lamotrigine
Lamotrigine (Lamictal) is an antiepileptic medication. The immediate-release version can treat different types of seizures as well as bipolar 1 disorder. But the extended-release version is only for seizures. Your dose depends on your age, the other medications you take, and what problem you're treating. Side effects can include dizziness, headache, and serious skin reactions. It can also cause withdrawal symptoms like seizures if you stop taking it suddenly.
What is Lamotrigine (Lamictal)?
What is Lamotrigine (Lamictal) used for?
- Partial-onset seizures
- Primary generalized tonic-clonic seizures
- Seizures from Lennox-Gastaut syndrome - immediate-release only
- Bipolar 1 disorder - immediate-release only
How Lamotrigine (Lamictal) works
Lamotrigine (Lamictal) is an antiepileptic medication. It's not exactly clear how it works. But research suggests that it can block and prevent signals in your brain that make your nerves too active. This helps calm the brain and prevent seizures.
For bipolar disorder, researchers aren't sure how lamotrigine (Lamictal) works to keep your mood in balance.
Drug facts
More on Lamotrigine (Lamictal) essentials
Side effects of Lamotrigine (Lamictal)
The following side effects may get better over time as your body gets used to the medication. Let your healthcare provider know immediately if you continue to experience these symptoms or if they worsen over time.
Common Side Effects
Immediate release:
- Dizziness (38%)
- Headache (29%)
- Double vision (28%)
- Problems with coordination (22%)
- Nausea (19%)
- Blurry vision (16%)
- Sleepiness (14%)
- Runny or stuffy nose (14%)
- Sore throat (10%)
- Rash (10%)
Extended release:
- Dizziness (14%)
- Nausea (7%)
- Vomiting (6%)
- Tremor (6%)
- Feeling tired (6%)
- Double vision (5%)
- Diarrhea (5%)
Less Common Side Effects
Immediate release:
- Vomiting
- Diarrhea
- Constipation
- Stomach pain
- Indigestion
- Flu-like symptoms
- Fever
- Cough
- Trouble sleeping
Extended release:
- Feeling like the room is spinning (vertigo)
- Blurry vision
- Low appetite
Note: Side effects were from adults taking lamotrigine (Lamictal) and other medications for seizures. Side effects might be different for children or for people with bipolar disorder.
Lamotrigine (Lamictal) serious side effects
Contact your healthcare provider immediately if you experience any of the following.
- Serious rash: rash, blisters, peeling skin, painful sores, swelling
- Severe allergic reaction: rash that spreads over your body, fever, swollen lymph nodes
- Overactive immune reaction to the medication: fever, rash, swollen lymph nodes, stomach pain, swelling of the stomach, yellowing of the eyes or skin, irritability, trouble with coordination
- Irregular heartbeat
- Suicidal thoughts and behavior
- Meningitis (inflammation in the brain): sudden headache, stiff neck, fever, rash, chills, eye sensitivity to bright lights, sleepiness, confusion, muscle pain, nausea, vomiting
More on Lamotrigine (Lamictal) side effects
The following Lamotrigine (Lamictal) side effects have also been reported
Along with its needed effects, a medicine may cause some unwanted effects. Although not all of these side effects may occur, if they do occur they may need medical attention.
