How long does lamictal take to work for anxiety?

Lamotrigine

Side effects

Some side effects that appear should get better after a few days. If they do not, you should go back to your doctor.
Do not stop taking the tablets until you talk to your doctor, or you may get withdrawal symptoms as well.

Very common side effects of taking lamotrigine (affecting more than one in ten people) include:

  • headaches
  • skin rashes

Common side effects of taking lamotrigine (affecting up to one in ten people) include:

  • feeling aggressive, agitated or irritable
  • feeling sleepy, tired or drowsy
  • insomnia (having difficulty sleeping)
  • feeling dizzy
  • shaking or tremors
  • diarrhoea (loose poo)
  • dry mouth
  • nausea (feeling sick) or vomiting (being sick)
  • having pain in your back or joints, or elsewhere

There are other side effects that you can get when taking this medicine; we have only included the most common ones here.

Please look at the leaflet inside your medicine box, or ask a doctor or pharmacist, if you want to know whether you are getting a side effect from your medicine.

If you do get a side effect, please think about reporting it via the Yellow Card Scheme.

Sleep

Lamotrigine may make you feel very drowsy or sleepy when you start taking it.

It may also make it difficult for you to get to sleep.

If these symptoms carry on for a long time, or if this is difficult for you, talk to your doctor or pharmacist about other medicines you could take.

Fertility

There is nothing to suggest that lamotrigine has any effects on fertility.

Pregnancy, post-natal and breastfeeding

Pregnancy

If you become pregnant while you are on lamotrigine, you should carry on taking the medicine and go back to your doctor as soon as possible to discuss whether you should stop or change your medicine.

Studies of over 7,500 women taking lamotrigine showed no increase in problems during the early stages of pregnancy.

Your doctor might also give you extra folic acid to take, which helps prevent any spine problems in your baby.

From month four onwards, you are likely to need a higher dose of lamotrigine to keep the level of the medication in your body constant. After giving birth, your lamotrigine dose will go back to what it was before.

If you are taking lamotrigine for epilepsy, any dose increases may be made based on the results of your blood level tests.

Post-natal

If you and your doctor agree that you will carry on taking lamotrigine throughout your pregnancy, you should tell your midwife that you are taking it before you give birth.

Breastfeeding

Lamotrigine can be passed to the baby in breastmilk, and side effects have been seen in breastfed babies. Usually there is no problem with breastfeeding a healthy baby.

Talk to your midwife or doctor about the benefits and risks of breastfeeding while taking lamotrigine.

Driving and transport

Do not drive a car or ride a bike just after you start taking lamotrigine.

Taking lamotrigine may make you feel dizzy and may affect your eyesight when you start taking it (possibly causing blurred or double vision).

This could affect you if you drive a car, ride a bike, or do anything else that needs a lot of focus. It might be best to stop doing these things for the first few days, until you know how it affects you.

Do not worry – most people do these things as normal while taking lamotrigine.

School and exams

Try not to take lamotrigine for the first time just before your exams, as
you may have sleep problems (feeling tired or having difficulty getting to sleep), and some blurred eyesight or double vision when you start taking lamotrigine.

You should talk to your doctor about any future exams if you are starting lamotrigine.

You might decide together to delay starting it until you have done them.

If they are more than a month away, however, you might find that it is better to start lamotrigine to improve your motivation to study.

Do not worry – most people do all these things as normal while taking lamotrigine.

Friends and family

You may want to let your family and friends know you are taking lamotrigine so they can support you and help you look out for side effects.

For guidance on this, check out our page on getting support with your medication.

Sport

Lamotrigine is not a banned substance in sport.

It could, however, make you feel dizzy and give you blurred or double vision when you start taking it.

It might be better to delay any sport that needs a lot of focus until you know how it affects you.

Do not worry – most people play sports as normal while taking lamotrigine.

Alcohol and street drugs

Alcohol

You can drink alcohol while taking lamotrigine, but it is likely to make you feel sleepier.

Street drugs

We do not know how street drugs affect lamotrigine, but all these drugs affect the way the brain works so they may not mix well.

Prescription medicines

Lamotrigine does not mix well with some other medicines and drugs and may affect the way in which they work. Tell your doctor if you are taking any other medications including over-the-counter medicines for common illnesses and things you put on your skin.

