lamotrigine
Lamotrigine (Lamictal) can be used alone or together with other medications to treat seizures. It's available in immediate-release and extended-release formulations. The immediate-release formulation can also be used for bipolar disorder. Lamotrigine (Lamictal) can cause serious skin reactions like rash.
What is Lamotrigine (Lamictal)?
What is Lamotrigine (Lamictal) used for?
Seizures (partial seizures, tonic-clonic seizures)
Seizures of Lennox-Gastaut syndrome - immediate-release only
Bipolar disorder - immediate-release only
How Lamotrigine (Lamictal) works
Lamotrigine (Lamictal) is an antiepileptic. It's not exactly clear how this medication works to manage seizures and treat bipolar disorder.
For seizures, research suggests that lamotrigine (Lamictal) can block and prevent your brain from sending certain chemicals or signals that can overly excite your nerves. This helps lower bursts of activity in your brain, which can prevent seizures.
Drug Facts
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What are the side effects of Lamotrigine (Lamictal)?
Common Side Effects
Immediate release
- Dizziness (38%)
- Headache (29%)
- Double vision (28%)
- Loss of coordination (22%)
- Nausea (19%)
- Blurry vision (16%)
- Sleepiness (14%)
- Stuffy nose (14%)
- Sore throat (10%)
- Rash (10%)
- Dizziness (14%)
- Nausea (7%)
- Vomiting (6%)
- Tremor (6%)
- Feeling tired (6%)
- Double vision (5%)
- Diarrhea (5%)
Other Side Effects
- Indigestion
- Vomiting
- Constipation
- Diarrhea
- Dry mouth
- Cough
- Flu-like symptoms
- Trouble sleeping
- Back pain
- Worsening seizure
- Anxiety
Serious Side Effects
- Severe allergic reaction or skin reaction: rash, blistering or peeling of skin, hives, painful sores in your mouth or around your eyes, fever, trouble breathing, swollen lymph nodes
- Overactive immune system: fever, rash, belly pain or swelling, brown urine, yellowing of the whites of the eyes or skin
- Irregular heartbeat
- Suicidal thoughts and behavior
- Meningitis (brain inflammation): stiff neck, rash, fever, light sensitivity, headache, chills, nausea, vomiting
Source: DailyMed
More on Lamotrigine (Lamictal) side effects
The following 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.
Pros and cons of Lamotrigine (Lamictal)
Pros
Starter kits are available to help with dosing when you first start the medication.
Dose can be adjusted based on your response
Available in various forms: chewable tablets, quick-dissolving tablets, and extended-release tablets
Available as a lower-cost generic
Cons
Can cause dizziness
Dose has to be slowly raised due to risk of serious rash
Interacts with many medications such as birth control pills, divalproex (Depakote), and dofetilide (Tikosyn)
Unknown if safe or works well in children under 2 years old (immediate release) or children under 13 years old (extended release)
Pharmacist tips for Lamotrigine (Lamictal)
Lamotrigine (Lamictal) can sometimes cause rash and other severe skin reactions. If you or your child has a rash, skin pain, blisters, or skin peeling, talk with a provider right away.
You might be prescribed a starter kit when you first start lamotrigine (Lamictal). This can help you stay on track with your dose changes every week. Closely look at the blister pack before using. Don't use it if any of the pockets are torn, broken, or missing.
If you want to stop treatment with lamotrigine (Lamictal), talk with your provider. Don't stop taking lamotrigine (Lamictal) suddenly because doing so can raise your risk for seizures. Your provider can help you stop this medication safely by lowering your dose slowly over time.
Let your provider know right away if you have a headache, stiff neck, fever, chills, feeling sleepy, or feeling confused. Lamotrigine (Lamictal) can raise the risk of a serious brain problem (meningitis), so your provider should check this out to see what the cause of these symptoms is.
Before starting any new medications, including lamotrigine (Lamictal), let your provider or pharmacist know what medications you take or plan to take. These include prescription medications, over-the-counter products, and supplements. Since lamotrigine (Lamictal) can interact with many medications, they can make sure they're safe to take together. Talk with your provider or pharmacist if you have any questions about drug interactions with this medication.
For lamotrigine (Lamictal) extended-release tablets: Don't chew, crush, or cut the tablets. This can change how the medication gets absorbed in your body.
For lamotrigine (Lamictal) orally disintegrating tablets: Place the medication on the tongue. Move the tablet around the mouth to help it to dissolve quickly. You can swallow the dissolved medication with or without water.
For lamotrigine (Lamictal) chewable tablets for oral suspension: You can swallow the tablets whole, chew the tablet and swallow, or dissolve the tablet in a small amount of liquid, such as water. If you're chewing the tablet, drink some water to help you swallow all the medication afterwards. If you're dissolving the tablet with liquid, add the tablet to the liquid, wait at least 1 minute before stirring, and then drink the mixture right away.