Check with your doctor immediately if any of the following side effects occur:
More common
Blurred vision
changes in vision
chest pain, discomfort, or tightness
clumsiness or unsteadiness
decreased urine output
dilated neck veins
double vision
irregular breathing
irregular heartbeat
pain or discomfort in the arms, jaw, back, or neck
poor coordination
seizure that will not stop
skin rash
sweating
swelling of the face, fingers, feet, or lower legs
trouble breathing
unusual tiredness or weakness
vomiting
Less common
confusion
continuous, uncontrolled back and forth or rolling eye movements
increase in seizures
infection
irritability
Rare
Blistering, peeling, or loosening of the skin
chills
dark urine
general feeling of discomfort or illness
headache
joint pain
loss of appetite
memory loss
muscle cramps, pain, or weakness
red or irritated eyes
shivering
small red or purple spots on the skin
sores, ulcers, or white spots on the lips or in the mouth
swelling of the face, mouth, hands, or feet
swollen lymph nodes
trouble sleeping
unusual bleeding or bruising
yellow eyes or skin
Incidence not known
Back, leg, or stomach pains
bleeding gums
blood in the urine
bloody, black or tarry stools
bluish lips or skin
coughing or vomiting blood
difficulty with swallowing
fainting
fast heartbeat
general body swelling
high fever
hoarseness
lightheadedness
loss of balance control
lower back or side pain
mask-like face
nosebleeds
not breathing
pain or burning in the throat
painful or difficult urination
pains in the stomach or side, possibly radiating to the back
pale skin
persistent bleeding or oozing from puncture sites, mouth, or nose
rapid, shallow breathing
redness, soreness, or itching skin
shuffling walk
slowed movement
slurred speech
sores, welting, or blisters
stiffness of the arms and legs
swollen or painful glands
tic-like (jerky) movements
Get emergency help immediately if any of the following symptoms of overdose occur:
Symptoms of overdose
Clumsiness or unsteadiness (severe)
continuous, uncontrolled back and forth or rolling eye movements (severe)
dizziness (severe)
drowsiness (severe)
dryness of the mouth (severe)
headache (severe)
increased heart rate
loss of consciousness
slurred speech (severe)
Some side effects may occur that usually do not need medical attention. These side effects may go away during treatment as your body adjusts to the medicine. Also, your health care professional may be able to tell you about ways to prevent or reduce some of these side effects. Check with your health care professional if any of the following side effects continue or are bothersome or if you have any questions about them:
More common
Dizziness
drowsiness
Other side effects not listed may also occur in some patients. If you notice any other effects, check with your healthcare professional.
Call your doctor for medical advice about side effects. You may report side effects to the FDA at 1-800-FDA-1088.
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Pros and cons of Lamotrigine (Lamictal)
Pros
- Available in different formulations (regular immediate-release tablets, chewable tablets, quick-dissolving tablets, and extended-release tablets)
- Can use a starter kit to help with dosing when you first start the medication
- Approved for children of certain ages with seizures (age depends on formulation)
Cons
- Can cause dizziness and headaches
- Must start at a low dose and have the dose slowly raised to lower the risk of serious rash
- Interacts with many medications, like birth control pills, divalproex (Depakote), and dofetilide (Tikosyn)
Pharmacist tips for Lamotrigine (Lamictal)
- Each time you pick up lamotrigine (Lamictal) from the pharmacy, make sure it's the right medication since it comes in different formulations. The immediate-release version comes as regular tablets, chewable tablets, and tablets that melt on your tongue (orally disintegrating tablets or ODTs). The extended-release version only comes as tablets. Ask your pharmacist if you're not sure which one you're taking.
- You can take lamotrigine (Lamictal) with or without food.
- For lamotrigine (Lamictal) regular immediate-release tablets: Swallow the tablets whole. If you have trouble swallowing, talk to your prescriber about other options.
- For lamotrigine (Lamictal) chewable tablets for oral suspension: You can swallow these tablets whole. You can also chew them and then drink some water or watered down juice to swallow all the medication. Another option is to put the tablet in a cup with a small amount of liquid, wait about a minute, stir, and then drink it right away.
- For lamotrigine (Lamictal ODT) orally disintegrating tablets: Place the tablet on your tongue. Then, move the tablet around your mouth to help it dissolve quickly. Once dissolved, you can swallow the medication with or without water.
- For lamotrigine (Lamictal XR) extended-release tablets: Swallow the tablets whole. Don't chew, crush, or cut the tablets. This can change how the medication gets absorbed into your body. Talk to your prescriber if you have trouble swallowing the extended-release tablets.
- You might get a starter kit when you first start lamotrigine (Lamictal). This can help you stay on track with your dose changes every week at the beginning of treatment. Closely look at the blister pack before using. Don't use if any of the pockets are torn, broken, or missing.
- Lamotrigine (Lamictal) can make you feel dizzy, sleepy, or tired. It can also make your vision blurry. Don't drive or use machines until you know how this medication affects you.
- Lamotrigine (Lamictal) can sometimes cause rash, which can be serious. Watch out for a rash, blisters, or peeling skin. If you notice this, get medical help right away.
