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Lamictal® (lamotrigine)

Brand names

Lamictal®

  • 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

  • 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®).

Lamictal® XR™

  • Tablets (extended release): 25mg, 50 mg, 100 mg, 200 mg

Generic Name : lamotrigine (la MOE tri jeen)

Medication class : mood stabilizer, anticonvulsant

All FDA Black Box Warnings are at the end of this fact sheet. Please review before taking this medication.

What is Lamictal® and what does it treat?

Lamotrigine is a medication that works in the brain to treat bipolar disorder (also known as manic depression). It is also approved for the treatment of seizure disorders. Bipolar disorder involves episodes of depression and/or mania.

Symptoms of depression include:

  • Depressed mood – feeling sad, empty, or tearful

  • Feeling worthless, guilty, hopeless, or helpless

  • Loss of interest or pleasure in normal activities

  • Sleep and eat more or less than usual (for most people it is less)

  • Low energy, trouble concentrating, or thoughts of death (suicidal thinking)

  • Psychomotor agitation ('nervous energy')

  • Psychomotor retardation (feeling like you are moving in slow motion)

Symptoms of mania include:

  • Feeling irritable or 'high'

  • Having increased self esteem

  • Feeling like you don’t need to sleep

  • Feeling the need to continue to talk

  • Feeling like your thoughts are too quick (racing thoughts)

  • Feeling distracted

  • Getting involved in activities that are risky or could have bad consequences (e.g. excessive spending)

What is the most important information I should know about Lamictal®?

Bipolar disorder requires long-term treatment. 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 and increase the risk of side effects when you take it.

Do not stop taking lamotrigine or change your dose without talking to with your healthcare provider first.

In order for lamotrigine to work properly, it should be taken every day as ordered by your healthcare provider.

Are there specific concerns about Lamictal® 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 for the fetus as well as the mother. It is important to discuss the risks and benefits of treatment with your doctor and caregivers.

Lamotrigine has been associated with an increased risk of oral clefts. There may be precautions to decrease the risk of this effect. Discontinuing mood stabilizer medications during pregnancy has been associated with a significant increase in symptom relapse.

Regarding breastfeeding, caution is advised since lamotrigine does pass into breast milk.

What should I discuss with my healthcare provider before taking Lamictal®?

  • Symptoms of your condition that bother you the most

  • If you have thoughts of suicide or harming yourself

  • Medications you have taken in the past for your condition, whether they were effective or caused any adverse effects

  • If you experience side effects from your medications, discuss them with your provider. Some side effects may pass with time, but others may require changes in the medication.

  • Any other psychiatric or medical problems you have

  • All other medications you are currently taking (including over the counter products, herbal and nutritional supplements) and any medication allergies you have

  • Other non-medication treatment you are receiving, such as talk therapy or substance abuse treatment. Your provider can explain how these different treatments work with the medication.

  • If you are pregnant, plan to become pregnant, or are breast-feeding

  • If you drink alcohol or use illegal drugs

How should I take Lamictal®?

Lamotrigine is usually taken 1 or 2 times daily. It may be taken with or without food.

Typically patients begin at a low dose of medicine and the dose is increased slowly over several weeks.

The dose usually ranges from 25 mg to 200 mg. Only your healthcare provider can determine the correct dose for you.

Extended release tablets: Swallow whole. Do not crush, chew or split tablets.

Lamotrigine orally disintegrating tablets must remain in their original packaging. Open the package with clean dry hands before each dose. Do not try to put tablets in a pillbox if you take the orally disintegrating tablets.

Lamotrigine orally disintegrating tablets will dissolve in your mouth within seconds and can be swallowed with or without liquid.

Use a calendar, pillbox, alarm clock, or cell phone alert to help you remember to take your medication. You may also ask a family member a friend to remind you or check in with you to be sure you are taking your medication.

What happens if I miss a dose of Lamictal®?

If you miss a dose of lamotrigine take it as soon as you remember, unless it is closer to the time of your next dose. Discuss this with your healthcare provider. Do not double your dose or take more than what is prescribed. If you miss more than 3 days of medication, contact your prescriber because he/she may need to adjust your dose.

What should I avoid while taking Lamictal®?

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) of the medication.

What happens if I overdose with Lamictal®?

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.

A specific treatment to reverse the effects of lamotrigine does not exist.

What are possible side effects of Lamictal®?

Common Side Effects

  • Nausea, insomnia, runny nose, non–serious rash, headache, diarrhea, abnormal dreams and itchy skin

  • Feeling dizzy, drowsy or physically tired (fatigued)

Rare Side Effects

A serious, life threatening rash (also known as Stevens–Johnson Syndrome) may occur with the use of lamotrigine. 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.

Contact your healthcare provider immediately if you develop a skin reaction, fever, swelling, or shortness of breath.

Seizures may occur if a patient taking lamotrigine suddenly stops taking it.

Serious Side Effects

Studies have found that individuals who take antiepileptic medications including lamotrigine have suicidal thoughts or behaviors up to twice as often than individuals who take placebo (inactive medication). These thoughts or behaviors occurred in approximately 1 in 550 patients taking the antiepileptic class of medications.

Aseptic meningitis has been identified as a very rare but serious side effect of lamotrigine. It has been reported in less than 1/100,000 people taking lamotrigine. Contact your healthcare professional immediately if you experience headache, fever, chills, nausea, vomiting, stiff neck, rash, sedation, confusion or abnormal sensitivity to light while taking lamotrigine.

Are there any risks for taking Lamictal® 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 Lamictal®?

The following medications may increase the level and effect of lamotrigine:

  • valproic acid/valproate/divalproex (Depakene®/Depakote®/Depakote ER®)

The following medications may decrease the level and effect of lamotrigine:

  • Anticonvulsants such as phenytoin (Dilantin®), carbamazepine (Tegretol®/Carbatrol®/Equetro®), and phenobarbital

  • Oral contraceptives (birth control pills)

  • Rifampin (Rifadin®), ritonavir (Norvir®)

Lamotrigine may increase the levels and effects of clozapine

How long does it take for Lamictal® to work?

It is very important to tell your doctor how you feel things are going 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 illness.

Provided by

College of Psychiatric and Neurologic Pharmacists

(January 2013)

Summary of FDA Black Box Warning

Serious skin rashes requiring hospitalization and discontinuation of treatment have been associated with lamotrigine. Although rare, this rash (also known as Stevens-Johnson Syndrome) can be life threatening. It has been reported in 0.08%to 0.13% of adult patients and up to 0.8% of pediatric patients taking lamotrigine. The rash usually occurs in the first 2-8 weeks of treatment. The risk of rash increases with use of Depakote®; rapid increases of lamotrigine dose; and age <16 years.

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