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Generic name: lamotrigine (la MOE tri jeen)
All FDA black box warnings are at the end of this fact sheet. Please review before taking this medication.
Lamotrigine is a mood stabilizer medication that works in the brain. It is approved for the treatment of bipolar disorder (also known as manic depression) and certain types of seizure disorders. Bipolar disorder involves episodes of depression and/or mania.
Symptoms of depression include:
Lamotrigine may also be helpful when prescribed “off-label” for bipolar depression. “Off-label” means that it hasn’t been approved by the Food and Drug Administration for this condition. Your mental health provider should justify his or her thinking in recommending an “off-label” treatment. They should be clear about the limits of the research around that medication and if there are any other options.
Bipolar disorder requires long-term treatment. Do not stop taking lamotrigine, even when you feel better. With input from you, your health care provider will assess how long you will need to take the medicine. Missing doses of lamotrigine may increase your risk for a relapse in your mood symptoms.
Do not stop taking lamotrigine or change your dose without talking to your health care provider first.
In order for lamotrigine to work properly, it should be taken every day as ordered by your health care provider.
If you are planning on becoming pregnant, notify your health care provider so that he/she can best manage your medications. People living with bipolar disorder who wish to become pregnant face important decisions. 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 cleft birth defects. There may be precautions to decrease the risk of this effect. Do not stop taking lamotrigine without first speaking to your health care provider. Discontinuing similar 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.
Lamotrigine is usually taken 1 or 2 times daily 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 400 mg. Only your health care 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.
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 health care 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.
Avoid drinking alcohol or using illegal drugs while you are taking lamotrigine. They may decrease the benefits (e.g., worsen your condition) and increase adverse effects (e.g., sedation) of the medication.
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.
Common side effects
Rare/serious side effects
A serious, life-threatening skin rash (also known as Stevens–Johnson Syndrome) may occur with the use of lamotrigine. Contact your health care provider immediately if you have any of the following: a skin rash, blistering or peeling of your skin, hives, shortness of breath, or painful sores in your mouth or around your eyes. Extra caution is needed in children and teenagers ages 2-17 receiving lamotrigine. These patients may be at an increased risk of developing this life-threatening rash.
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 500 patients taking the antiepileptic class of medications. If you experience any thoughts or impulses to hurt yourself, you should contact your doctor immediately.
Aseptic meningitis, a serious inflammation of the protective membrane that covers the brain and spinal cord has been identified as a very rare but serious side effect of lamotrigine. Contact your health care provider immediately if you experience headache, fever, nausea, vomiting, stiff neck, rash, unusual sensitivity to light, muscle pains, chills, confusion, or drowsiness while taking lamotrigine.
A rare but life-threatening immune system reaction which can cause serious blood or liver problems has been reported with lamotrigine use. Contact your health care provider immediately if you experience fever, frequent infections, severe muscle pain, swelling of the face, eyes, lips, or tongue, swollen lymph glands, unusual bruising or bleeding, weakness, fatigue, or yellowing of the skin or white part of your eyes. Onset usually occurs within the first several weeks after starting therapy. Patients with hemophagocytic lymphohistiocytosis (HLH) symptoms should be evaluated promptly; discontinuation and conversion to alternate therapy may be required.
Seizures may occur if a patient taking lamotrigine suddenly stops taking it.
A rare but serious multiorgan hypersensitivity reactions, also known as drug reaction with eosinophilia and systemic symptoms (DRESS), which may damage organs, including the liver, kidney, or heart have been reported with the use of lamotrigine. Contact your health care provider immediately if you experience fever, rash, swollen or enlarged lymph nodes. Discontinuation and conversion to alternate therapy may be required.
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.
It is important to note that some of the side effects listed above (particularly rash and suicidal thoughts) may continue to occur or worsen if you continue taking the medication. It is important to follow up with your doctor routinely and to contact your doctor immediately if you notice any skin rash or changes in mood or behavior.
The following medications may increase the level and effects of lamotrigine:
The following medications may decrease the level and effect of lamotrigine:
Lamotrigine may increase the level and effects of:
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.
Serious skin reactions
Serious and sometimes fatal skin reactions have been reported with lamotrigine use. Since it is not always possible to predict which rashes will prove to be serious or life threatening, it is important to talk to your doctor at the first sign of a rash while taking lamotrigine.
©2020 The College of Psychiatric and Neurologic Pharmacists (CPNP) and the National Alliance on Mental Illness (NAMI). CPNP and NAMI make this document available under the Creative Commons Attribution-NoDerivatives 4.0 International License. Last Updated: January 2016.
This information is being provided as a community outreach effort of the College of Psychiatric and Neurologic Pharmacists. This information is for educational and informational purposes only and is not medical advice. This information contains a summary of important points and is not an exhaustive review of information about the medication. Always seek the advice of a physician or other qualified medical professional with any questions you may have regarding medications or medical conditions. Never delay seeking professional medical advice or disregard medical professional advice as a result of any information provided herein. The College of Psychiatric and Neurologic Pharmacists disclaims any and all liability alleged as a result of the information provided herein.
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