*An off-label use of a medication is a use that is not FDA-approved. Prescribers can decide to use a medication off-label because, in their professional judgment, they believe it may offer a benefit to someone.
Common lamotrigine side effects can include drowsiness, unsteadiness, and dizziness. Serious side effects require medical attention, such as a risk of seizures and suicidal thoughts or behaviors.
If lamotrigine still causes side effects after the first few weeks of taking it, contact your provider. They can walk you through your options, which may include an adjustment to the dosage, changing the time you take your medication, or possibly a different medication.
If you are considering lamotrigine or want to discuss your current medication treatment with a provider, online psychiatry platforms, such as Talkiatry and Brightside Health are a good place to start. Their providers offer assessments and prescription consultation, and can answer any questions you have about lamotrigine side effects.
Boxed Warning: Lamotrigine (Lamictal) - Risk of serious skin rashes that can require hospitalization
Lamotrigine, the active ingredient in Lamictal, has a black box warning. This is the most serious type of warning from the Food and Drug Administration (FDA). Lamotrigine can increase the risk serious skin rashes that can require hospitaliztions and possible discontinuation of treatment. You should talk with your doctor about serious risks with lamotrigine and any other medications before starting treatment.
Key Takeaways
Common lamotrigine side effects may include unsteadiness, dizziness, and drowsiness. Serious side effects requiring medical attention can also occur.
If lamotrigine side effects persist longer than a few weeks, your provider can help you determine next steps, which may include a change in dosage, timing of dosage, or medication.
There are several ways to cope with lamotrigine side effects, including self care practices, medication adjustments, and therapy.
If you are considering lamotrigine or an alternative, a good place to start is with an evaluation from a medical provider. Many online psychiatry platforms offer online assessments and medication management, such as Talkiatry or Brightside Health.
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Common Lamotrigine Side Effects
Common side effects of lamotrigine (Lamictal) can affect alertness and coordination. Side effects may occur for some people and not others, and they can appear even when taking medication correctly. Many fade away as your body adjusts, but some may continue. Talk to your provider if these side effects bother you or get worse.
Common side effects of lamotrigine may include:*1
- Nausea
- Insomnia
- Drowsiness
- Back pain
- Fatigue
- Rash
- Stuffy nose
- Abdominal pain
- Dry mouth
- Double vision
If any of these side effects persist, worsen, or interfere with your daily life, call your provider
*All medications, including lamotrigine, can cause side effects that 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 understand the potential side effects and benefits of any medication.
Serious Lamotrigine Side Effects
Though serious side effects from lamotrigine are rare, it’s important to understand the risks because some may be fatal. Talk to your provider about your full health history before starting lamotrigine. Doing so can help them identify any potential risks you may have for serious side effects. If you experience any of the side effects listed below, seek emergency medical care.
Serious side effects of lamotrigine that require immediate medical care include:*1
- Seizures for the first time or happening more often
- Suicidal thoughts and behavior
- Hypersensitivity (high fever, rash, swelling, muscle pains)
- Racing heartbeat, shortness of breath (possible sign of heart problems)
- Severe skin rash (Stevens-Johnson syndrome)
- Hemophagocytic lymphohistiocytosis (serious immune system reaction)
- Cardiac rhythm abnormalities
- Blood dyscrasias (blood cell disorder)
- Aseptic meningitis (swelling in the brain)
- Worsening of seizures / withdrawal seizures
- Status epilepticus (prolonged seizure)
- Sudden unexplained death in epilepsy (SUDEP)
- Serotonin syndrome
- Angle-closure glaucoma
- Severe liver injury
- Respiratory reactions in children
*All medications, including lamotrigine, 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.
What Are the Risks & Warnings for Lamictal?
Serious Skin Rashes
Lamotrigine, the active ingredient in Lamictal, can increase the risk serious skin rashes that can require hospitalizations and possibly stopping the medication, including Stevens-Johnson syndrome. Stop taking Lamictal at the at first sign of rash unless it is clearly unrelated.