- Tell your prescribers and pharmacists about the medications you take or plan to take. Lamotrigine (Lamictal) can interact with many medications. For example, it can interact with other anti-seizure medications and birth control pills. It's important for your care team to check that all your medications are safe to take together. They can recommend changes if needed.
- Don't stop taking lamotrigine (Lamictal) suddenly because it can raise your risk of seizures. If you want to stop taking the medication, talk to your prescriber first. They can help you lower your dose slowly and safely over time.
Common questions about Lamotrigine (Lamictal)
It's not common, but some people have reported weight gain while taking lamotrigine (Lamictal). In general, this medication isn't known to have an effect on body weight. This is unlike some other anti-seizure medications. If you're worried about weight changes while taking lamotrigine (Lamictal), talk to your prescriber.
A dose of 300 mg is high for a starting dose of lamotrigine (Lamictal). This medication is started at a lower dose. Then, the dose is raised slowly over several weeks to lower the risk of side effects. As a maintenance dose, calling 300 mg high depends on many things. It depends on your age, weight (for children), and liver and kidney function. It also depends on what condition you're treating and what other medications you take. Because your dose is personalized for you, ask your prescriber or pharmacist if you're worried about your dose.
No, lamotrigine (Lamictal) isn't an antipsychotic. It belongs to a group of medications called antiepileptics. This medication works in a different way than antipsychotics.
Yes, lamotrigine (Lamictal) can sometimes make you sleepy. To be safe, don't drive or do anything that you need to be alert for until you know how this medication affects you. If you get too sleepy from the medication and it's affecting your daily life, talk to your prescriber.
It can take up to several weeks to feel the full effects of lamotrigine (Lamictal). A part of this is because you start at a low dose first and then your dose is raised over several weeks. This lowers your risk of serious side effects from the medication. Typically, your prescriber will raise your dose slowly every 1 to 2 weeks until you get to a dose that works for you. Keep taking the medication as prescribed, even if you don't feel too different at first. It's important not to stop taking it suddenly because this can cause seizures. Follow up with your prescriber about how you're doing with lamotrigine (Lamictal).
No, lamotrigine (Lamictal) isn't a controlled substance. It isn't known to have a risk of addiction or misuse.
It's pretty rare for people taking lamotrigine (Lamictal) to have hair loss as a side effect. If you notice more hair falling out or your hair getting thinner, tell your care team. They can help figure out what might be causing it and talk about ways to manage it.
If you're pregnant or planning to be, talk to your prescriber about the risks and benefits of taking lamotrigine (Lamictal). It's important to keep seizures or bipolar disorder under control while pregnant. Some studies suggest that lamotrigine (Lamictal) has a relatively low risk of serious harm to babies compared to other seizure medications. In fact, clinical guidelines for epilepsy recommend lamotrigine (Lamictal) as an option during pregnancy. If you become pregnant, tell your prescriber right away so they can help you choose the safest option. If you take seizure medication while pregnant, you can join the North American Antiepileptic Drug (NAAED) Pregnancy Registry. It helps researchers learn more about the safety of these medications during pregnancy.
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Risks and warnings for Lamotrigine (Lamictal)
Lamotrigine (Lamictal) can cause some serious health issues. This risk may be even higher for certain groups. If this worries you, talk to your doctor or pharmacist about other options.
Serious skin rashes
- Risk factors: History of rash from other anti-seizure medications | Children | Taking a higher-than-recommended starting dose of lamotrigine (Lamictal) | Raising the dose of lamotrigine (Lamictal) too fast | Taking divalproex (Depakote) or valproic acid
In rare cases, lamotrigine (Lamictal) can cause a serious rash. It can sometimes be serious even to need hospital care. Some serious rashes that can happen can be related to Stevens-Johnson syndrome (SJS) or toxic epidermal necrolysis (TEN).
The risk of rash might be higher if your starting dose is too high or if your dose is raised too fast. It can also be higher if you also take divalproex (Depakote) or valproic acid. In studies, serious rash happened more often in children than in adults. And, people who've had allergic reactions or rashes from other anti-seizure medications might also have a higher risk.
Serious skin rashes can happen at any time while taking lamotrigine (Lamictal). But they're most common within 2 to 8 weeks after starting the medication. Get medical care right away if you notice a rash, blisters, peeling skin, painful sores, or swelling.