Special information about contraceptive pills containing oestrogen

  • when lamotrigine is taken with any type of the Pill (oral contraceptive) containing oestrogen, it lowers the level of lamotrigine that you have in your body
  • if you have a pill-free week, the levels of lamotrigine will then rise, which may give you side effects
  • if you take the Pill without a break, it will make your lamotrigine levels stable. You will not be harmed by not having the break
  • talk to your doctor or pharmacist before you start taking lamotrigine if you also take the Pill
  • the morning-after pill does not affect the level of lamotrigine in your body as it does not contain oestrogen

If you have any further questions about this, you should speak to your doctor or pharmacist.

References and further reading

For more helpful links and information, have a look at our references and further reading page.

Lamotrigine, Oral Tablet

All possible dosages and drug forms may not be included here. Your dosage, form, and how often you take the drug will depend on:

  • your age
  • the condition being treated
  • the severity of your condition
  • other medical conditions you have
  • how you react to the first dose

Drug forms and strengths

Generic: Lamotrigine

Brand: Lamictal

  • Form: oral tablet
  • Strengths: 25 mg, 100 mg, 150 mg, 200 mg

Brand: Lamictal CD

  • Form: chewable tablet
  • Strengths: 2 mg, 5 mg, 25 mg

Brand: Lamictal ODT

  • Form: orally disintegrating tablet (can be dissolved on the tongue)
  • Strengths: 25 mg, 50 mg, 100 mg, 200 mg

Brand: Lamictal XR

  • Form: extended-release tablet
  • Strengths: 25 mg, 50 mg, 100 mg, 200 mg, 250 mg, 300 mg

Dosage for seizures in people with epilepsy

Adult dosage (ages 18–64 years)

Immediate-release form (tablets, chewable tablets, orally disintegrating tablets)

  • TAKING with valproate:
    • Weeks 1–2: Take 25 mg every other day.
    • Weeks 3–4: Take 25 mg per day.
    • Week 5 onward: Your doctor will increase your dose by 25–50 mg once per day every one to two weeks.
    • Maintenance: Take 100–400 mg per day.
  • NOT TAKING carbamazepine, phenytoin, phenobarbital, primidone, or valproate:
    • Weeks 1–2: Take 25 mg per day.
    • Weeks 3–4: Take 50 mg per day.
    • Week 5 onward: Your doctor will increase your dose by 50 mg once per day every one to two weeks.
    • Maintenance: Take 225–375 mg per day, in 2 divided doses.
  • TAKING carbamazepine, phenytoin, phenobarbital, or primidone and NOT TAKING valproate:
    • Weeks 1–2: Take 50 mg every day.
    • Weeks 3–4: Take 100 mg per day, in 2 divided doses.
    • Week 5 onward: Your doctor will increase your dose by 100 mg once per day every one to two weeks.
    • Maintenance: Take 300–500 mg per day, in 2 divided doses.

Extended-release form (tablets)

  • TAKING with valproate:
    • Weeks 1–2: Take 25 mg every other day.
    • Weeks 3–4: Take 25 mg per day.
    • Week 5: Take 50 mg per day.
    • Week 6: Take 100 mg per day.
    • Week 7: Take 150 mg per day.
    • Maintenance: Take 200–250 mg per day.
  • NOT TAKING carbamazepine, phenytoin, phenobarbital, primidone, or valproate:
    • Weeks 1–2: Take 25 mg every day.
    • Weeks 3–4: Take 50 mg per day.
    • Week 5: Take 100 mg per day.
    • Week 6: Take 150 mg per day.
    • Week 7: Take 200 mg per day.
    • Maintenance: Take 300–400 mg per day.
  • TAKING carbamazepine, phenytoin, phenobarbital, or primidone and NOT TAKING valproate:
    • Weeks 1–2: Take 50 mg per day.
    • Weeks 3–4: Take 100 mg per day.
    • Week 5: Take 200 mg per day.
    • Week 6: Take 300 mg per day.
    • Week 7: Take 400 mg per day.
    • Maintenance: Take 400–600 mg per day.

Conversion from adjunctive therapy to monotherapy

Your doctor may choose to stop your other antiseizure medications and have you take lamotrigine by itself. This dosing will be different from what is outlined above. Your doctor will slowly increase your dosage of lamotrigine and slowly decrease the dosages of your other antiseizure medications.

Conversion from immediate-release to extended-release (XR) lamotrigine

Your doctor can switch you directly from the immediate-release form of lamotrigine to the extended-release (XR) form. This dosing will be different from what is outlined above. Once you switch to the XR form, your doctor will monitor you to make sure your seizures are under control. Your doctor may change your dosage based on how you respond to treatment.

