What to Know About Lamictal (Lamotrigine)

Lamictal (lamotrigine) is used as a mood stabilizer for people with bipolar disorder and as an anticonvulsant for people with epilepsy. When used to treat bipolar disorder, the drug helps reduce the occurrence of mood episodes. For people with epilepsy, Lamictal prevents seizures, and it may be used alone or together with another anticonvulsant.

Lamictal belongs to the phenyltriazine class of anticonvulsants. It's not known exactly how it works, but it may stabilize mood by acting on sodium channels in the brain.

Lamictal is taken orally and is available as a tablet intended to be swallowed whole, chewable tablet, or disintegrating tablet that is placed on the tongue. The generic form of Lamictal is called lamotrigine.

Lamictal Uses

For those 18 years and older, Lamictal is used for maintenance treatment of bipolar disorder to reduce the occurrence of mood episodes.

Lamictal is also used to control seizures in people with epilepsy. For children age 2 and older, it's often prescribed together with another anticonvulsant medication, but it may be used alone for adolescents and adults age 16 and up.

The exact mechanism by which Lamictal stabilizes mood is not clear. It is believed to work by inhibiting activity in sodium channels, blocking calcium channels, and inhibiting the release of excitatory amino acids.

Before Taking Lamictal

Before a doctor considers prescribing Lamictal, they will need to evaluate you for bipolar disorder. Your doctor will check to see if you're experiencing symptoms of bipolar disorder like:

• Agitation
• Delusions or hallucinations
• Difficulty concentrating or remembering things
• Distractibility
• Excessive fatigue
• Excessive talking
• Guilt or hopelessness
• Impulsive risk-taking
• Inappropriate behavior
• Increased sexual desire
• Irritability, hostility, or aggression
• Loss of interest in activities that usually give you pleasure
• Loss of interest in your health, nutrition, or physical appearance
• Prolonged periods of sadness
• Racing thoughts
• Sleep disturbances, either sleeping less than usual or too much
• Suicidal thoughts

A doctor will also determine whether you fit the criteria for bipolar I or II and rule out other similar conditions.

Since Lamictal is a maintenance drug, the doctor will likely ensure that you're not currently experiencing an acute manic or depressive episode before beginning treatment. Your prescribing doctor should also reassess you periodically to make sure you still need maintenance treatment for bipolar disorder.

Precautions and Contraindications

There are some situations where you should not take Lamictal based on your preexisting conditions and other medications you're currently taking.

If You Are Pregnant, Trying to Conceive, or Breastfeeding

You should share with the doctor if you're pregnant or trying to conceive. Data from animal studies show that Lamictal may pose a risk to the fetus, but those results haven't been observed in people. Caution is warranted, but you should discuss the issue with your doctor. The benefits of Lamictal might outweigh the potential risks in some cases.

Lamictal does appear to travel through breastmilk, so talk to your prescribing doctor before breastfeeding while taking this medication.

If You Have Liver or Kidney Problems

Let the doctor know if you have a history of liver and/or kidney problems. Caution may be warranted in these cases, and your doctor may need to adjust your Lamictal dosage.

If You Are Taking Other Medications

Talk to your doctor about all medications, supplements, and vitamins that you currently take. While some drugs pose minor interaction risks, others may outright contraindicate use or prompt careful consideration as to whether the pros of treatment outweigh the cons in your case.

Certain drugs may cause problems with Lamictal, like:

• Specific anticonvulsants that can reduce the concentration of Lamictal in your blood, like Dilantin (phenytoin), Mysoline (primidone), phenobarbital, and Tegretol (carbamazepine)
• Oral estrogen-containing contraceptives, which can also reduce Lamictal concentration
• Valproate, which may increase your blood level of Lamictal and can increase the risk of developing a life-threatening rash

In some cases, your doctor may need to adjust your dosage; in others, they may recommend another medication instead of Lamictal.

When pregnant or taking hormonal contraceptives and taking Lamictal, your doctor will monitor your lamotrigine serum levels frequently in order to make dosage adjustments as needed to prevent significant fluctuations in your lamotrigine levels.

