). Valproate should not be considered a straightforward alternative where hair loss is the primary concern.
Supportive measures The following general measures may help minimise hair loss and support regrowth:
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Ensure adequate nutrition — a balanced diet with sufficient protein, iron, and B vitamins supports healthy hair follicle function. Address any confirmed nutritional deficiencies with appropriate supplementation under medical guidance.
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Avoid harsh hair treatments — minimise heat styling, chemical processing, and tight hairstyles that place mechanical stress on fragile hair.
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NHS dermatology referral — if hair loss is severe, persistent, rapidly progressive, patchy, or associated with scalp changes, ask your GP for a referral to an NHS dermatologist for specialist assessment. Urgent referral is appropriate if scarring alopecia or inflammatory scalp disease is suspected. If you choose to consult a trichologist independently, be aware that trichologists are not medically regulated in the UK and their assessment does not replace a medical diagnosis; always ensure any concerns are also reviewed by a qualified clinician.
Ultimately, open communication with your healthcare team is the most important step. Side effects such as hair loss are a legitimate concern and should never be dismissed. Your prescriber can work with you to find the most appropriate and safe management plan, guided by NICE recommendations and your individual clinical needs.
Useful UK resources: lamotrigine SmPC (emc.medicines.org.uk); NHS Medicines A–Z: Lamotrigine; BNF: Lamotrigine; NICE NG217; NICE CG185; MHRA Yellow Card scheme (yellowcard.mhra.gov.uk); MHRA Valproate Pregnancy Prevention Programme; NICE CKS: Alopecia.
Frequently Asked Questions
How long after starting lamotrigine does hair loss usually begin?
Hair loss linked to lamotrigine typically appears two to four months after starting the medication or increasing the dose, which is consistent with the telogen effluvium pattern. This delay occurs because affected follicles enter a resting phase before shedding, so the trigger and the visible hair loss are separated by several weeks.
Will my hair grow back if lamotrigine is causing the hair loss?
In many cases, hair loss associated with lamotrigine may improve over time even without changing the medication, though this cannot be guaranteed for every individual. If the drug is the cause and treatment is adjusted under medical supervision, regrowth may take several further months to become apparent.
Can I just stop taking lamotrigine if I think it is causing my hair loss?
No — you should never stop lamotrigine abruptly without speaking to your GP or specialist first. Sudden withdrawal can trigger breakthrough seizures in people with epilepsy or mood relapse in those with bipolar disorder, both of which carry serious health risks.
What is the difference between hair loss caused by lamotrigine and hair loss caused by sodium valproate?
Sodium valproate has a considerably higher and better-documented association with hair loss than lamotrigine, and there is evidence it depletes micronutrients such as zinc and selenium that are important for hair follicle health. Lamotrigine-related hair loss is classified as uncommon, and no confirmed mechanism has been identified.
What blood tests should my GP arrange if I am losing hair while taking lamotrigine?
Your GP will typically arrange a full blood count (FBC), serum ferritin, and thyroid function test (TSH) as first-line investigations, as iron deficiency and thyroid disorders are common and treatable causes of hair thinning. Further tests such as vitamin B12, vitamin D, or zinc levels may be considered if there is a specific clinical reason, in line with NICE CKS guidance on alopecia.
How do I get a referral to a dermatologist for hair loss related to lamotrigine?
Ask your GP for an NHS dermatology referral if your hair loss is severe, persistent, rapidly progressive, patchy, or associated with scalp changes such as inflammation or scarring. Urgent referral is appropriate if scarring alopecia or inflammatory scalp disease is suspected.
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