Lamictal (Lamotrigine) for Bipolar: Uses, Dosages, Side Effects, & More

What Is Lamictal?

Lamictal contains the active ingredient lamotrigine and is an anticonvulsant medication. It works by stabilizing abnormal electrical activity in the brain, which is why it can be beneficial for those with epilepsy. Lamictal can also provide mood stabilization and improve symptoms of bipolar disorder. The U.S. Food and Drug Administration (FDA) has approved Lamictal for these two main purposes: the treatment of epilepsy and the management of bipolar disorder. This article will focus on the use of Lamictal for mental health conditions.

How Does Lamictal Work?

Lamictal works by calming down unusual electrical activity in the brain. It does this by blocking the activity of specific cells in the brain, leading to improved brain balance and mood stabilization.^{1, 2} By providing improved mood stabilization, Lamictal can help prevent the extreme mood changes associated with bipolar disorder.

What Is Lamictal Used to Treat?

Lamictal is an FDA-approved medication for the treatment of bipolar I disorder and several types of epilepsy. FDA-approved means that it has undergone rigorous evaluation by the U.S. Food and Drug Administration to ensure its safety and effectiveness. Lamictal, however, has also been used off-label for other conditions, including psychosis and major depressive disorder.³ Off-label use occurs when healthcare professionals believe the medication could benefit patients for conditions beyond its approved uses.

Common Side Effects of Lamictal

Lamictal can cause side effects, but the side effects experienced will vary from person to person. Most side effects are mild and will resolve over time as the body adjusts to the new medication. However, some side effects can be severe or persistent, requiring immediate medical attention. You should be seen by a medical provider immediately if you experience severe side effects, such as allergic reactions, difficulty breathing, or irregular heartbeat.

Common side effects of Lamictal include:^{1, 2}

• Headache
• Nausea
• Dizziness
• Incoordination
• Drowsiness
• Double vision
• Blurred vision

*All medications, including Lamictal, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Serious Side Effects of Lamictal

While most side effects are mild and resolve over time, Lamictal can cause serious side effects. Lamictal can cause severe rashes, which may affect the skin or mucous membranes (such as the eyes or mouth).³ Other serious side effects may include mood changes, signs of infection, and unusual bleeding or bruising. These severe side effects require immediate medical attention.

Serious side effects of Lamictal include:^{1, 2 4}

• Severe skin rashes
• Irregular heart rhythm
• Shortness of breath
• Fever
• Swollen lymph nodes
• Neck stiffness
• Increased seizures

*All medications, including Lamictal, can cause side effects which can be mild or serious. This is not a comprehensive list of all possible side effects. You should talk with your doctor about any questions you have and to understand the potential side effects and benefits of any medication.

Can Lamictal Cause Weight Gain?

Weight gain has been reported with Lamictal use. However, this is unusual and not expected.³

Lamictal Warnings & Precautions

Before starting Lamictal, it’s crucial to be aware of the potential warnings and precautions. There are several warnings about certain reactions to be aware of, as these can be life-threatening and require immediate medical attention. While not every side effect requires immediate medical attention, it is important to discuss with your healthcare provider to know what to do if side effects develop.

Below are the warnings and precautions to be aware of:^{1, 2}

• Serious skin rash: Lamictal can cause severe skin rashes that can be life-threatening. These skin rashes include toxic epidermal necrolysis and Stevens-Johnson syndrome. Lamictal has a black box warning, the most serious type of warning from the FDA, for this.
• Body-wide inflammation: On rare occasions, Lamictal has caused body-wide inflammation, leading to symptoms that may include fever, enlarged liver, enlarged spleen, rash, and enlarged lymph nodes. This condition is called hemophagocytic lymphohistiocytosis and can be life-threatening.
• Organ failure: Extreme reactions to Lamictal leading to organ failure have occurred and have been fatal. Although this is rare, it is important to monitor for signs of this, which may include rash, fever, and swollen lymph nodes.
• Abnormal heart rhythm: Lamictal may cause slowing of the heart’s electrical activity, leading to dangerous heart rhythms in those with a history of heart problems.
• Reduced blood cells: Lamictal has been reported to cause decreased white blood cells, red blood cells, and platelets. This can increase the risk of infection, anemia, and abnormal bleeding/bruising.
• Suicidal thoughts and behavior: Lamictal may increase the risk of suicidal thoughts and behaviors. It is important to closely monitor for mood changes when taking this medication.
• Meningitis: There have been reports of Lamictal causing inflammation around the brain (meningitis). These symptoms may include fever, headache, and neck stiffness.
• Pregnancy: Taking Lamictal during pregnancy may increase the risk for fetal malformations, but this is unclear. The decision to continue or stop Lamictal during pregnancy should be made in conjunction with your healthcare provider.
• Breastfeeding: Lamictal is excreted in breast milk, but the effect on the infant is unknown. The decision to breastfeed while taking Lamictal should be made in conjunction with your healthcare provider.

There may be additional warnings or precautions with this medication. Talk with your healthcare provider about all risks before you start taking this medication.

Interactions With Lamictal

Lamictal can interact with various medications, substances, and herbs, potentially leading to harmful outcomes. It’s essential to be cautious and consult with your healthcare provider before using Lamictal in combination with other substances.