Child dosage (ages 13–17 years)

Immediate-release form (tablets, chewable tablets, orally disintegrating tablets)

  • TAKING with valproate:
    • Weeks 1–2: Take 25 mg every other day.
    • Weeks 3–4: Take 25 mg per day.
    • Week 5 onward: Your doctor will increase your dose by 25–50 mg once per day every one to two weeks.
    • Maintenance: Take 100–400 mg per day.
  • NOT TAKING carbamazepine, phenytoin, phenobarbital, primidone, or valproate:
    • Weeks 1–2: Take 25 mg per day.
    • Weeks 3–4: Take 50 mg per day.
    • Week 5 onward: Your doctor will increase your dose by 50 mg once per day every one to two weeks.
    • Maintenance: Take 225–375 mg per day, in 2 divided doses.
  • TAKING carbamazepine, phenytoin, phenobarbital, or primidone and NOT TAKING valproate:
    • Weeks 1–2: Take 50 mg every day.
    • Weeks 3–4: Take 100 mg per day, in 2 divided doses.
    • Week 5 onward: Your doctor will increase your dose by 100 mg once per day every one to two weeks.
    • Maintenance: Take 300–500 mg per day, in 2 divided doses.

Extended-release form (tablets)

  • TAKING with valproate:
    • Weeks 1–2: Take 25 mg every other day.
    • Weeks 3–4: Take 25 mg per day.
    • Week 5: Take 50 mg per day.
    • Week 6: Take 100 mg per day.
    • Week 7: Take 150 mg per day.
    • Maintenance: Take 200–250 mg per day.
  • NOT TAKING carbamazepine, phenytoin, phenobarbital, primidone, or valproate:
    • Weeks 1–2: Take 25 mg every day.
    • Weeks 3–4: Take 50 mg per day.
    • Week 5: Take 100 mg per day.
    • Week 6: Take 150 mg per day.
    • Week 7: Take 200 mg per day.
    • Maintenance: Take 300–400 mg per day.
  • TAKING carbamazepine, phenytoin, phenobarbital, or primidone and NOT TAKING valproate:
    • Weeks 1–2: Take 50 mg per day.
    • Weeks 3–4: Take 100 mg per day.
    • Week 5: Take 200 mg per day.
    • Week 6: Take 300 mg per day.
    • Week 7: Take 400 mg per day.
    • Maintenance: Take 400–600 mg per day.

Conversion from adjunctive therapy to monotherapy

Your doctor may choose to stop your other antiseizure medications and have you take lamotrigine by itself. This dosing will be different from what is outlined above. Your doctor will slowly increase your dose of lamotrigine and slowly decrease the doses of your other antiseizure medications.

Conversion from immediate-release to extended-release (XR) lamotrigine

Your doctor can switch you directly from the immediate-release form of lamotrigine to the extended-release (XR) form. This dosing will be different from what is outlined above. Once you switch to the XR form, your doctor will monitor you to make sure your seizures are under control. Your doctor may change your dose based on how you respond to treatment.

Child dosage (ages 2–12 years)

Immediate-release form (tablets, chewable tablets, orally disintegrating tablets)

  • TAKING with valproate:
    • Weeks 1–2: Take 0.15 mg/kg per day, in 1–2 divided doses.
    • Weeks 3–4: Take 0.3 mg/kg per day, in 1–2 divided doses.
    • Week 5 onward: Your doctor will increase dose by 0.3 mg/kg per day every one to two weeks.
    • Maintenance: Take 1–5 mg/kg per day, in 1–2 divided doses (maximum of 200 mg per day).
  • NOT TAKING carbamazepine, phenytoin, phenobarbital, primidone, or valproate:
    • Weeks 1–2: Take 0.3 mg/kg per day, in 1–2 divided doses.
    • Weeks 3–4: Take 0.6 mg/kg per day, in 2 divided doses
    • Week 5 onward: Your doctor will increase dose by 0.6 mg/kg per day every one to two weeks.
    • Maintenance: Take 4.5–7.5 mg/kg per day, in 2 divided doses (maximum of 300 mg per day).
  • TAKING carbamazepine, phenytoin, phenobarbital, or primidone and NOT TAKING valproate:
    • Weeks 1–2: Take 0.6 mg/kg per day, in 2 divided doses.
    • Weeks 3–4: Take 1.2 mg/kg per day, in 2 divided doses.
    • Week 5 onward: Your doctor will increase dose by 1.2 mg/kg per day every one to two weeks.
    • Maintenance: Take 5–15 mg/kg per day, in 2 divided doses (maximum of 400 mg per day).