Frequently asked questions about Lamotrigine (Lamictal)
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What are the 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.
Severe skin reactions and allergic reactions
Risk factors: Taking divalproex (Depakote) or valproic acid | Taking more lamotrigine (Lamictal) than prescribed or raising the dose too quickly | Children | History of rash from other antiseizure medications
Lamotrigine (Lamictal) can sometimes cause rash and other severe skin reactions. In rare cases, these skin reactions can lead to hospitalization and other complications. The risk is higher if you're also taking divalproex (Depakote) or valproic acid, if you're taking lamotrigine (Lamictal) at too high of a dose, or if your dose is raised too fast. In studies, serious rash occurred more often in children than in adults. Severe skin reactions can happen at any time while you're taking lamotrigine (Lamictal), but are most common within 2 to 8 weeks of starting treatment. Get medical care immediately if you have a rash, blistering or peeling skin, painful sores on your face, swelling, or trouble breathing.
Note that severe allergic reactions, such as drug reaction with eosinophilia and systemic symptoms (DRESS), have happened with or without a rash. Although these reactions are rare, they can cause organ failure or blood problems. Get medical help right away if you have signs like sudden rash, mouth sores, fever, chills, body aches, or swollen lymph nodes.
Overactive immune system
Some people taking lamotrigine (Lamictal) developed hemophagocytic lymphohistiocytosis (HLH), a life-threatening medical condition that's caused by an overactive immune system. Although rare, symptoms might occur between 8 and 24 days of starting this medication. Symptoms can be life-threatening and include fever, rash, belly pain or swelling, brown urine, or yellowing of the whites of the eyes and skin. Seek medical attention right away if you experience any of these symptoms.
Irregular heartbeat
Risk factors: History of heart failure, irregular heartbeat, or other heart disease | Risk of coronary artery disease (CAD) | Taking other medications that can affect heart rhythm
Lamotrigine (Lamictal) might cause irregular heartbeat to develop. You're at higher risk for problems if you have a history of heart disease, have multiple risks for CAD (e.g., identify as obese, smoking tobacco), or if you take other medications that can affect heart rhythm. Let your provider know if you have heart disease so they can discuss the risks and benefits of taking lamotrigine (Lamictal) with you.
Suicidal behavior and thoughts
Risk factors: History of depression | Taking antiseizure medications
As with many other antiseizure medications, lamotrigine (Lamictal) can raise the risk of suicidal thoughts or actions as early as 1 week after starting treatment. The risk is higher if you've had suicidal thoughts or actions in the past. Let your friends and family know to watch out for new or worsening signs of depression or other changes in mood or behavior. Call your provider right away if any suicidal thoughts or actions occur.
Meningitis (brain inflammation)
Although rare, lamotrigine (Lamictal) raises the chance of a very serious brain problem called meningitis. Meningitis happens when the lining around the brain is inflamed. Symptoms of meningitis have occurred anytime from 1 to 45 days after starting treatment. Get medical attention right away if you have a headache, stiff neck, fever, chills, upset stomach, rash, feeling sleepy or confused, or if bright lights bother your eyes.
Withdrawal seizures
Risk factor: Stopping lamotrigine (Lamictal) suddenly
If you suddenly stop taking lamotrigine (Lamictal), it can make you more likely to have seizures due to medication withdrawal. Don't suddenly stop using this medication without talking to your provider. If you need to stop lamotrigine (Lamictal), your provider will help you slowly lower your dose until you can stop altogether.
Possible eye problems
Risk factor: Taking lamotrigine (Lamictal) long term
Lamotrigine (Lamictal) could potentially cause eye problems. This is because lamotrigine (Lamictal) attaches to melanin, a natural chemical in your body that gives color to your eyes. Your risk of eye problems might be higher if you've been using this medication for a long time. Keep in mind that the effects of lamotrigine (Lamictal) on the eyes or vision aren't fully known at this time. If you experience any changes in vision during treatment with this medication, let your provider know. Your provider can give you an eye exam to make sure lamotrigine (Lamictal) is safe for you in the long run.
Interaction with other medications
Some medications can interfere with how your body gets rid of lamotrigine (Lamictal). This can affect the amount of lamotrigine (Lamictal) in your body, how well it works, and the risk of side effects. Likewise, lamotrigine (Lamictal) can also interfere with how your body gets rid of other medications and raise your risk of side effects from those medications.
