Lamictal (Lamotrigine): Uses, Side Effects, Dosage, & More

What Is Lamictal?

Lamictal is an anticonvulsant belonging to the phenyltriazine class. It decreases the release of excitatory chemicals, including glutamate and aspartate, in the brain, which can result in decreased seizure frequency. The absorption of lamotrigine (the active ingredient in Lamictal) after oral intake is rapid, complete, and unaffected by food ingestion.

Lamictal is an FDA-approved treatment for generalized tonic-clonic seizures (simple and complex partial), Lennox-Gestault syndrome, and bipolar I disorder as a mood stabilizer. FDA approval means the drug has passed the FDA standards for effectiveness and safety.^{1, 2}

How Does Lamictal Work?

Lamictal can decrease the frequency, duration, and intensity of mood swings associated with bipolar I disorder, which is characterized by persistently abnormally increased activity or energy (mania), hypomania, and depressive episodes.¹

Is Lamictal a Strong Mood Stabilizer?

Lamictal has been found to be effective in treating bipolar I disorder, particularly in preventing depressive episodes.³ Its maintenance dose can help decrease the risk of recurrences by preventing or delaying their onset. However, it is important to note that the response time to lamotrigine can be lengthy, typically taking several weeks.

What Is Lamictal Used to Treat?

Lamictal is FDA-approved to treat bipolar I disorder. It is a maintenance treatment to delay the occurrence of mood episodes such as depression, mania, hypomania, and episodes with mixed features. Specialists can use it as a single or supplemental treatment. It is also FDA-approved to treat focal (partial) and generalized onset seizures, Lennox-Gastaut syndrome, and primary generalized tonic-clonic seizures.

Additionally, Lamictal can also be used as non-FDA-approved (off-label), to treat conditions that are not FDA-approved. Off-label use includes short-lasting unilateral neuralgiform headache attacks, trigeminal neuralgia, and binge eating disorder.² It is important to note that prescribers can decide to use a drug off-label because, in their professional judgment, they believe it may offer a benefit to someone.

Is Lamictal Used for Anxiety?

Lamictal is an effective drug that helps with chronic stress and associated anxiety with Post-traumatic stress disorder (PTSD), self-injury, and trouble in eating behavior leading to overweight or obesity.

Common Side Effects of Lamictal

Common side effects from Lamictal can occur when starting, decreasing/increasing Lamictal doses.¹ Side effects may also lead to non-compliance with prescribed treatment. When severe side effects develop, the dose may be adjusted to limit their impact. Lifestyle or dietary changes may also help to minimize side effects.

Common side effects of Lamictal include:*

• Fever, nausea, and vomiting
• Headache and lack of coordination
• Insomnia (trouble sleeping) or excessive sleepiness (somnolence)
• Blurred or double vision
• Tiredness and dizziness
• Rhinitis (nasal congestion, runny nose, sneezing, and itching)
• Abdominal and back pain
• Dry mouth (xerostomia)

*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

Lamictal can cause severe rashes after 2 to 8 weeks of taking the drug, which may require hospitalization.¹ The rash can vary in severity, but there is a risk of developing Stevens-Johnson syndrome (life-threatening). Seek medical attention immediately if you experience fainting, fast, slow, irregular, or pounding heartbeat, easy or unusual bruising, bleeding, stiff neck, vision problems, loss of coordination, muscle pain, tenderness, weakness, or a change in urine output (kidney problem).

Serious side effects of Lamictal include:*

• Life-threatening serious rash and rash-related death
• Multiorgan hypersensitivity reactions
• Heart failure (rhythm and conduction abnormalities)
• Hemophagocytic lymphohistiocytosis (HLH, whole body swelling)
• Infection and bleeding
• Aseptic meningitis (swelling in the brain)
• Suicidal behavior and ideation
• Potential medication errors
• Withdrawal seizures
• Status epilepticus
• Sudden Unexplained Death in Epilepsy (SUDEP)

*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.

Lamictal Warnings & Precautions

Individuals treated with Lamictal for bipolar disorder should be monitored closely for clinical worsening or suicidality. Reassessment is essential to determine the need for maintenance treatment >16 weeks. Prescriptions should be written for the smallest quantity, consistent with good disease care. Before using the drug, tell your doctor or pharmacist your medical history, especially of kidney disease, liver disease, and heart problems.

A life-threatening immune system disorder, hemophagocytic lymphohistiocytosis (HLH) may occur. Seek medical attention right away if you develop fever, swollen glands, rash, seizures, feeling confused, or trouble walking that is new or worse.