Six substances you should avoid while taking Lamictal include:¹

• Estrogen-containing oral contraception pills: Oral contraceptive pills containing 30 mcg ethinylestradiol and 150 mcg levonorgestrel can decrease the blood levels of lamotrigine and levonorgestrel. This can decrease the effectiveness of both of these medications.
• Carbamazepine: This medication can decrease the blood level of Lamictal, decreasing its effectiveness. Lamictal may increase the blood levels of carbamazepine.
• Antiviral medications: Some antiviral medications, such as lopinavir and atazanavir, may decrease the blood level of Lamictal, decreasing its effectiveness.
• Antiseizure medications: Some antiseizure medications, such as phenobarbital and phenytoin, can decrease the blood level of Lamictal, decreasing its effectiveness.
• Rifampin: Rifampin, an antibiotic, can decrease the blood level of Lamictal, reducing its effectiveness.
• Valproate: This antiseizure medication can increase the blood level of lamotrigine. This can increase the risk of severe side effects.

This is not a comprehensive list of interactions. Talk with your healthcare provider about all prescription and over-the-counter medications, herbs, and supplements you are taking or plan to take before starting this medication.

Lamictal Dosages for FDA-Approved Treatment

Lamictal dosages can vary significantly from person to person and are tailored to the specific condition being treated. The dose is also dependent on the simultaneous use of other medications. The typical dosage range for bipolar disorder is 100-200 mg per day. For the treatment of epilepsy in individuals over 12 years of age, the dose is higher and typically around 300-500 mg per day. For children under 12 years, the dose is based on their weight and use of other medications.³

Lamictal Forms & Strengths

Lamictal is available in various forms and strengths, including oral tablets, chewable tablets, oral disintegrating tablets, and extended-release tablets. These forms offer flexibility in dosing to accommodate an individual’s needs. The choice of the most appropriate form and strength depends on several factors, including the person’s age, the condition being treated, and the desired dosing schedule.

Prescribers consider an individual’s specific requirements when choosing one form over another. The goal is usually to maintain a steady and consistent drug level in the body. The time it takes for each form and strength to take effect may vary. Immediate-release forms may take effect more quickly but require more frequent dosing. Extended-release forms can provide a more gradual and sustained release of the medication.

Lamictal is available in the following forms and strengths:^{1, 3, 5}

• Tablet: 25 mg, 100 mg, 150 mg, 200 mg
• Chewable tablet: 2 mg, 5 mg, 25 mg
• Disintegrating oral tablet: 25 mg, 50 mg, 100 mg, 200 mg
• Extended-release tablet: 25 mg, 50 mg, 100 mg, 200 mg, 250 mg, 300 mg

Lamictal is also available as a generic lamotrigine in many forms and strengths. This article focuses on the brand Lamictal.

How Should I Take Lamictal?

To take Lamictal effectively, follow your prescriber’s instructions carefully. Lamictal can be taken with or without food. Typically, extended-release tablets are taken once per day, while immediate-release tablets may be taken 1-2 times per day. The tablets and extended-release tablets should be swallowed whole.

For chewable tablets, these can be swallowed, chewed, or dissolved in liquid. Orally disintegrating tablets should be placed on your tongue and moved around your mouth until the tablet dissolves. Once dissolved, it can be swallowed.

How Quickly Does Lamictal Work for Bipolar?

Lamictal is not a fast-acting medication. It may take several weeks to months to reach optimal mood stabilization.³ If Lamictal does not work, the dose may need to be increased before noticing an effect.

What Happens If I Miss a Dose of Lamictal?

If you miss a dose, take the missed dose as soon as you remember it. However, if it is close to the time of the next dose, skip the missed dose and continue your regular dosing schedule. Never double the dose to make up for a missed one.⁴

Can You Overdose on Lamictal?

Overdose on Lamictal is possible. This may occur intentionally or if you take too much by accident. Symptoms may include incoordination, uncontrollable eye movements, double vision, seizures, irregular heart rate, and loss of consciousness.⁴

What Should You Do If You Take Too Much Lamictal?

If you are concerned about overdose, you can call the poison control helpline at 1-800-222-1222. If severe symptoms develop, including seizures, loss of consciousness, or trouble breathing, immediately seek medical attention or call 911.

How to Get a Prescription for Lamictal

Lamictal is only available through a prescription by a healthcare provider. A psychiatrist or neurologist typically prescribes this. If Lamical might be helpful for you, start by scheduling an appointment with a healthcare professional. The healthcare provider will be able to evaluate your medical needs and decide if Lamictal is an appropriate treatment option.

How Much Does Lamictal Cost?

The cost of Lamictal can vary significantly depending on factors such as the dosage, if it’s brand name or generic, your location, and your insurance coverage. Generic lamotrigine may cost as low as $20, while brand-name Lamictal may cost over $500.^{6, 7} However, these costs may be significantly lower depending on your insurance coverage. If you are concerned about the cost, there are other options, including online discounts, manufacturer coupons, and patient assistance programs which can help reduce out-of-pocket costs.

Questions to Ask Your Healthcare Provider About Lamictal

To learn more about Lamictal and whether it’s right for you, discuss it with your healthcare team, which may include your doctor, psychiatrist, and therapist. If you do not have a healthcare provider or are looking to make a change, an option to consider is online psychiatry services, as these online platforms allow you to connect with a trusted healthcare provider from your home.

Questions to ask your care team about Lamictal include:

• How safe is Lamictal?
• How long will it take for me to adjust to taking Lamictal?
• Am I at risk for more serious symptoms if I am already taking other medications?
• What is the best dosage to ensure fewer side effects?
• How will I know if Lamictal is working for me?
• Does Lamictal cause withdrawal symptoms if I stop taking it?
• Are there other treatment options to consider alongside Lamictal?
• Who should I contact if I experience side effects?
• Can I use alcohol and lamotrigine together?
• How often should I have follow-up appointments to monitor my progress?
• Could Lamictal be considered an Abilify alternative?