Extended-release form (tablets)

It has not been confirmed that lamotrigine is safe and effective for use in children younger than 13 years. It should not be used in these children.

Child dosage (ages 0–1 year)

Immediate-release form (tablets, chewable tablets, orally disintegrating tablets)

It has not been confirmed that these forms of lamotrigine are safe and effective for use in children younger than 2 years. They should not be used in these children.

Senior dosage (ages 65 years and older)

Older adults may process drugs more slowly. A typical adult dose may cause drug levels in your body to be higher than normal. This can be dangerous. To help avoid this, your doctor may start you on a lower dose or a different schedule.

Dosage for bipolar disorder

Adult dosage (ages 18–64 years)

Immediate-release form (tablets, chewable tablets, orally disintegrating tablets)

  • TAKING with valproate:
    • Weeks 1–2: Take 25 mg every other day.
    • Weeks 3–4: Take 25 mg per day.
    • Week 5: Take 50 mg per day.
    • Week 6: Take 100 mg per day.
    • Week 7: Take 100 mg per day.
  • NOT TAKING carbamazepine, phenytoin, phenobarbital, primidone, or valproate:
    • Weeks 1–2: Take 25 mg per day.
    • Weeks 3–4: Take 50 mg per day.
    • Week 5: Take 100 mg per day.
    • Week 6: Take 200 mg per day.
    • Week 7: Take 200 mg per day.
  • TAKING carbamazepine, phenytoin, phenobarbital, or primidone and NOT TAKING valproate:
    • Weeks 1–2: Take 50 mg per day.
    • Weeks 3–4: Take 100 mg per day, in divided doses.
    • Week 5: Take 200 mg per day, in divided doses.
    • Week 6: Take 300 mg per day, in divided doses.
    • Week 7: Take up to 400 mg per day, in divided doses.

Child dosage (ages 0–17 years)

Immediate-release forms (tablets, chewable tablets, orally disintegrating tablets)

It has not been confirmed that these forms of lamotrigine are safe and effective for use in children younger than 18 years for the treatment of bipolar disorder. They should not be used in these children for the treatment of bipolar disorder.

Senior dosage (ages 65 years and older)

Older adults may process drugs more slowly. A typical adult dosage may cause drug levels in your body to be higher than normal. This can be dangerous. To help avoid this, your doctor my start you on a lower dosage or a different dosing schedule.

Special dosage considerations

  • For people with liver disease: If you have moderate to severe liver problems, your doctor may lower your dosage of lamotrigine.
  • For people with kidney disease: If you have kidney problems, your doctor may lower your dosage of lamotrigine. If your kidney problems are severe, talk to your doctor about whether you should use this drug.

Dosage warnings

Your starting dosage of lamotrigine should not be higher than the recommended starting dosage. Also, your dosage should not be increased too quickly. If your dosage is too high or increased too quickly, you’re at higher risk of a serious or life-threatening skin rash.

If you’re taking this drug to treat seizures and are supposed to stop taking it, your doctor will slowly lower your dosage over at least two weeks. If your dosage isn’t slowly lowered and tapered off, you will be at increased risk of having more seizures.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Lamotrigine (Brand names: Lamictal, Lamictal CD, Lamictal ODT, Lamictal XR)

Like other mood stabilizers, lamotrigine was originally developed as an anticonvulsant to treat seizures and is often used with other medications in the treatment of bipolar (manic-depressive) disorder. For the latest information on the use of lamotrigine, Psycom spoke with Joseph Goldberg, MD, Clinical Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai in New York, and co-author of Managing the Side Effects of Psychotropic Medications, 2nd Ed, a textbook published by American Psychiatric Association Publishing and Christopher Aiken, MD, the director of the Mood Treatment Center in North Carolina.

Lamotrigine is the only mood stabilizer that calms mood swings by lifting the depression rather than suppressing the mania, says Dr. Aiken. “That makes it a great choice for the bipolar spectrum, where the depressive symptoms usually outweigh the manic ones. Its greatest benefit is in prevention. It can prevent both the depressive and manic side, but its benefits are much stronger for depression and it does not treat active mania or hypomania.”

Dr. Aiken adds that part of the reason patients prefer lamotrigine is that it’s generally free of side effects. “In the original research studies people reported more side effects on the placebo than on lamotrigine. That may sound impossible, but it’s likely that lamotrigine helped them feel better physically by treating their depression,” explains the mood disorder expert adding that lamotrigine is also largely free of the “medicated” feelings that people dislike with mood stabilizers. “People don’t tend to feel dull, flat, or groggy on it.”