Avoid taking Lamictal if you:¹

• Have heart rhythm and conduction abnormalities: Lamotrigine could slow heart rate, which can lead to sudden death, in people with clinically structural or functional heart disease (heart failure, valvular heart disease, congenital heart disease, conduction system disease, ventricular arrhythmias, Brugada syndrome), ischemic heart disease, or coronary artery disease.
• Have depression or suicidal ideation: Lamictal may increase the risk of suicidal thoughts and behaviors, and a person should be advised to immediately report a new or worsening depression, suicidal thoughts or behavior, thoughts of self-harm, or other unusual changes in mood or behavior. The drug should be prescribed in the smallest quantity, consistent with good management to reduce the risk of overdose.
• Are breastfeeding: Lamictal is present in milk from nursing women and can be detected in babies. Hence, they are at high risk for developing a rash, slow breathing, drowsiness, poor sucking, and weight gain if the mother takes the drug while nursing. Monitoring of symptoms by obtaining the drug’s blood level is essential if toxicity occurs.

Lamictal Dosages for FDA-Approved Treatment

Lamictal dosing is based on age, current drugs, multiple health conditions, and clinical response. For the maintenance treatment of bipolar I disorder in adults, a weekly escalating dose guideline is followed. The recommended maximum dose is 200 mg daily and may be lower if taking other medications, such as carbamazepine, phenytoin, phenobarbital, primidone, rifampin, lopinavir, atazanavir, or ritonavir. For liver disease, the dose is reduced by 25%, if severe impairment (with ascites), the dose reduction is 50%.

The Lamictal dose range for off-label use in migraine, panic disorder, and trigeminal neuralgia is 25 to 50 mg daily, then increases as needed based on response and tolerability. However, the usual daily maintenance dose is 200 mg in 1 to 2 divided doses based on the formulation to doses up to 400 mg for optimal response in some individuals.^{4, 5}

Lamictal Forms & Strengths

Lamotrigine is available as tablets, chewable tablets, and orally disintegrating tablets (ODTs). Dosing recommendations are represented as the total daily dose (per 24 hours). Place it on your tongue and let it dissolve, water is not needed. It is not advised to swallow, chew, break, or crush the tablet.

The dose may depend on the type and severity of the condition to treat, age, accompanying drugs and heart, liver, and kidney functions, and body weight in children. The drug dose may be increased or decreased based on other anticonvulsants an individual uses.

Lamictal is available in the following forms and strengths:

• 25 milligrams (mg) oral tablet
• 100 milligrams (mg) oral tablet
• 150 milligrams (mg) oral tablet
• 200 milligrams (mg) oral tablet
• 2 milligrams (mg) oral suspension (chewable) tablet
• 5 milligrams (mg) oral suspension (chewable) tablet
• 25 milligrams (mg) oral suspension (chewable) tablet
• 25 milligrams (mg) oral disintegrating tablets
• 50 milligrams (mg) oral disintegrating tablets
• 100 milligrams (mg) oral disintegrating tablets
• 200 milligrams (mg) oral disintegrating tablets

What’s the Most Effective Dose of Lamictal?

Lamictal has convincingly demonstrated its efficacy in the prevention of bipolar depression. The daily dose range is between 200 to 400 mg, with the majority of studies demonstrating efficacy at the lower end of this range. Clinical studies have shown a significant benefit of using a 200 mg daily dose in delaying the time to occurrence of bipolar depression. It has also revealed no added benefit from the higher dose.¹

How Long Does it Take for Lamictal to Work?

The absorption of Lamictal after oral intake is rapid, complete, and unaffected by food ingestion. However, the timeframe of response seems to be several weeks, perhaps as early as three, and a daily drug dose of 200 mg appears to be effective for its bipolar indications with lowered risks of birth defects and serious rash.⁶

How Should I Take Lamictal?

Take this medication by mouth with or without food as directed by your doctor. It is very important to follow your doctor’s dosing instructions exactly. The dose must be increased slowly. It may take several weeks or months to reach the best dose for you and to get the full benefit from this medication. Take this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time each day.

Do not stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased. Also, if you have stopped taking this medication, do not restart lamotrigine without consulting your doctor. Tell your doctor if your condition does not improve or if it worsens.

What Happens If I Miss a Dose of Lamictal?

People may feel tired, moody, and unfocused when they miss Lamictal. Some individuals may experience physical sensations like body tingles. Stopping it suddenly can potentially cause uncontrolled seizures or new or worsening mental health problems. Take a missed dose as soon as you think about it but avoid taking two or more doses at the same time.^{7, 8}

Can You Overdose on Lamictal?

Overdoses involving quantities of up to 15 grams of Lamictal have been reported, some of which have been fatal. Overdose symptoms are abnormal body (ataxia) and eye movements (nystagmus), seizures, decreased level of consciousness, coma, and heart failure.¹

Large exposures were associated with severe depression, seizures, heart attack (cardiac arrest), and death In adults. In children younger than 3.5 years of age, ingestions of more than 525 mg may produce severe depression and seizures.⁹

What Should You Do If You Take Too Much Lamictal?

Hospitalization is advised for a suspected overdose. General supportive care may include frequent monitoring of temperature, breathing, blood pressure, heart rate, and close observation. It should be kept in mind that immediate-release lamotrigine is rapidly absorbed. Call 911 for serious symptoms such as passing out or trouble breathing.