Multi-organ Hypersensitivity Reactions & Organ Failure
Multi-organ hypersensitivity reactions have occurred when taking lamotrigine, with symptoms including swelling in the lymph nodes, fever, and rash. While rare, these symptoms may signal a risk of organ failure.
Heart Rhythm Abnormalities
Irregular heart rhythms may develop while taking Lamictal. This may increase risks for those with cardiac conditions, such as heart failure and coronary artery disease.
Blood Disorders
Taking Lamictal has been associated with an increased risk of developing disorders affecting blood cells, such as anemia.
Aseptic Meningitis
Aseptic meningitis is a serious condition involving severe swelling of the linings of the brain. This condition may develop in children and adults taking Lamictal.
Withdrawal Seizures
Patients with epilepsy are at risk of increased seizures when Lamictal is abruptly stopped. Your provider will taper your dose if making a dosage change or stopping the medication.
Status Epilepticus (Serious Seizures)
There is an increased risk of serious seizures or a worsening of seizures when taking Lamictal, which is a medical emergency.
Sudden Unexplained Death in Epilepsy
A few sudden and unexplained deaths have been reported among patients with epilepsy who have taken Lamictal.
Pregnancy
The potential risks of taking Lamictal while pregnant are unclear. Talk with your provider about whether taking lamotrigine during pregnancy is a good fit for your treatment plan.
Breastfeeding
Lamotrigine is present in breast milk and can be detected in babies. They are at high risk for developing a rash, slow breathing, drowsiness, poor sucking, and weight gain if the breastfeeding parent takes the medication while nursing. Talk with your provider about how to safely breastfeed your child during your treatment.
Allergic Reactions
Lamotrigine allergies can range from mild to severe. These symptoms may go away after patients have been on Lamictal for some time. In other cases, they can persist or worsen, but this is less common.
Allergic reactions to Lamictal include:
- Rash
- Fever
- Sore throat
- Difficulty breathing
If you suspect an allergic reaction to Lamictal, seek immediate medical care.
Taking certain medications, herbs, or supplements alongside Lamictal can change how Lamictal works in your body or increase the risk for serious side effects. Do not start, stop, or change the dosage of any medications without your provider’s approval.
Substances you should avoid using while taking Lamictal include:*
- Carbamazepine
- Phenytoin
- Phenobarbital
- Primidone
- Rifampin
- Valproate
- Contraceptives containing estrogen
*This is not a comprehensive list of medications that interact with Lamictal. Be sure to talk with your doctor or pharmacist about any prescription or over the counter medications you take, as well as supplements, herbs, and teas.
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Important Things to Know About Taking Lamotrigine
Before starting lamotrigine, talk to your provider about how it may affect you. Side effects often appear in the first few days or weeks of taking a new medication. But they can appear at any time while taking your medication.
Your prescriber will discuss how to take lamotrigine, your dosage, precautions and warnings, and side effects that may occur. They will also discuss what to do if side effects don’t go away on their own and which ones may require medical care.
How Long Does it Take for Lamotrigine to Start Working?
Lamotrigine typically begins to work within hours, with peak blood levels reached 1.4 to 4.8 hours after ingestion.1 However, this timing can be different for everyone since each person has a unique response to medication. The form you take doesn’t significantly affect how your body absorbs the medication. It may take several weeks to notice that it’s making a difference with your bipolar symptoms.
Can Lamotrigine Make You Feel Worse at First?
Yes, some people starting lamotrigine may notice uncomfortable side effects. These may include insomnia, nausea, and fatigue.1 Lamotrigine also has a risk of rare but serious side effects. A severe rash, swelling, and persistent fever may be signs of serious reactions to medication, which can be dangerous. If you experience any of these or other serious side effects, seek immediate medical attention.
What Happens If I Miss a Dose?
If you miss a dose, take it as soon as you remember. If it’s almost time for your next dose, skip the missed dose and take your scheduled dose at the usual time. Do not take double doses to make up for a missed one.
Lamotrigine builds up in your body over several weeks, so you may not notice it working right away. Stopping lamotrigine suddenly can cause seizures that don’t stop, which can be life-threatening. Always speak to your provider if you want to consider a change of any kind to your medication.