Serious allergic reaction
Some people have had a serious allergic reaction to lamotrigine (Lamictal) called drug reaction with eosinophilia and systemic symptoms (DRESS). This reaction is rare, but it can be life-threatening and cause problems with your organs or blood. It can happen with or without a rash.
Get medical help right away if you suddenly get a rash that spreads over your body and have a fever. Also watch for swollen lymph nodes. These can be early signs of DRESS and you should get checked out as soon as possible.
Overactive immune response to the medication
Although it's rare, some people taking lamotrigine (Lamictal) can have an overactive immune response to the medication. This reaction is called hemophagocytic lymphohistiocytosis (HLH). It can be life-threatening if it isn't caught and treated early.
Symptoms can happen within 8 to 24 days after starting lamotrigine (Lamictal). This can include fever, rash, and swollen lymph nodes. You might also have stomach pain, swelling of the stomach, and yellowing of the eyes or skin. Other signs include irritability or trouble with coordination. Get medical help right away if you notice any of these symptoms while taking this medication.
Irregular heartbeat
- Risk factors: Heart failure | Heart disease | Irregular heartbeat (arrhythmia) | Risk of coronary artery disease (CAD) | Taking other medications that can affect heart rhythm
Studies suggest that lamotrigine (Lamictal) might cause an irregular heartbeat, which could lead to serious problems. Your risk might be higher if you have heart disease, heart failure, or an irregular heart rhythm (arrhythmia). It can also be higher if you have risk factors for coronary artery disease (CAD), like high cholesterol or smoking. Taking other medications that affect heart rhythm can raise the risk too.
Tell your prescriber about your medical history and any medications you take. They can check if you're at risk for heart rhythm problems with lamotrigine (Lamictal). Your prescriber can help you decide if this medication is safe for you.
Risk of suicidal thoughts and behavior
- Risk factors: History of depression | Taking anti-seizure medications
As with many other anti-seizure medications, lamotrigine (Lamictal) can raise the risk of suicidal thoughts or behavior. The risk can appear as early as 1 week after starting the medication.
Let your friends and family know to watch for any signs of depression or unusual changes in mood or behavior. If this happens, tell your prescriber. If you start thinking about hurting yourself, call 911 right away.
Meningitis (inflammation in the brain)
Although rare, lamotrigine (Lamictal) raises the chance of a very serious brain problem called meningitis. This happens when the lining around the brain is inflamed. Symptoms of meningitis have happened anytime from 1 to 45 days after starting treatment.
Get medical help right away if you have a sudden headache, stiff neck, fever, nausea, or vomiting. Other signs are rash, chills, eye sensitivity to bright lights, sleepiness, and confusion. These can be early signs of meningitis.
Withdrawal seizures
- Risk factors: Stopping lamotrigine (Lamictal) suddenly
Don't suddenly stop taking lamotrigine (Lamictal) without talking to your prescriber. Otherwise, it can cause seizures. If you need to stop lamotrigine (Lamictal), talk to your prescriber. They'll help you lower your dose slowly until you can stop it altogether.
Possible eye problems
- Risk factor: Taking lamotrigine (Lamictal) long term
Lamotrigine (Lamictal) could potentially cause eye problems. This could happen because the medication can attach to melanin, a natural chemical that gives color to your eyes. The risk might be higher if you've been taking the medication for a long time. Keep in mind that it's not fully know what the effects of lamotrigine (Lamictal) are on the eyes or vision.
If you notice any changes in your vision while taking lamotrigine (Lamictal), tell your prescriber or optometrist. They can give you an eye exam to make sure it's safe for you to keep taking the medication.
Interactions with other medications
Some medications can interfere with how your body gets rid of lamotrigine (Lamictal). This can affect how much lamotrigine (Lamictal) is in your body, how well it works, and how likely you are to have side effects. In a similar way, lamotrigine (Lamictal) can change how your body removes other medications, which can affect your safety.
For example, divalproex (Depakote) and valproic acid can raise the amount of lamotrigine (Lamictal) in your body. This can make side effects, like a serious rash, more likely. If you need to take one of these medications, you'll usually get prescribed a lower dose of lamotrigine (Lamictal) to help keep you safe.
