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™
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:
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.