In some research studies comparing a placebo to the medicine, the results were exceptional. “Lamotrigine is the only medicine we know of where patients were unable to tell they were taking the medication,” he explains. “It didn’t make them feel medicated, and its benefits built up very gradually. After 2 years, people taking lamotrigine had half as many days of depression as those who did not take it.”

Which conditions are treated with lamotrigine?

Although lamotrigine is not considered an antidepressant, it is used as a maintenance treatment for bipolar I disorder to help stabilize mood changes. (Bipolar I disorder is characterized by manic episodes.) 1,2

“The drug manufacturer’s original studies of lamotrigine in bipolar depression found that improvements were stronger in bipolar 1 than bipolar II disorder,” Dr. Goldberg recalls. (Bipolar II disorder is characterized by longer episodes and more frequent occurrence of major depression and hypomania.) Newer research suggests, however, that lamotrigine may be even more effective as a mood stabilizer in preventing relapses in treating bipolar II disorder.2

There are also conditions lamotrigine treats off-label including borderline personality disorder, schizoaffective disorder, and obsessive-compulsive disorder (OCD), Dr. Aiken says.

How does lamotrigine work?

Lamotrigine delays the time between mood changes and manic or depressive states in people with bipolar disorder by decreasing the intensity of irregular electrical activity in the brain. People with bipolar disorder are at high risk of experiencing recurrent and relapsing episodes of mood change. Maintenance treatment with lamotrigine helps reduce the risk by preventing or delaying these recurrences and relapses.

“Many clinicians think that lamotrigine helps achieve and sustain even moods over time by virtue of its antidepressant properties, rather than anti-manic (mood-stabilizing) properties,” says Dr. Goldberg. “It works with mood stabilizers like lithium and Divalproex, but it’s not interchangeable with these drugs and cannot be used in their place.”

Lamotrigine is used over time as a preventative medication. Clinical trials that looked at lamotrigine’s potential for treating acute (in-the-moment) episodes of mania found no difference between the medication and placebo.2

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Is there a typical dose of lamotrigine?

Your doctor will initially prescribe a low dose of lamotrigine and gradually increase your dose every week or two for several weeks, until you reach an effective dose level.

“Treatment guidelines for target blood levels of lamotrigine have not been established for conditions other than epilepsy,” Dr. Goldberg points out. “In relapse prevention studies conducted by its manufacturer, however, 200 mg/day was found to be a better target dose than 50 mg/day, while higher doses (400 mg/day) did not provide greater benefit against relapse.”

The dosing regimen of lamotrigine can depend on which other medications you are taking to treat bipolar disorder, and is adjusted when you wean off and discontinue other medications.

“Some medicines slow down the metabolism of lamotrigine (notably, Divalproex), requiring a slower rate of increase and a lower target dose,” notes Dr. Goldberg. “Others speed up its metabolism (notably, carbamazepine), requiring a faster-than-usual dose increase and a higher-than-usual target dose.”

Lamotrigine comes in several forms for treating bipolar disorder: Tablets, chewable tablets, dissolving tablets. Your doctor may tell you to take tablets once a day, twice a day or every other day.

If you miss a dose of lamotrigine, take the missed dose as soon as you remember. If it is close to the time of your next dose, however, skip the missed dose and continue with your usual schedule. Never take a double dose of lamotrigine.

How long does it take to work?

In certain cases, the antidepressant and antimanic benefits of lamotrigine are noticed pretty early on in the treatment cycle, says Dr. Aiken. “For some other patients, though, effects are seen after about a month of being on lamotrigine treatment. But there will always be others that take a bit longer to experience the positive effects.”

Cost of Lamictal/Lamotrigine

When ordered in lots of 100 tablets, here is the breakdown in pricing for one tablet of the medication in the following doses (Note: pricing information generated April 2011):

  • $4.83 for 25 mg tablet
  • $5.43 for 100 mg tablet
  • $5.93 for 150 mg tablet
  • $6.67 for 200 mg tablet

Generic cost (lamotrigine) is as follows:

  • $0.3 for 25 mg tablet
  • $0.3 for 100 mg tablet
  • $0.53 for 150 mg tablet
  • $0.53 for 2000 mg tablet

Advantages of Lamotrigine

Dr. Aiken reports there are some major advantages of lamotrigine including:

  • It’s effective in a majority of bipolar patients
    Almost two-thirds of patients who are suffering from bipolar mood disorders have responded extremely well to lamotrigine.
  • It’s ideal for mixed states
    People who, due to mania switches during intense cycling, have not been able to rely on other antidepressants have responded well to lamotrigine when given in therapeutic doses.
  • It’s good for patients who respond to nothing else
    Patients who fail to respond to any other mood stabilizers and lithium have shown good results when treated using lamotrigine.
  • There are minimal side effects
    Lamotrigine has minimal side effects that usually fade away after some time.