Other Anticonvulsants

Anticonvulsants, also known as antiepileptic drugs or AEDs, are sometimes used as mood stabilizers for people with bipolar disorder. Other common anticonvulsants used in bipolar disorder treatment include:

• Depakote (divalproex sodium)
• Equetro or Tegretol (carbamazepine)
• Oxtellar or Trileptal (oxcarbazepine)
• Topamax (topiramate)

Lamictal Dosage

Lamictal is offered in a tablet form and available in a number of different formulations and strengths:

• Lamictal tablets, available in 25-, 100-, 150-, and 200-milligram (mg) strengths
• Lamictal orally disintegrating tablets (ODT), available in 25-, 50-, 100-, and 200-mg strengths
• Lamictal chewable dispersible (CD) tablets, available in 2-, 5-, and 25-mg strengths

Lamotrigine is also available as an extended-release formulation called Lamictal XR. It produces more stable serum levels of the medication.

To avoid the risk of a hypersensitivity reaction, Lamictal is usually started at a lower dose and gradually increased over a period of several weeks. The target dose of Lamictal is typically 200mg daily, though this may vary, particularly if you're taking certain other medications.

Starter kits are available for both Lamictal and Lamictal ODT. These kits provide instructions on how and when to increase dosages, and the instructions vary based on whether you are taking Lamictal alone or with other drugs. The starter kit may be useful if you are starting Lamictal for the first time.

Modifications

You can disperse Lamictal CD in liquid to make them easier to take. To do this, simply:

1. Add the tablets to enough liquid to cover the medication (around 1 teaspoon).
2. Wait one minute, or until the medication is dissolved.
3. Swirl the mixture to make sure the medication is evenly dispersed.

Then you should take the entire mixture (don't take a partial quantity).

How to Take and Store

Lamictal tablets should be swallowed whole. They can be taken with or without water or food, but if you have side effects like nausea, taking your medication with a small snack may help.

Lamictal CD can be swallowed whole, chewed, or diluted in water or fruit juice. If you chew these tablets, you may want to drink a small amount of water or diluted fruit juice to help you swallow.

Lamictal ODT should be placed on your tongue and moved around in your mouth until dissolved. These tablets will dissolve quickly and can be swallowed with or without water. They can also be taken with or without food.

It may take several weeks before you start feeling positive effects from this medication. Be sure to keep taking your recommended dosage; don't stop because you haven't noticed any change.

Lamictal Side Effects

Common

For people with bipolar disorder, the most common side effects of Lamictal are:

• Abdominal pain
• Back pain
• Dry mouth
• Fatigue
• Insomnia
• Nausea
• Sleepiness
• Stuffy, runny nose

Severe

Lamictal very rarely has been associated with severe, even life-threatening conditions, like:

• Acute multi-organ failure
• Blood disorders like anemia
• Cardiac rhythm and conduction abnormalities
• Fever or enlarged lymph nodes, which may be signs of hypersensitivity
• Serious rash
• Suicidal behavior and ideation
• Worsening of bipolar symptoms or the emergence of new symptoms
  

Lamictal Warnings and Interactions

Lamictal carries a black box warning regarding a potentially life-threatening hypersensitivity drug rash. In some cases, a severe rash can develop and lead to conditions known as Stevens-Johnson syndrome (SJS) or toxic epidermal necrosis (TEN), both of which require emergency medical treatment.

The risk of developing a serious rash may be increased if:

• You're currently taking a valproate medication (like Depacon, Depakote, Depakene, or Stavzor)
• You have a history of hypersensitivity to other anticonvulsants
• You take more than the recommended dose of Lamictal or increase the dosage more quickly than recommended

Children may also face a higher risk of developing a serious rash than adults.

Other potential problems with Lamictal include:

• Blood problems and acute organ failure: Lamictal can lead to potentially life-threatening blood and organ disorders. Liver failure, blood clots, muscle breakdown, and blood abnormalities like anemia may be possible.
• Increased risk of suicidal thoughts and/or behavior: This warning accompanies the whole category of antiepileptic drugs. If you notice any signs of worsening depression, unusual mood changes, worsening bipolar symptoms, or the emergence of suicidal thoughts, seek help immediately.
• Other signs of hypersensitivity: While a rash is typically a clear sign of hypersensitivity, it's not the only one. Fever and enlarged lymph nodes can also indicate an adverse reaction.
• Problems operating machinery: Because Lamictal can cause dizziness and drowsiness, you should be cautious about operating a vehicle or heavy machinery while taking this medication.

You should remain under the close care of your doctor while taking Lamictal.

For bipolar disorder, dosages may be decreased by 50% each week over a period of at least two weeks. After discontinuing, your doctor should continue to monitor your symptoms for several weeks or months to watch for a reappearance of symptoms of mania or hypomania. Your doctor should also take into account other medications you may be taking that might cause the medication to remain in your body for longer than usual.