For example, taking divalproex (Depakote) or valproic acid can raise the amount of lamotrigine (Lamictal) in your body. Taking a lower dose of lamotrigine (Lamictal) might help reduce your risk of serious side effects like rash. On the other hand, estrogen-containing birth control pills can lower the amount of lamotrigine (Lamictal) in your body and potentially cause lamotrigine (Lamictal) to not work as well. Then, lamotrigine (Lamictal) levels in the body rise again during the week when you're taking the non-active birth control pills. So you might be more likely to experience side effects from lamotrigine (Lamictal), like dizziness or double vision, during that week.
For your safety, let your provider or pharmacist know what other medications you’re taking before and while taking lamotrigine (Lamictal).
More on Lamotrigine (Lamictal) warnings
Lamotrigine (Lamictal) dosage forms
| Dosage | Quantity | Price as low as | Price per unit |
|---|---|---|---|
| 98 tablets of 25mg and 100mg (green) | 1 kit | $439.04 | $439.04 |
| 56 tablets of 50mg and 100mg (green odt) | 1 kit | $252.45 | $252.45 |
| 49 tablets of 25mg and 100mg (orange) | 1 kit | $258.46 | $258.46 |
| 35 tablets of 25mg and 100mg (orange odt) | 1 kit | $116.49 | $116.49 |
| 35 tablets of 25mg (blue) | 1 kit | $163.40 | $163.40 |
| 28 tablets of 25mg (blue odt) | 1 kit | $92.59 | $92.59 |
Typical dosing for Lamotrigine (Lamictal)
This medication is available in several different formulations.
Immediate-release (IR): tablets (Lamictal brand, Subvenite brand), orally disintegrating tablets (Lamictal ODT brand), chewable tablets for suspension (Lamictal brand)
Extended-release (ER): tablets (Lamictal XR brand)
You'll typically 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 that you're taking. Your dose might also differ if you have kidney or liver problems. General dosing is listed below.
Seizures
People 13 years and older (IR and ER): The dose depends on if you're taking other seizure medications. The typical starting dose ranges from 25 mg by mouth every other day to 50 mg by mouth once daily. For immediate-release, the typical maintenance dose ranges from 100 mg to 500 mg per day, split into 1 or 2 doses throughout the day. For extended release, the typical maintenance dose ranges from 200 mg to 600 mg once daily.
Children age 2 to up to 12 years (IR only): Your child's provider will calculate the dose based on your child's body weight. This medication is taken by mouth once or twice per day. The maximum amount your child can take is 400 mg per day.
Bipolar disorder
Adults (IR only): The typical starting dose ranges from 25 mg by mouth every other day to 50 mg by mouth once daily. The typical maintenance dose ranges from 100 mg daily to 200 mg twice daily.
More on Lamotrigine (Lamictal) dosage forms
Interactions between Lamotrigine (Lamictal) and other drugs
More on Lamotrigine (Lamictal) interactions
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
How much does Lamotrigine (Lamictal) cost?
What are alternatives to Lamotrigine (Lamictal)?
Seizures (partial seizures, tonic-clonic seizures)
Seizures of Lennox-Gastaut syndrome - immediate-release only
Bipolar disorder - immediate-release only
Bipolar disorder
Seizures (focal impaired awareness seizure, absence seizure)
Migraine prevention
Focal aware (partial-onset) seizures in people ages 1 month and older
Add-on treatment for myoclonic seizures from juvenile myoclonic epilepsy in people ages 12 years and older
Add-on treatment for generalized tonic-clonic seizures in people ages 6 years and older
What is the latest news about Lamotrigine (Lamictal)?
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References
Best studies we foundBetchel, N. T., et al. (2023). Lamotrigine. StatPearls.
GlaxoSmithKline LLC. (2023). LAMICTAL XR- lamotrigine tablet, film coated, extended release LAMICTAL XR- lamotrigine [package insert]. DailyMed.
GlaxoSmithKline LLC. (2023). LAMICTAL- lamotrigine tablet LAMICTAL- lamotrigine tablet, for suspension LAMICTAL ODT- lamotrigine tablet, orally disintegrating LAMICTAL- lamotrigine kit [package insert]. DailyMed.
Mackey, F. J., et al. (1997). Safety of long-term lamotrigine in epilepsy. Epilepsia.
National Organization for Rare Disorders. (2018). Hemophagocytic lymphohistiocytosis.
OWP Pharmaceuticals, Inc. (2021). LAMOTRIGINE KIT- lamotrigine kit LAMOTRIGINE tablet. DailyMed.
REMEDYREPACK INC. (2021). SUBVENITE- lamotrigine tablet [package insert]. DailyMed.
Samokhvalov, A. V., et al. (2010). Alcohol consumption, unprovoked seizures, and epilepsy: A systematic review and meta-analysis. Epilepsia.
Taro Pharmaceuticals U.S.A., Inc. (2023). LAMOTRIGINE tablet [package insert]. DailyMed.
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