Who can (and cannot) take lamotrigine for bipolar disorder?

Doctors may prescribe lamotrigine to adults or adolescents who are otherwise being treated for bipolar disorder or weaning off other medications used to treat bipolar disorder. Older adults may be more sensitive to the effects of lamotrigine and prescribed lower doses. “When people respond to lamotrigine, they often say they can see things in perspective better and are less reactive under stress. They usually still have days of depression, but these tend to be shorter and less frequent,” says Dr. Aiken.

Children under age 18 are at higher risk of developing a skin rash from lamotrigine if dosed too rapidly. In spite of the potential side effects, however, Dr. Goldberg points out that many studies support the use of lamotrigine for treating bipolar disorder in youth.

Definitive information about the safety of lamotrigine in pregnancy is not available, but according to Dr. Goldberg, many doctors perceive it to be among the safer options when treatment is required, especially in women who are more prone to depression than mania. Like many psychotropic drugs, lamotrigine is secreted into breast milk, so women are advised to discuss with their doctors the risk and benefits of breastfeeding while taking lamotrigine.

Lamotrigine Side Effects

Some people who take lamotrigine may experience adverse reactions or side effects. In approximately 8 in 10,000 people, lamotrigine can cause severe, life-threatening rashes and other skin disorders, typically between the second and eighth weeks of treatment. The risk of rash increases with higher starting doses, higher escalating doses and use of lamotrigine in combination with valproate. Early clinical trials and follow-up research showed that the overall incidence of any skin disorders was 11 to 12% in both bipolar I and bipolar II patients treated with lamotrigine. 2

“Most of these skin issues are benign,” Dr. Goldberg emphasizes. “Serious rashes from lamotrigine are not due to an allergy, but rather, a systemic reaction that also usually includes fever, sore throat, swollen glands, and other physical symptoms.”

But as with any medication, Dr. Goldberg adds, allergic reactions to lamotrigine can occur. Get immediate emergency help if you show any signs of an allergic reaction, such as hives, facial or throat swelling, or difficulty breathing. Notify your doctor if you develop a skin rash, especially if it occurs within your mouth or on soft body tissue such as eyelids or around nasal openings, and if it is blistering, peeling, painful, burning, or involves a fever or sore throat. Be sure to report all medications you are taking to medical staff.

Serious side effects that should be reported immediately to your doctor include:

  • Any skin rash, blistering or peeling of skin
  • Painful (burning) sores in or around the mouth, eyes or genitals
  • Jaundice (yellowish skin or eyes)
  • Swollen gland, fever, severe muscle pain
  • Weakness, drowsiness, confusion
  • Stiff neck, headache
  • Increased sensitivity to light
  • Mood or behavior changes, such as depression, anxiety, agitation, hostility, restlessness, mental or physical hyperactivity, suicidal thoughts

Common side effects of lamotrigine that are not emergencies but should also be reported to your doctor include:

  • Headache or dizziness
  • Blurred or double vision
  • Dry mouth
  • Gastrointestinal distress such as nausea, vomiting, diarrhea or stomach pain
  • Fever, sore throat, runny nose
  • Drowsiness or fatigue
  • Tremor
  • Insomnia

Lamotrigine Rash

The biggest risk with lamotrigine is a rare allergic reaction called Stevens-Johnson Syndrome, which can be fatal if left untreated. Many medications can cause this reaction, including antibiotics like Bactrim and penicillin and over-the-counter medications like Tylenol and Motrin. The risk of getting the rash can be prevented if the following precautions are followed:

  1. Dosing increases must be raised very slowly.
  2. It should be stopped if any new rash or skin changes occur while you’re starting the medication. (After the first 3 months the risk of Stevens-Johnson Syndrome declines to almost zero).
  3. To avoid false-alarm rash confusion, the use of new soaps, getting a sunburn, exposure to poison ivy and starting any other new medications should be avoided during the first 3 months of starting lamotrigine.

With those steps, the risk of this severe rash is about 1 in 3,000; without them, it’s more like 1 in 100. “Unfortunately, there is still a high risk of non-serious, benign rashes (10% chance), so many people have to stop lamotrigine to be on the safe side,” Dr. Aiken explains. “If you responded to lamotrigine but had to stop it because of a rash, it may be possible to restart at a lower dose.”

