Medication Minute: Lamotrigine (Lamictal)

What Is Lamotrigine and What Does It Treat?

Lamotrigine is a mood stabilizing medication approved for treatment of bipolar disorder (also known as manic depression) and certain types of seizure disorders. It affects neural pathways in the brain. Bipolar disorder involves episodes of depression and/or mania. Lamotrigine may also be helpful when prescribed "off-label" for bipolar depression.

*Information for this report provided by the National Alliance on Mental Illness.

Download our PDF about Lamotrigine.

Generic name: lamotrigine (la MOE tri jeen)

• Tablets: 25 mg, 100 mg, 150 mg, 200 mg
• Chewable tablets: 5 mg, 25 mg
• Oral disintegrating tablets: 25 mg, 50 mg, 100 mg, 200 mg
• Extended-release tablets: 25 mg, 50 mg, 100 mg, 200 mg, 250 mg, 300 mg

Brand names:

• Lamictal®
  • Tablets: 25 mg, 100 mg, 150 mg, 200 mg
• Lamictal Blue Starter Kit®
  • Tablets: 25 mg
• Lamictal CD®
  • Chewable tablets: 2 mg, 5 mg, 25 mg
• Lamictal ODT®
  • Oral disintegrating tablets: 25 mg, 50 mg, 100 mg, 200 mg
• Lamictal® XR
  • Extended-release tablets: 25mg, 50 mg, 100 mg, 200 mg, 250 mg, 300 mg
• Subvenite®
  • Tablets: 25 mg, 100 mg, 150 mg, 200 mg
• Subvenite Blue Starter Kit®
  • Tablets: 25 mg

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.

What Is the Most Important Information I Should Know About Lamotrigine?

Bipolar disorder requires long-term treatment. Missing doses of lamotrigine may increase risk for a relapse in mood symptoms.

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

Are There Specific Concerns About Lamotrigine and Pregnancy?

People living with bipolar disorder who wish to become pregnant face important decisions. It is important to discuss the risks and benefits of treatment.
Lamotrigine has been associated with an increased risk of oral cleft birth defects. There may be precautions to decrease the risk of this effect. 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 Health Care 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 breastfeeding
• 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 medication and the dose is increased slowly over several weeks.

The dose usually ranges from 25 mg to 400 mg.

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 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.

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 condition) 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 the Possible Side Effects Of Lamotrigine?

Common side effects of Lamotrigine include:

• Nausea
• Insomnia
• Runny nose
• Non-serious rash
• Headache
• Diarrhea
• Abnormal dreams
• Dizziness or drowsiness
• Fatigue

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.

Patients with certain underlying cardiac disorders or heart rhythm problems may experience serious arrhythmias or life-threatening effects. Those with structural or functional heart disease should be counseled on risk versus benefits of using this medication.

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 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.

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.
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 a provider routinely and to contact a provider immediately if you notice any skin rash or changes in mood or behavior.

What Other Medications May 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 will typically take several weeks to see an improvement in symptoms.
Mood stabilizer treatment is generally needed lifelong for persons with bipolar disorder.

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.