Who Experiences Side Effects More?
Some who take lamotrigine have a higher risk of side effects than others. Side effects can develop for anyone taking lamotrigine, but those with certain risks should be cautious or possibly avoid it.
Those Taking Other Medications
Lamotrigine can have harmful interactions with medications and other substances. This may include serious reactions requiring medical care or reduced effectiveness of lamotrigine, the other substance, or both.
Those taking certain medications or treatments also have a higher risk of side effects, such as:*
- Oral birth control containing estrogen
- Valproate
- Carbamazepine
- Phenytoin
- Phenobarbital
- Primidone
- Rifampin
- Lopinavir
- Ritonavir
This is not a complete list of the possible interactions with lamotrigine. You should talk with your healthcare provider and your pharmacist about all prescription and over-the-counter medications, herbs, and supplements you take before starting lamotrigine.
Those With Certain Health Risks
Discuss any health conditions you have with your provider when considering lamotrigine as a treatment. This information will help them select the most suitable medication for you.
Those with a history of certain health concerns have a higher risk of side effects, such as:1
- Heart conditions
- At risk for suicidal thoughts and behaviors, history of depression
- History of blood disorders
- Those at risk for multiorgan hypersensitivity (DRESS)
- Those at risk for depressed central nervous system (CNS)
- Pregnant or plan to be pregnant
- Breastfeeding or plan to breastfeed
Children are also vulnerable to certain side effects, including skin rash, and infectious and respiratory reactions. However, lamotrigine is only FDA-approved to treat bipolar disorder in adults. Research support is limited for off-label psychiatric uses in children and adolescents.
How to Cope With Common Lamotrigine Side Effects
Side effects of lamotrigine tend to occur when you are just starting the medication. For some, these symptoms may disappear after a few days or several weeks. But some side effects may last for as long as a person takes the medication. If side effects continue or worsen, speak to your provider for guidance.
Here are some ways to cope with several common lamotrigine side effects:
Skin Rash
Rash and itchiness are common side effects of lamotrigine. Some individuals experience a very mild rash that goes away after a few days. Others may experience a more severe rash and hives. Lamotrigine has a black box warning for serious rashes that can be fatal. If you suspect a rash appearing with lamotrigine treatment, contact your prescriber or pharmacist immediately.1
Dizziness
Take your time when standing up or changing positions to prevent sudden drops in blood pressure. Avoid rapid head movements or sudden changes in body position. Stay hydrated and maintain a healthy blood sugar level. If dizziness worsens, consult your prescriber and pharmacist.1
Trouble With Balance & Coordination
Use assistive devices such as canes or walkers, if needed, to improve stability. Adjust your environment to minimize fall risks by removing trip hazards and improving lighting. Use exercises that promote balance and coordination, such as yoga or tai chi, if possible. Consult your provider or pharmacist if balance and coordination issues persist or worsen.1
Tremors
Reduce caffeine and stimulant intake as they can exacerbate tremors. Consider relaxation techniques such as deep breathing exercises or meditation. Use assistive devices or adaptive strategies to manage daily tasks if necessary. If the tremor becomes severe or significantly affects your quality of life, consult your prescriber or pharmacist for possible solutions.1
Nausea and Vomiting
Take lamotrigine with food or a light snack to help reduce stomach irritation. Avoid triggers such as strong odors of certain foods that may worsen nausea. Consider over-the-counter remedies like ginger or antacids after consulting with your prescriber or pharmacist. If your nausea and vomiting become severe or persistent, consult your healthcare providers for further guidance.1
Drowsiness
Drowsiness may occur when taking lamotrigine. If you experience drowsiness, tell your provider so they can make sure you are taking an appropriate dose. Avoid doing activities that require alertness, such as driving or operating machinery. Your provider may also recommend taking your medication at a certain time of the day or may adjust your dose.1
*All medications, including lamotrigine, 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.
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More Ways to Manage Lamotrigine Side Effects
Here are more ways to cope with and reduce the impact of lamotrigine side effects.