Does lamotrigine interact with any medications or other substances?

Certain other drugs can affect the way lamotrigine works in your body by decreasing its effectiveness or delaying its excretion from your body. These include hormonal birth control methods, hormone treatments, seizure medications such as phenobarbital, and valproic acid, which is also used to treat bipolar disorder.

Your doctor will carefully prescribe and monitor your dosage when lamotrigine is taken with other treatments. Avoid alcohol, cannabis, and other substances that can increase dizziness or drowsiness while taking lamotrigine. To rule out dangerous side effects, discuss all other medications or mind-altering substances you consume with your doctor before taking lamotrigine.

One recent British study found that folic acid supplements can cancel out lamotrigine’s benefits (Geddes et al., 2016). “No one expected that result, as folic acid usually helps depression, and other medications, like valproate (a mood stabilizer approved for mania associated with bipolar disorder, seizures/epilepsy, and migraine headaches),” says Dr. Aiken. “More research is needed before we can fully trust this result, but until then, we recommend taking lamotrigine without any folic acid supplements, including those found in multivitamins. Once you’re doing well on lamotrigine, if you decided to add folic acid, watch out for a potential loss of benefits.”

Is it OK to suddenly stop taking lamotrigine?

Consult your doctor before stopping lamotrigine. If you do stop for more than a few days, DO NOT restart at your current dose. Call your doctor to review your dosing schedule.

Article Sources Last Updated: Oct 13, 2019

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I’ve been on 200mg of lamotrigine(generic) 2x a day for 2 months now. I titered up since june while getting off zonegran. After getting off the zonegran I crawled out of the horrible ditch I was in and felt amazing. But because my lamotrigine level was not optimal yet I had seizures every week for about 6 weeks. Once I got to the proper dosage it controls my seizures now but If I can’t get sleep 2 many days in a row It will trigger one. The double edge sword here is that I cannot sleep without taking trazodone. It’s impossible. I also will sleep only 7-8 hours max as the trazodone wears off my lamotrigine becomes too powerful for it and takes over. It also gives me terrible anxiety and I already had general anxiety. I litterly have to do whatever necessary to keep my anxiety under control. I will get neck tension and terrible irritability. I’m hoping these issues will lessen over time but I’m pretty doubtful at this point. Besides these 2 issues I don’t really have any other problems so I’m scared to try a new drug and all the while get seizures again trying to switch over. I’m not sure if this treatment is acceptable or not. Too be dependent on trazodone can’t be a good thing right? Also sleep is the number 1 trigger for me so you would think it would be counterproductive you know? I guess these are issues I have to talk to my doctor with in january. Some days I think, I have to get off this med and other days I think it’s soooooo much better then zonegran and I just have to learn to manage. Zonegran is the worst drug ever made. I was suicidal rather quickly. The only positive thing I can say about that drug is that I had no problems sleeping. I really feel like that was the main reason I had no seizures on it. I wish the doctors would look at my sleep disorder as the main focus and not just treating generalized.

“And God shall wipe away all tears from their eyes; and there shall be no more death, neither sorrow, nor crying, neither shall there be any more pain: for the former things are passed away” – Rev 21:4

Lamictal is available in the following formulations:

  • 25 mg tablets
  • 100 mg tablets
  • 150 mg tablets
  • 200 mg tablets

Dosage

The usual dosage of Lamictal is 0.5 mg/kilogram of body weight per day initially. Lamictal can be increased very slowly (over weeks) to a maximum dosage of 5-15mg/kilogram of body weight per day. Lamictal is usually taken twice a day.

Therapeutic drug levels

The value of monitoring blood levels of Lamictal is not yet established.

Side effects

All drugs have side effects. The most common side effects associated with the use of Lamictal include dizziness, incoordination, sleep problems, headache, double or blurred vision, nausea, vomiting and rash. Most of these symptoms are dose related, and may resolve with a lesser dose. Other rare side effects include abnormal thinking, nervousness and weight gain. A serious rash has occurred in 5-10% of patients taking Lamictal. This is a particular problem for patients taking both Lamictal and Depakote (valproic acid) concurrently.

Toxic symptoms are symptoms experienced when the blood Lamictal level is too high. Toxic symptoms can include drowsiness, incoordination, slurred speech, dizziness, headache and coma.

Common labs

While children taking Lamictal do not require specific labs, your child will likely be on other anticonvulsant medications that may require occasional blood work.

