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Lamictal® (lamotrigine)

All FDA warnings are at the end of this fact sheet. Please consult them before taking this medication.

Brand and Generic Names

Brand Name: Lamictal®
- Tablets (non–chewable): 25 mg, 100 mg, 150 mg, 200 mg
- Chewable tablets: 2 mg, 5 mg, 25 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®).
Generic name: lamotrigine (la MOE tri jeen)

What is Lamictal® and what does it treat?

Lamotrigine is an anticonvulsant drug approved for the treatment of seizures (epilepsy) in adults and children. It can be used alone, or in combination with other anticonvulsants. It has also been approved for the maintenance treatment of bipolar disorder (manic-depressive disorder). That means lamotrigine will help to delay the time to occurrence of mood episodes.

A manic episode, or mania, is when a person experiences several of the following symptoms at the same time: “high” or irritable mood, very high self esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees). Lamotrigine by itself has not been useful for severe or recurrent mania.

A depressive episode, or depression, is when a person experiences several of the following symptoms at the same time: “low” or depressed mood (for example, sad, empty, tearful), decreased interest in most or all activities, changes in appetite (usually decreased), changes in sleep (usually poor sleep), loss of energy, feeling worthless/guilty/ hopeless/ helpless, difficulty concentrating, thoughts of death (suicidal thinking). Lamotrigine has been studied for the treatment of bipolar depression.

Bipolar disorder is a brain disorder (mental illness) that exposes people to these mood changes over the course of time. Bipolar disorder affects more than two million American each year, but patients with this disorder can lead fulfilling lives when they receive proper treatment. Unfortunately, many people with this illness do not receive treatment.

What is the most important information I should know about Lamictal®?

Bipolar disorder requires long-term treatment. Do not stop taking the 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 seizures.

Do not stop taking lamotrigine or change your dose without talking to with your healthcare provider first.
You should not drink or use illegal drugs while taking lamotrigine.
Tell your healthcare provider if you are taking birth control pills. These medications may alter the levels of lamotrigine.
Lamotrigine may be prescribed by itself or along with other medications to manage your mood symptoms.
Compared to lithium and valproic acid, lamotrigine may not be as effective in stabilizing a manic episode, however, it may be more effective in treating depressive episodes experienced by individuals with bipolar disorder.
Lamotrigine can be associated with serious skin rashes, which are rare. If you experience a new rash while taking lamotrigine, call your doctor immediately.
Bipolar disorder is an illness that may have suicidal thinking as a possible symptom. You should report any new occurrence, or worsening, of suicidal thinking to your doctor.
It is very important to check your medication at the pharmacy each time it is filled. There have been pharmacy dispensing errors reported with consumers receiving “Lamisil®” instead of “Lamictal®”. Lamisil® is a medication that is used for the treatment of fungal infections of the toenails or fingernails.

Are there specific concerns about Lamictal® and pregnancy?

Lamotrigine can interfere with folic acid which may increase the chances of birth defects in babies. New information suggests that babies exposed to lamotrigine during the first three months of pregnancy may have a higher chance of being born with a cleft lip or cleft palate. Babies born with cleft lip or cleft palate have a gap in the upper lip or roof of the mouth. More research is needed to be sure about this possibly increased chance of cleft lip or cleft palate in babies born to mothers who take lamotrigine.

If you are planning on becoming pregnant or have become pregnant, you should talk with 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 about the risks and benefits of the medications as they relate to the illness and to the fetus. This is a complex decision as untreated bipolar disorder has risks to the fetus as well as the mother. There are many dimensions to these choices, so be sure to confer with your doctor and caregivers. Do not start or stop taking lamotrigine without talking to your doctor.

Due to a lack of data to ensure safety, breast feeding while taking lamotrigine is not recommended.

What should I discuss with my healthcare provider before taking Lamictal®?

Tell your doctor if you have taken lamotrigine before. If you are allergic to it, tell your doctor and pharmacist exactly what the medication did to you before taking even one dose.
Symptoms which are most bothersome to you about your condition
If you have thoughts of suicide
Medications you have taken in the past to treat bipolar disorder, whether they were effective or caused any adverse effect
All other medications you are currently taking (including over the counter, herbal and nutritional supplements) and any medication allergies you have
Any medication side effects that you have experienced in the past, or are currently experiencing
If you are pregnant, plan to become pregnant, or are breast-feeding
If you smoke, drink alcohol, or use illegal drugs
Any medical problems you may have, especially liver or kidney disease

How should I take Lamictal®?

The amount of lamotrigine you take and how quickly your dose will increase depends on whether or not you are taking other medications that may interact with lamotrigine. The table that follows provides important information about dosing. The maximum lamotrigine dose in the treatment of bipolar disorder is different depending on other medications you are taking. Your healthcare provider will determine the dose that is right for you based upon your response

Schedule of lamotrigine dose increases in patients being treated for bipolar disorder.