Practice Good Sleep Hygiene
Your sleep habits play an important role when adjusting to new medications. Lamotrigine can cause both drowsiness and insomnia, so consistent rest is important. Try waking and going to bed at the same time every day. Make sure your sleep environment is dark and comfortable as well.
Also, lamotrigine can also cause drowsiness and dizziness. Be aware of the precautions for taking lamotrigine and how it affects your mental alertness and motor skills. Avoid activities such as driving or operating machinery until you know how lamotrigine may affect you.
Healthy Lifestyle Activities
Supporting your body with healthy lifestyle choices can help you feel better while adjusting to a new medication. Make it a priority to eat well, get enough sleep, be physically active, and stay connected socially.
Follow a Daily Routine
Following your normal daily routine can ease your adjustment to taking lamotrigine. A consistent schedule will reduce stress on your body and mind as you get used to the effects of lamotrigine. Also, be sure you’re following your provider’s instructions for taking your medication, paying close attention to the timing.
Consider Therapy
Psychotherapy can play an important role in helping you manage the effects of medication and develop healthy coping strategies. For in-person therapy, your primary care provider or insurance company can provide referrals in your local area. Or, You may also want to ask someone you trust for suggestions based on their experience.
To find an online therapist, an online therapist directory is a great starting point. Many online psychiatry platforms, such as Talkiatry and Brightside Health, also offer therapy services.
Should I Stop Taking Lamotrigine If I Start Feeling Side Effects?
No, do not stop taking lamotrigine if you start feeling side effects. Stopping lamotrigine abruptly can lead to serious side effects like seizures that don’t stop, which can be life threatening. Instead, talk to your provider about side effects that bother you or persist. Do not adjust your dosage on your own. If needed, your provider will tell you how to safely reduce your dose.1
When Should I Call My Doctor About Lamotrigine Side Effects?
If your side effects continue or get worse, talk to your provider right away. Side effects are one of the most common reasons people stop taking medications, but stopping lamotrigine without medical supervision can be dangerous.
Some side effects are manageable and may disappear after a few weeks. Others can last as long as you take the medication. Medications can cause side effects even when taken exactly as prescribed. Serious side effects from lamotrigine include seizures, suicidal thoughts and behaviors, and severe skin rash. These can be life-threatening and require immediate medical care.
When Should I Seek an Alternative to Lamotrigine Due to Side Effects
Some people notice side effects from lamotrigine within the first few days or weeks of treatment, but your experience may be different. Each person has a unique response to medication so this timeframe may vary. Some early side effects may improve on their own, and others may continue or worsen over time.
If you’re considering a change in your medication, talk with your provider. There are many lamotrigine alternatives available and they can help you determine which one may be a good fit. Several types of mood stabilizers can help reduce bipolar disorder symptoms, though it’s important to understand the potential risks and benefits of each option.
Other anticonvulsant medications, such as Tegretol and Depakote, can be used as alternatives to lamotrigine for bipolar disorder. These medications are effective mood stabilizers, helping to reduce symptoms of mania and controlling mood changes.
Lithium is one of the main FDA-approved treatments for bipolar disorders. It is effective for acute mania and long-term therapy after mania symptoms have been treated.2 However, it also comes with a considerable risk for side effects and it may not be right for everyone. Your provider can help you understand if lithium may be an appropriate alternative for you.
Atypical antipsychotics, such as Latuda and Seroquel, are also used as mood stabilizers for bipolar disorder. They are helpful for people who have psychotic symptoms as part of their manic or depressive episodes. These medications reduce agitation, delusions, hallucinations, paranoia, and confusion. They are often used in combination with another mood stabilizer.
How to Get a Prescription for Lamotrigine or Alternative Medications
To get lamotrigine or alternative in person, you’ll typically begin with a visit to your healthcare provider, who may be a physician, nurse practitioner, or PA. They’ll assess your symptoms and may recommend seeing a psychiatrist or other specialist, depending on your needs. After reviewing your symptoms and medical history, your provider will help you decide whether lamotrigine or an alternative makes the most sense.
