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Lamotrigine (Lamictal)
Brand names: Lamictal and Lamictal XR™
- Tablets (non–chewable): 25 mg, 100 mg, 150 mg, 200 mg
- Chewable tablets: 2 mg, 5 mg, 25 mg
- Oral Disintegrating tablets: 25 mg, 50 mg, 100 mg, 200 mg
- Extended Release tablets: 25mg, 50 mg, 100 mg, 200 mg
- Two different dosing “starter” kits are also available. One is for patients who are already taking valproate (Depakote); the other is for patients who are already taking carbamazepine (Tegretol).
Generic Name: lamotrigine (la MOE tri jeen)
What is lamotrigine and what does it treat?
Lamotrigine is a medication that works in the brain to treat bipolar disorder. It is also approved for the treatment of seizure disorders. Bipolar disorder involves episodes of depression and/or mania.
A depressive episode, or depression, occurs when a person experiences several of the following symptoms at the same time: “low” or depressed mood (e.g., sad, empty, tearful), decreased interest in most or all activities, changes in appetite (usually decreased), changes in sleep (usually poor sleep), loss of energy, feeling worthless/guilty/ hopeless/ helpless, difficulty concentrating, thoughts of death (suicidal thinking).
A manic episode, or mania, is when a person experiences several of the following symptoms at the same time: “high” or irritable mood, very high self esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, and frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees).
Bipolar disorder is a brain disorder (mental illness) that exposes people to these mood changes over the course of time. Bipolar disorder affects more than two million Americans each year, but individuals with this disorder can lead fulfilling lives when they receive proper treatment. Unfortunately, many people with this illness do not receive treatment.
What is the most important information I should know about lamotrigine?
Do not stop taking lamotrigine or change your dose without first talking to your healthcare provider.
Lamotrigine is used for long-term treatment of bipolar disorder.
Do not stop taking lamotrigine even when you feel better. Only your healthcare provider can determine the length of lamotrigine treatment that is right for you.
Missing doses of lamotrigine may increase your risk for a relapse in your mood symptoms.
In order for lamotrigine to work properly, it should be taken every day as ordered by your healthcare provider.
Lamotrigine is rarely associated with serious skin rashes. If you experience a new rash while taking lamotrigine, call your doctor immediately.
Are there specific concerns about lamotrigine and pregnancy?
If you are planning on becoming pregnant, notify your healthcare provider to best manage your medications. People living with bipolar disorder who wish to become pregnant face important decisions. This is a complex decision since untreated bipolar disorder has risks to the fetus as well as the mother. It is important to discuss with your doctor and caregivers.
Exposure to lamotrigine during pregnancy is associated with an increased risk of oral clefts. (See warning at the end of this sheet.)
Breast-feeding is not recommended in women taking lamotrigine.
What should I discuss with my healthcare provider before taking lamotrigine?
- Symptoms that are most bothersome to you about your condition
- If you have thoughts of suicide
- Medications you have taken in the past to treat bipolar disorder, whether they were effective or caused any adverse effects
- Any psychiatric or medical problems you have
- All other medications you are currently taking (including over the counter, herbal and nutritional supplements), and any medication allergies you have
- Other non-medication treatment you are receiving (such as psychotherapy [i.e., “talk therapy”] or substance abuse treatment). Your provider can explain how these difference treatments work with the medication.
- If you are pregnant, plan to become pregnant, or are breast-feeding
- If you smoke, drink alcohol, or use illegal drugs
How should I take lamotrigine?
Lamotrigine is usually taken once or twice daily. It may be taken with or without food.
While the dose usually ranges from 25 mg to 200 mg, your healthcare provider will determine the dose that is right for you based upon your response.
What happens if I miss a dose of lamotrigine?
If you miss a dose of lamotrigine, take it as soon as you remember it. If it is close to your next dose, wait until then to take the medication and skip the missed dose. Do not double your next dose or take more than your prescribed dose. Discuss any missed doses with your healthcare provider.
If you miss more than three days of this medication, contact your prescriber.
What should I avoid while taking lamotrigine?
Avoid drinking alcohol or using illegal drugs while you are taking lamotrigine. They may decrease the benefits (e.g., worsen your symptoms) and increase adverse effects (e.g., sedation, dizziness).
What happens if I overdose with lamotrigine?