Another example is with medications that contain estrogen, such as birth control pills. They can lower how much lamotrigine (Lamictal) is in your body. This means that the medication might not work as well. During the week when you take the non-active birth control pills, the amount of lamotrigine (Lamictal) in your body goes back up. During that week, your risk of side effects might be higher.
Tell your prescribers and pharmacist about all the medications you take or plan to take. They can make sure everything is safe to take together and adjust your doses if needed.
Lamotrigine (Lamictal) dosage
Chewable tablet| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 5mg | 60 chewable tablets | $19.36 | $0.32 |
| 25mg | 120 chewable tablets | $29.19 | $0.24 |
Kit| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 35 tablets of 25mg (blue) | 1 kit | $163.40 | $163.40 |
| 49 tablets of 25mg and 100mg (orange) | 1 kit | $258.46 | $258.46 |
| 98 tablets of 25mg and 100mg (green) | 1 kit | $439.04 | $439.04 |
| 28 tablets of 25mg (blue odt) | 1 kit | $92.34 | $92.34 |
| 56 tablets of 50mg and 100mg (green odt) | 1 kit | $252.20 | $252.20 |
| 35 tablets of 25mg and 100mg (orange odt) | 1 kit | $116.49 | $116.49 |
Typical dosage for Lamotrigine (Lamictal)
In general, you start lamotrigine (Lamictal) at a low dose, and the dose will be raised in the following weeks. The dose depends on what you're taking lamotrigine (Lamictal) for, your age, and the other medications you're taking. Your dose might also differ if you have kidney or liver problems. General dosing is listed below.
-
Immediate-release tablets (Lamictal)
- Immediate-release tablets come in different forms. These include regular tablets and chewable tablets for suspension. There are also orally disintegrating tablets (Lamictal ODT).
- Seizures
- People 13 years and older: The typical starting dose ranges from 25 mg by mouth every other day to 50 mg by mouth once daily. Your prescriber will raise your dose every 1 to 2 weeks to reach a maintenance dose. The typical maintenance dose ranges from 100 mg to 500 mg per day, split into 1 or 2 doses throughout the day.
- Children 2 to 12 years: The prescriber will calculate the dose based on your child's body weight. This medication is taken by mouth once or twice per day. The dose is slowly raised over several weeks to a maintenance dose.
- Bipolar 1 disorder
- Adults: The typical starting dose ranges from 25 mg by mouth every other day to 50 mg by mouth once daily. Your prescriber will raise your dose every 1 to 2 weeks to reach a maintenance dose. The typical maintenance dose can range from 100 mg to 200 mg daily. Some people might need doses up to 200 mg twice daily.
-
Extended-release tablets (Lamictal XR)
- Seizures
- People 13 years and older: The typical starting dose ranges from 25 mg by mouth every other day to 50 mg by mouth every day. Your prescriber will raise your dose every 1 to 2 weeks to reach a maintenance dose. The typical maintenance dose ranges from 200 mg to 600 mg once daily.
- Seizures
More on Lamotrigine (Lamictal) dosage
Interactions between Lamotrigine (Lamictal) and other drugs
More on Lamotrigine (Lamictal) interactions
Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking this medicine, it is especially important that your healthcare professional know if you are taking any of the medicines listed below. The following interactions have been selected on the basis of their potential significance and are not necessarily all-inclusive.
Using this medicine with any of the following medicines is usually not recommended, but may be required in some cases. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Atazanavir
- Calcifediol
- Carbamazepine
- Cenobamate
- Desmopressin
- Dofetilide
- Ezogabine
- Fosphenytoin
- Lopinavir
- Orlistat
- Phenobarbital
- Phenytoin
- Primidone
- Rifampin
- Valproic Acid
Using this medicine with any of the following medicines may cause an increased risk of certain side effects, but using both drugs may be the best treatment for you. If both medicines are prescribed together, your doctor may change the dose or how often you use one or both of the medicines.
- Desogestrel
- Dienogest
- Drospirenone
- Escitalopram
- Estradiol
- Ethinyl Estradiol
- Ethynodiol
- Gestodene
- Ginkgo
- Ginseng
- Levonorgestrel
- Mestranol
- Methsuximide
- Nomegestrol
- Norethindrone
- Norgestimate
- Norgestrel
- Oxcarbazepine
- Risperidone
- Ritonavir
- Rufinamide
- Sertraline
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