To get a prescription for lamotrigine or an alternative online, you’ll also begin with an evaluation from a platform that prescribes anticonvulsants like lamotrigine. We have carefully reviewed Talkiatry and Brightside and determined they are both good places for such an evaluation.
Their providers can also prescribe mood stabilizers, such as lamotrigine or an alternative, if they deem the medication helpful for your symptoms. Both platforms offer assessments and prescription management.
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Questions to Ask Your Provider
Discuss the possible side effects of lamotrigine with your provider. They’ll tell you about side effects that may appear when you first start taking lamotrigine, which may go away on their own, and when you need to seek medical care for them. They’ll tell you what you can do if side effects become difficult to manage or don’t go away.
Also, many online psychiatry services make it easy to get started with mental health care. You’ll get a mental health evaluation, diagnosis, and personalized treatment plan. Some platforms also allow you to change providers, if needed.
Questions to ask your care team about lamotrigine side effects may include:
- How often should I come for checkups for my Lamictal prescription?
- What common side effects will I likely experience when I start my lamotrigine prescription?
- What time of day should I take Lamictal?
- Can I use alcohol with lamotrigine?
- How long will Lamictal’s side effects last?
- Am I at risk for more severe side effects if I am already taking medication for anxiety, depression, or other mental health conditions?
- When should I reach out to you if I am experiencing side effects?
- What should I do if lamotrigine does not work for me?
- What will happen if I suddenly stop my medication?
- What is the best Lamictal dosage to ensure fewer side effects?
- Can the side effects of Lamictal interfere with my daily activities, such as work, school, or driving?
Prescriber’s Tips
Before starting lamotrigine, your provider will give you important instructions for your medication. They’ll discuss how to take it, what to avoid, and how to store it properly. They’ll also talk through what to do if side effects occur. Follow these tips for safe and effective use of lamotrigine.
- Take your medication exactly as prescribed by your provider. Keeping a consistent dosing schedule reduces the chance of unwanted side effects.1
- Do not stop taking lamotrigine without first talking to a healthcare provider. Stopping lamotrigine suddenly can be dangerous. Stopping a seizure medication suddenly can cause seizures that will not stop (status epilepticus).1
- Take your medication at the same time each day. Doing so can help you remember to take it and make your treatment as effective as possible. Your healthcare provider can determine the best time to take your medication based on how you respond to it.
- Lamotrigine may increase the risk of suicidal thoughts and behaviors and symptoms of depression. Tell your prescriber right away if you have any new or worsening depression, suicidal thoughts or behavior, and any unusual changes in your mood or behavior.1
- Ask your prescriber if it is safe for you to drink alcohol while taking lamotrigine.
- Tell your prescriber about all medications and supplements you take, including over-the-counter treatments. Many over-the-counter medications and supplements can interact with prescription medications.
Frequently Asked Questions
What Is Lamotrigine & What Is It Used For?
Lamictal, with the active ingredient lamotrigine, is an anticonvulsant medication. It is FDA-approved for use as a mood stabilizer with bipolar disorder for adults only. Lamotrigine also comes in an extended release tablet, Lamictal XR. But it is not FDA-approved for any mental health conditions and has limited off-label mental health uses.
How Does Lamotrigine 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 By providing improved mood stabilization, Lamictal can help prevent the extreme mood changes associated with bipolar disorder.
How Long Do Lamotrigine Side Effects Last?
Lamotrigine side effects and duration of side effects can vary from person to person, and it is challenging to monitor them regularly. Some patients experience more and longer side effects than others. Some side effects last a few days to weeks, while others can happen randomly throughout the treatment time. Side effects tend to happen more often when patients just start lamotrigine treatment or when the dosage is adjusted. 1
What Are the Long-term Side Effects of Lamotrigine?
The long-term side effects of lamotrigine are still unclear and additional research studies are needed to determine long-term side effects.1,3,4
Does Lamotrigine Have Any Rare Side Effects I Should Look For?