Duration of Treatment	No Other Interacting Meds	For Patients Taking Depakote	For Patients Taking Tegretol
Weeks 1 & 2	25 mg daily	25 mg every other day	50 mg daily
Weeks 3 & 4	50 mg daily	25 mg daily	100 mg daily (in divided doses)
Week 5	100 mg daily	50 mg daily	200 mg daily (in divided doses)
Week 6	200 mg daily	100 mg daily	300 mg daily (in divided doses)
Week 7	200 mg daily	100 mg daily	400 mg daily (in divided doses)

Lamotrigine may be taken with food to minimize stomach cramping, nausea and vomiting.
Always take lamotrigine at the same time every day
Use a pillbox or a calendar as a reminder to take your medications. If needed, have a family member or friend check-in with you to help you take your medications.

What happens if I miss a dose of Lamictal®?

If you miss a dose of lamotrigine, take it as soon as you remember if it is not too close to when your next dose is due - discuss this with your healthcare provider. If it is close to your next dose, wait until then to take the medication and skip the missed dose. Do not double your next dose or take more than what you have been told to take.

If you miss more than three days of the medication, contact your prescriber.

What should I avoid while taking Lamictal®?

Avoid drinking alcohol or using illegal drugs while taking lamotrigine because the beneficial effects of the medication may be decreased and adverse effects (e.g. sedation) and risk of seizures may be increased.
Lamotrigine may cause dizziness or drowsiness, especially when first starting the medication. Make sure you know how it will affect you before you drive, operate machinery or do other activities that may be dangerous if you are not alert.

What happens if I overdose?

If an overdose occurs, whether intentional or accidental, immediate medical attention may be necessary. Call your doctor or emergency medical service (911). You may also contact the poison control center at 1 (800) 222-1222.

There have been reports of people who have overdosed with lamotrigine. Some of the overdoses resulted in death. Overdose has resulted in dizziness, abnormal eye movements, seizures, sleepiness or loss of consciousness and abnormal heart rhythms.

A specific antidote for lamotrigine does not exist.

What are the possible side effects of Lamictal®?

Like all medications, lamotrigine has side effects. Most of these will get better or even go away completely as your body gets used to the medicine. Everyone responds differently so let your doctor, pharmacist, and other healthcare professionals know how the medication is affecting you.

Remember the lists of side effects below are only possible problems. Nobody gets them all and very few people get the more serious side effects. This list is to help you know when to contact your doctor or pharmacist. It is not meant to scare you. Talk with your healthcare provider if you experience side effects that are bothersome to you.

More common side effects are:

Nausea, insomnia, daytime sleepiness, feeling physically tired (fatigue), runny nose, and non–serious rash, headache, dizziness, diarrhea, abnormal dreams and itchy skin

Rare side effects are:

A serious, life threatening rash (also known as Stevens–Johnson Syndrome) may occur with the use of lamotrigine. Although this rash is believed to be rare, any patient who develops a rash while taking lamotrigine (or any other medication) should report this to their doctor quickly. 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. Talk with your healthcare provider if you experience side effects that are bothersome.

Seizures may occur if a patient taking lamotrigine suddenly stops taking it.

Patients being treated with lamotrigine for bipolar disorder should report to their doctor if suicidal thinking starts or worsens. They should also report to their doctor if their mood symptoms begin to “switch” from symptoms of depression to symptoms of mania.
Talk with your healthcare provider if you experience side effects that are bothersome to you.

Contact your healthcare provider immediately if you develop a skin reaction, fever, swelling, or shortness of breath.

Are there any risks with taking Lamictal® for long periods of time?

None are known, however, lamotrigine is meant to be taken for a long time.

What other drugs interact with Lamictal®?

Medications that may increase levels of lamotrigine in your body:
- valproic acid/valproate/divalproex (Depakene®/Depakote®/Depakote ER®)
- efavirenz (Sustiva®)
- delavirdine(Rescriptor®).
Medications that may decrease levels of lamotrigine in your body:
- carbamazepine (Tegretol®)
- oral contraceptives (birth control pills)
- phenytoin (Dilantin®)
- rifampin (Rifadin®)
- ritonavir (Norvir®)
- nevirapine (Viramune®).
Clozapine blood levels may become too high or “toxic” when lamotrigine therapy is added.

How long does it take for Lamictal® to work?

Several weeks are often required for lamotrigine to reach its maximum effectiveness; however, improvement in some symptoms may occur sooner.

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 enough changes in your symptoms to decide if lamotrigine is helpful for you.

Lifelong mood stabilizer treatment is generally needed in persons with bipolar illness. Your doctor can best discuss the duration of treatment you need based on your symptoms and course of illness.

Updated by Charles F. Caley, Pharm.D., BCPP
(November 2010)

NAMI wishes to thank the College of Psychiatric and Neurologic Pharmacists for producing this fact sheet.

Reviewed by Dr. Ken Duckworth, NAMI Medical Director

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