If an overdose occurs call your doctor or 911. You may need urgent medical care. You may also contact the poison control center at 1 (800) 222-1222.
Overdosing with lamotrigine may lead to dizziness, abnormal eye movements, seizures, sleepiness or loss of consciousness, and abnormal heart rhythms and possibly death.
A specific antidote for lamotrigine does not exist.
What are possible side effects of lamotrigine?
Common
Nausea, insomnia, daytime sleepiness, feeling physically tired (fatigue), runny nose, non–serious rash, headache, dizziness, diarrhea, abnormal dreams and itchy skin may occur with lamotrigine.
Rare
A serious, life threatening rash (also known as Stevens–Johnson Syndrome) may occur with the use of lamotrigine. Although this rash is believed to be rare, any patient who develops a rash while taking lamotrigine (or any other medication) should report this to their doctor quickly. Extra caution is needed in patients who are younger than the age of 16 and receiving lamotrigine. These patients may be at an increased risk of developing this life threatening rash.
Seizures may occur if a patient taking lamotrigine suddenly stops taking it.
Patients being treated with lamotrigine for bipolar disorder should report to their doctor if suicidal thinking starts or worsens. They should also report to their doctor if their mood symptoms begin to “switch” from symptoms of depression to symptoms of mania.
Contact your healthcare provider immediately if you develop a skin reaction, fever, swelling, or shortness of breath.
Are there any risks for taking lamotrigine for long periods of time?
To date, there are no known problems associated with long term use of lamotrigine. It is a safe and effective medication when used as directed.
What other medications interact with lamotrigine?
Medications that may increase levels of lamotrigine in your body:
- Valproic acid (Depakene), valproate (Depakote) and divalproex (Depakote ER)
Medications that may decrease levels of lamotrigine in your body: carbamazepine (Tegretol), oral contraceptives (birth control pills), phenytoin (Dilantin), phenobarbital, primidone, rifampin (Rifadin), ritonavir (Norvir).
Clozapine blood levels may become too high, or “toxic”, when lamotrigine therapy is added.
How long does it take for lamotrigine to work?
Several weeks are often required for lamotrigine to reach its maximum effectiveness; however, improvement in some symptoms may occur sooner.
It is very important to tell your doctor how you feel during the first few weeks after you start taking lamotrigine. It will probably take several weeks to see big enough changes in your symptoms to decide if lamotrigine is the right medication for you.
Mood stabilizer treatment is generally needed lifelong for persons with bipolar disorder. Your doctor can best discuss the duration of treatment you need based on your symptoms and course of illness.
Provided by College of Psychiatric and Neurologic Pharmacists, January 2012
Reviewed by Ken Duckworth, M.D., NAMI Medical Director
Important Warning: Serious skin rashes requiring medical hospitalization and discontinuation of treatment have been associated with Lamictal®. Although rare, this rash (also known as Stevens– Johnson Syndrome) can be life threatening. Any patient who develops a rash while taking Lamictal® (or any other medication) should report this to their doctor quickly. People who may be at a higher risk for this rash are those who are also taking Depakene® or Depakote®, those who have their Lamictal® doses increased rapidly, and those patients who are younger than 16 years.
FDA Alert (9/2006): New information suggests that babies exposed to Lamictal® during the first three months of pregnancy may have a higher chance of being born with a cleft lip or cleft palate. Babies born with cleft lip or cleft palate have a gap in the upper lip or roof of the mouth. If you take Lamictal® and are pregnant or are thinking of becoming pregnant, talk with your doctor. Lamictal® is used for seizures or bipolar disorder, serious conditions that need treatment even during pregnancy. Do not start or stop using Lamictal® without talking to your doctor. More research is needed to be sure about this possibly increased chance of cleft lip or cleft palate in babies born to mothers who take Lamictal®.
FDA Alert (8/2010): Aseptic meningitis has been identified as a rare but serious side effect of Lamictal®. The FDA identified 40 cases of aseptic meningitis over a 15 year period. In this same period over 46 million prescriptions for Lamictal® were dispensed. In most cases symptoms resolved after Lamictal® was discontinued. Patients should contact their healthcare professional immediately if they experience headache, fever, chills, nausea, vomiting, stiff neck, rash, abnormal sensitivity to light, drowsiness or confusion while they are taking Lamictal®.