Yes, lamotrigine can have rare side effects. These occur less frequently but may include various blood disorders, liver problems, or aseptic meningitis. It’s important to seek medical attention if you experience any unusual or severe symptoms (e.g. abdominal pain, swelling, fever, stiff neck, photophobia) while taking lamotrigine.1 This is not a comprehensive list of rare side effects. Talk with your healthcare professional about all of the potential risks before starting lamotrigine.
Does Lamotrigine Cause Weight Gain or Weight Loss?
Lamotrigine is generally considered weight-neutral, meaning it does not commonly cause significant weight gain or weight loss. However, individual responses may vary, and some people may experience slight changes in weight while taking the medication.1
Are There Any Interactions between Lamotrigine and Other Medications That May Worsen Side Effects?
Lamotrigine can potentially interact with other medications, which may lead to worsening side effects or reduced effectiveness. Notable interactions include valproic acid, carbamazepine, phenytoin, and certain oral birth control pills. It’s important to inform your prescriber and pharmacist about all the medications, supplements, and herbal products you are taking to prevent any potential interactions. 1
ChoosingTherapy.com strives to provide our readers with mental health content that is accurate and actionable. We have high standards for what can be cited within our articles. Acceptable sources include government agencies, universities and colleges, scholarly journals, industry and professional associations, and other high-integrity sources of mental health journalism. Learn more by reviewing our full editorial policy.
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Lamictal- lamotrigine tablet, lamotrigine tablet for suspension, lamotrigine tablet orally disintegrating, lamotrigine kit. (February 9, 2023). DailyMed.nlm.nih.gov. Retrieved from https://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm
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Malhi, G. S., Tanious, M., Das, P., Coulston, C. M., & Berk, M. (2013). Potential mechanisms of action of lithium in bipolar disorder. Current understanding. CNS drugs, 27(2), 135–153. https://doi.org/10.1007/s40263-013-0039-0
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Meador, K. J., & Loring, D. W. (2016). Developmental effects of antiepileptic drugs and the need for improved regulations. Neurology, 86(3), 297–306. Retrieved from https://doi.org/10.1212/WNL.0000000000002119
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Ramaratnam, S., Panebianco, M., & Marson, A. G. (2016). Lamotrigine add-on for drug-resistant partial epilepsy. The Cochrane database of systematic reviews, 2016(6), CD001909. Retrieved from https://doi.org/10.1002/14651858.CD001909.pub2
We regularly update the articles on ChoosingTherapy.com to ensure we continue to reflect scientific consensus on the topics we cover, to incorporate new research into our articles, and to better answer our audience’s questions. When our content undergoes a significant revision, we summarize the changes that were made and the date on which they occurred. We also record the authors and medical reviewers who contributed to previous versions of the article. Read more about our editorial policies here.
Author: No Change
Reviewer: No Change
Primary updates: Added “Key Takeaways” feature. Edited for clarity. Condensed “What is Lamictal (Lamotrigine) & How Is it Used?” and moved to FAQs. Revised and condensed “Common Side Effects of Lamotrigine” and “Serious Side Effects of Lamotrigine” sections. Revised and moved content from “Warnings & Interactions to Avoid While Taking Lamotrigine”, “Allergic Reactions to Lamotrigine”, “Side Effects In Children” sections into new “What Are the Warnings & Risks for Lamictal?” feature. Added new sections “Important Things to Know About Taking Lamotrigine” and “Who Experiences Side Effects More?”. Revised and retitled “How to Manage Side Effects” as “How to Cope With Common Lamotrigine Side Effects”. Added new sections “More Ways to Manage Lamotrigine Side Effects”, “Should I Stop Taking Lamotrigine If I Start Feeling Side Effects?”, “When Should I Seek an Alternative to Lamotrigine Due to Side Effects?”, “How to Get a Prescription for Lamotrigine or Alternative Medications” and all included subsections. Revised FAQ section and moved to the end. Retitled “Questions to Ask Your Healthcare Provider About Lamictal (Lamotrigine) Side Effects” to “Questions to Ask Your Provider”. Replaced “Final Thoughts” with “Prescriber’s Tips” feature. Removed “For Further Reading”.
Author: Pamela Wiltfang, PharmD, MPH
Medical Reviewer: Dena Westphalen, PharmD
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