Drug Interactions: Lamictal may interact with other drugs, including other antiepileptic drugs, especially Depakote. Inform your neurologist if your child is taking any other medications. Your pharmacist can often tell you if there are any known drug interactions between the medications your child takes.

Pediatric Neurology Staff

When is lamotrigine a good choice?

FDA-approved for maintenance treatment of bipolar I disorder, lamotrigine is more effective than lithium for preventing depressive relapses. Lamotrigine combined with lithium, carbamazepine, or valproate provides good protection against recurrences of mania and depression.

Unlike selective serotonin reuptake inhibitors and other antidepressants, lamotrigine does not appear to increase risk of hypomania or mania in bipolar patients.1 Unlike valproate and lithium, it is weight-neutral and requires no serum level monitoring.2 Although lamotrigine’s slow titration and prolonged period until reaching therapeutic effect limits its efficacy as monotherapy in an inpatient setting, the drug can be initiated along with quicker acting agents in the hospital and then titrated after discharge. This strategy allows close monitoring during initial exposure.

Consider lamotrigine as an adjunct for treatment-resistant major depression.3 It is useful for treating aggression and agitation in patients with traumatic brain injury4 or dementia.5 Borderline personality disorder patients treated with lamotrigine may show less affective lability, impulsivity, or aggression.6,7 Lamotrigine can act synergistically with clozapine in some patients with refractory schizophrenia.8

Metabolism and drug interactions

Lamotrigine is metabolized via glucuronidation and eliminated renally. Other drugs metabolized by glucuronidation could interact with lamotrigine (Table).9

Table

Drug interactions associated with lamotrigine

Interacting drug Effect on lamotrigine Management
Carbamazepine Phenytoin Phenobarbital Primidone Rifampin Increased clearance Double dose of lamotrigine when used concomitantly
Oral contraceptives containing estrogen Increased clearance Lamotrigine dose may need to be increased. Efficacy of oral contraceptives may be decreased; dose modification of oral contraceptive also may be required
Valproic acid Decreased clearance Reduce dose by at least half, even if your patient is on a medication with the potential to increase clearance
Source: Reference 9

Adverse reactions

Lamotrigine is well tolerated chronically, with fewer adverse effects than other mood stabilizers. Serious rashes, including Stevens-Johnson syndrome and toxic epidermal necrolysis, have been reported in 0.08% to 0.13% of patients treated with lamotrigine for bipolar disorder or other mood disorders.9 The risk of developing a skin rash within 2 to 8 weeks of therapy necessitates starting with a low dose, usually 25 mg/d, and gradually titrating.2,9

The FDA added a warning about increased risk of suicidality to the labeling of all anticonvulsants, regardless of indication.10 In a meta-analysis of 199 trials, for every 530 patients treated with anticonvulsants there was 1 additional case of suicidality—not completed suicide.10 Inform patients and their families about the potential risk for increased suicidality and document this discussion of risk vs benefit. All patients should be monitored for worsening depression or suicidal thoughts or behavior throughout treatment.

Other potential side effects occurring in at least 5% of patients receiving lamotrigine include somnolence, headache, rash, and the dose-related side effects of nausea, vomiting, dizziness, ataxia, blurred vision, and diplopia.9

Olanzapine is superior to lamotrigine in the prevention of bipolar depression: a naturalistic observational study

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Pre-publication history

  1. The pre-publication history for this paper can be accessed here:http://www.biomedcentral.com/1471-244X/14/145/prepub

It is not known if the depressive episodes in BPD II respond to medications the same way as in BPD I.2 There are no controlled studies about the management of depression in bipolar II patients, and open studies are still scarce in the literature. In the open studies reviewed, we found positive responses with fluoxetine,14,15 venlafaxine16 and also with lamotrigine.17

The case reported here, lamotrigine, corresponding to our expectations, improved the depressive symptoms with no side affects as to cognition. Surprisingly, however, its prescription was associated with a manic switch. It is not possible to assure that lamotrigine was the cause of this event, provided that it can occur even with placebo. Besides, there may have been a coincidence: a manic episode could have taken place even if the patient had not taken any medication, it could have been only part of the natural course of his illness. But we consider that, at least in this patient – and maybe in other cases of bipolarity – it may be safer to avoid the prescription of lamotrigine alone, using it preferably in association with another mood stabilizer, as lithium, valproate or carbamazepine.

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Received May 16, 2005. Revised May 16, 2005. Accepted May 17, 2005.

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