Uses
Lamotrigine (Brand Name: Lamictal) is an anticonvulsant medication prescribed in tandem with other medications to prevent and control seizures in children over age two, adolescents, and adults. It treats partial onset seizures, generalized tonic-clonic seizures, and generalized seizures of Lennox-Gastaut syndrome. It is not known if lamotrigine is safe or effective when prescribed as an antiepileptic on its own.
Lamotrigine can also be used to prevent the sudden mood changes that occur as a symptom of bipolar disorder in adults (ages 18-65). The safety and effectiveness of lamotrigine is not known for treating bipolar disorder in individuals under age 18 and over age 65.
How to Use Lamotrigine
Before starting or refilling a lamotrigine prescription, read the medication guide included with your pills, as it may be updated with new information.
This guide should not replace a conversation with your doctor, who has a holistic view of your or your child’s medical history, other diagnoses, and other prescriptions. If you have questions, ask your doctor or pharmacist before you begin taking the medication.
Dosage
As with all medications, follow your lamotrigine prescription instructions exactly. You should inspect your prescription, and ensure it is the correct medication and formulation. In the past, some patients have been given the wrong medication because several prescriptions have similar names to lamotrigine.
Lamotrigine is available in several formulations:
- Lamotrigine Tablet: Swallowed whole with water or another liquid.
- Lamotrigine Chewable Dispersible Tablets: Swallowed whole, chewed, or mixed with 1 teaspoon of water or a diluted fruit juice. If chewed, follow with a sip of water or another liquid to help with swallowing all medication.
- Lamotrigine XR (Extended-Release): Taken once daily in the morning with water or another liquid. It is not known if lamotrigine XR is safe for children under age 13.
- Lamotrigine ODT (Orally Disintegrating Tablet): Taken with or without water or another liquid, with or without food. To keep it from dissolving before you place the tablet in your mouth, leave it contained in its blister package until you are ready to take it. When opening the medication, make sure your hands are clean and dry so as not to accidentally trigger dissolution. Peel back the blister package backing to take out the tablet, instead of pushing it through the foil. Place the tablet on your tongue where it will dissolve. Do not crush or chew the tablet.
The optimal dosage varies by patient; it is impacted by other medications the patient is taking, condition treated, and patient age. To minimize the risk of side effects, your doctor may start you on a low dose, and gradually increase to the desired dosage over five weeks.
For updated information about dosages, interactions, and precautions, see the Lamotrigine drug monograph on WebMD.
It may take several weeks or months of treatment for lamotrigine to reach full effectiveness. If you miss a dose of lamotrigine, take it as soon as you remember, unless it is almost time for your next dose. You should not take two doses of lamotrigine simultaneously.
When discontinuing treatment, or decreasing dosage, patients should work with a doctor to gradually taper the level of medication over a minimum of two weeks’ time. Stopping lamotrigine suddenly can cause serious health problems including seizures that do not stop.
Side Effects
The most common side effects of lamotrigine are as follows: dizziness, headache, blurred or double vision decreased motor coordination, sleepiness, nausea, vomiting, difficulty sleeping, tremor, rash, fever, abdominal pain, and dry mouth. If you stop taking lamotrigine suddenly, a seizure that does not stop can occur. Do not stop taking, or change the dosage of lamotrigine prescription without contacting your healthcare provider.
Tell your doctor if you have had an allergic reaction to a medication similar to lamotrigine, or have a history of liver or kidney problems. Lamotrigine can sometimes cause severe allergic reaction, organ failure, or problems with blood cells. The warning signs of a serious reaction include: a skin rash, hives, fever, swollen lymph glands, painful sores in the mouth or around the eyes, swelling of your lips or tongue, yellowing of your skin or eyes, unusual bruising or bleeding, severe fatigue, severe muscle pain, or frequent infections. Seek medical help immediately if you experience these symptoms.
Taking lamotrigine may impair your ability to drive, operate machinery, or perform other potentially dangerous tasks. This side effect usually wears off with time. If side effects are bothersome, or do not go away, talk to your doctor.
Most people taking this medication do not experience any of these side effects.
Tell your doctor if you are taking valproate. Lamotrigine can cause a severe, sometimes life-threatening skin rash – including Stevens-Johnson syndrome and toxic epidermal necrolysis – for certain patients, and the risk is higher while using this medication. The rash can result in hospitalization, and rarely death. Contact your doctor immediately at the first sign of a rash.
Disclose to your physician all mental health issues including any family history of suicide, anxiety, mania, or depression. Lamotrigine may create new or exacerbate existing suicidal thoughts or mental problems. Call your doctor immediately if you or your child experiences new or worsening mental health symptoms including panic attacks or unusual changes in mood.
In rare cases, lamotrigine can cause aseptic meningitis, a severe and potentially life threatening inflammation of the membrane around the brain and spinal cord. Contact your doctor immediately if you experience stiff neck, unusual sensitivity to light, headache, or any other symptoms of meningitis.
The above is not a complete list of potential side effects. If you notice any health changes not listed above, discuss them with your doctor or pharmacist.
Precautions and Safety
Store lamotrigine in a secure place out of reach of children, and at room temperature. If you are taking the quick-dissolving tablet, keep the tablets in the blister packaging and hard plastic travel case or carton until you are ready to take it.
You should not take lamotrigine if you have had an allergic reaction to lamotrigine or any ingredients in lamotrigine. Tell your doctor if you have ever had a rash or allergic reaction to another antiseizure medication.
If you are thinking of becoming pregnant, discuss the use of lamotrigine with your doctor. Animal studies show a potential risk of fetal or maternal harm. If you become pregnant while taking lamotrigine, do not stop taking it immediately without discussing it with your physician. Consider registering with the North American Antiepileptic Drug Pregnancy Registry. They are actively collecting information about the safety of anticonvulsants during pregnancy. lamotrigine is passed through breastmilk, so it is recommended that mothers do not nurse while taking it.
Interactions
Before taking lamotrigine, discuss all other active prescription medications with your doctor.
Lamotrigine can have a drug interaction with oral contraceptives, and other hormonal medications. It can cause side effects including changes in menstrual pattern, dizziness, lack of coordination, double vision, or decreased effectiveness of both medications. The following medications also decrease the effectiveness of lamotrigine when taken together:
- Carbamazepine
- Phenobarbital/Primidone
- Phenytoin
- Rifampin
Taking valproate concurrently with lamotrigine can increase the concentration in the body, which increases the likelihood of developing a severe skin rash reaction.
Share a list of all vitamin or herbal supplements, and prescription and non-prescription medications you take with the pharmacist when you fill your prescription, especially any drugs that cause drowsiness. Let all doctors and physicians know you are taking lamotrigine before having any surgery or laboratory tests. The above is not a complete list of all possible drug interactions
Lamotrigine and Other Medications: More Information
- Read: A Parent’s Guide to Psychiatric Medicines for Children
- Read: The Physician’s Guide to Distinguishing Bipolar Disorder and ADHD
- Free Download: The Complete Guide to ADHD Medications
- Find: ADHD Specialists and Clinics Near You
Sources:
http://www.fda.gov/downloads/drugs/drugsafety/ucm166013.pdf
http://www.fda.gov/downloads/drugs/drugsafety/ucm152835.pdf
http://www.fda.gov/downloads/AdvisoryCommittees/CommitteesMeetingMaterials/PediatricAdvisoryCommittee/UCM235547.pdf