What to Avoid When Taking Lamictal

Potential interactions with other drugs may change how Lamictal works or increase the risk for serious side effects. Share all the products you use (prescription and nonprescription drugs and herbal products) with your doctor and pharmacist. Do not start, stop, or change the dose of any drug without your doctor’s approval. Interactions may occur when enzyme-inducing drugs are taken with lamotrigine, which may lower its effects.

Inform your doctor or pharmacist if you are taking other products that cause drowsiness, such as alcohol, marijuana (cannabis), antihistamines (cetirizine, diphenhydramine), drugs for sleep or anxiety (alprazolam, diazepam, zolpidem), muscle relaxants, and opioid pain relievers (codeine). Combining alcohol and lamotrigine, for example, may intensify side effects such as dizziness and coordination.

10 substances you should avoid while taking Lamictal include:¹

• Oral contraceptive preparations (OCPs): Women taking estrogen-containing OCPs may decrease Lamictal concentration by 50%.
• Carbamazepine/carbamazepine epoxide: Lamictal concentration may be decreased when combined with carbamazepine. However, carbamazepine epoxide levels may be increased with the addition of Lamictal.
• Phenytoin: Lamotrigine concentration decreased by approximately 40% when combined with phenytoin. Adjustments in lamotrigine might be needed when used with phenytoin.
• Phenobarbital: During simultaneous use of lamotrigine with phenobarbital, lamotrigine concentration decreases by approximately 40%. Adjustments in lamotrigine might be needed when used with phenobarbital.
• Primidone: During simultaneous use of lamotrigine with primidone, lamotrigine concentration decreases by approximately 40%. Adjustments in lamotrigine might be needed when used with primidone.
• Rifampin: It may significantly decrease the amount of lamotrigine by approximately 40%. Adjustments in lamotrigine might be needed.
• Lopinavir/ritonavir: Lopinavir or ritonavir reduces the lamotrigine effect, hence the dose increment may be needed if individuals take a maintenance dose of lamotrigine. However, a dose of lamotrigine may need to be decreased if lopinavir or ritonavir is discontinued.
• Atazanavir/ritonavir: Atazanavir or ritonavir reduces the lamotrigine effects, hence the dose increment may be needed if individuals take a maintenance dose of lamotrigine. However, a dose of lamotrigine may need to be decreased if atazanavir/ritonavir is discontinued.
• Valproate: Valproate also treats epilepsy and bipolar disorder. Adding valproate increases lamotrigine levels in the body and may cause drug toxicity if not monitored under medical supervision.
• Orlistat: It decreases the amount of Lamictal in the body. Prescribers may raise the dose and monitor the person closely due to the risk of convulsions.

How to Get a Prescription for Lamictal

Lamictal is a prescription-only drug approved for epilepsy and bipolar disorders that can be prescribed by neurologists, general practitioners, internists, family practitioners, pediatricians, and psychiatrists. The lamotrigine blood test is used in monitoring its blood concentration, assessing compliance, and adjusting lamotrigine dose in individuals receiving other anticonvulsants that interact with lamotrigine.

There is evidence that HLA-B*1502 is associated with lamotrigine-induced rash. The drug label of lamotrigine does give a warning about serious skin rash, usually occurring within 2–8 weeks of initiation of lamotrigine.¹⁰ The incidence is higher in children than in adults.

How Much Does Lamictal Cost?

The average cost for an oral tablet of 100 mg of lamotrigine, a generic version of Lamictal, is around $10 for a supply of 60 tablets, depending on the pharmacy you visit.¹¹ It can be purchased at a discounted price through online or in-store coupons.

Even if the lamotrigine is covered by Medicare or private insurance, always compare prices, as the cash price may be less than your co-pay. Generic (lamotrigine) drugs, on average, are 80–85% less expensive than brand-name (Lamictal) drugs.

Questions to Ask Your Healthcare Provider About Lamictal

It is important to ask questions if you are considering Lamictal as a treatment, like its duration of use, potential side effects, and drug or food interactions. You must provide your complete medical history to your doctor, psychiatrist, and therapist. You may even get a drug prescription online if you need a second opinion or change prescriber. Many online psychiatry services may be a good option for individuals who prefer to discuss their health issues with specialists and manage their symptoms in the comfort and privacy of their homes.

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 drugs?
• What is the best dose to ensure fewer side effects?
• How is this drug best taken?
• Can I stop taking the drug if I feel better or don’t notice any improvement?
• Can I increase the drug dose for faster recovery?
• Will I experience withdrawal effects after stopping Lamictal?
• How long does it take for the Lamictal to work?
• What do I need to tell my doctor before I take Lamictal?
• What are some side effects that I need to call my doctor right away?
• What other substances may interact with Lamictal?
• Are there any risks in taking Lamictal for a long time?
• What should I avoid while on Lamictal?
• What is the most important information I should know about Lamictal?
• Could Lamictal be considered as an Abilify alternative?