- Tablets: 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®).
- Tablets (extended release): 25mg, 50 mg, 100 mg, 200 mg
Generic name: lamotrigine (la MOE tri jeen)
Medication class: mood stabilizer, anticonvulsant
What is Lamotrigine and what does it treat?
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:
- 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)
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.
What is the most important information I should know about Lamotrigine?
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.
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 Lamotrigine and pregnancy?
If you are planning on becoming pregnant, notify your healthcare 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 healthcare 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.
What should I discuss with my healthcare provider before taking Lamotrigine?
- 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 Lamotrigine?
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 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 Lamotrigine?
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 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) of the medication.
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. A specific treatment to reverse the effects of lamotrigine does not exist.
What are possible side effects of Lamotrigine?
The most common side effects of Lamotrigine are:
- Nausea, insomnia, runny nose, non–serious rash, headache, diarrhea, abnormal dreams, dizziness or drowsiness, fatigue
Rare/Serious 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.
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. If you experience any thoughts or impulses to hurt yourself, you should contact your doctor immediately.
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.
Hemophagocytic lymphohistiocytosis (HLH), a rare but life-threatening immune system reaction, has been reported with lamotrigine use. Symptoms may include fever, rash, liver and spleen swelling, organ system dysfunction, and blood abnormalities. Onset usually occurs within the first several weeks after starting therapy. Patients with HLH symptoms should be evaluated promptly; discontinuation and conversion to alternate therapy may be required.
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?
The following medications may increase the level and effects of lamotrigine:
- Valproate/divalproex (Depakote®)
The following medications may decrease the level and effect of lamotrigine:
- Anticonvulsants such as phenytoin (Dilantin®), carbamazepine (Tegretol®/Carbatrol®/Equetro®), phenobarbital, and primidone (Mysoline®)
- Oral contraceptives (birth control pills)
- Rifampin (Rifadin®), ritonavir (Norvir®)
Lamotrigine may increase the level and effects of:
- Clozapine (Clozaril®, FazaClo®)
How long does it take for Lamotrigine 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.
Summary of FDA Black Box Warnings —
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.
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.