lamotrigine

Pronunciation

Generic Name: lamotrigine (la MOE tri jeen)
Brand Name: LaMICtal, LaMICtal ODT, LaMICtal ODT Patient Titration Kit (Blue), LaMICtal ODT Patient Titration Kit (Green), LaMICtal ODT Patient Titration Kit (Orange), LaMICtal Starter Kit (Blue), LaMICtal Starter Kit (Green), LaMICtal Starter Kit (Orange), LaMICtal XR, LaMICtal XR Patient Titration Kit (Blue), LaMICtal XR Patient Titration Kit (Green), LaMICtal XR Patient Titration Kit (Orange), LaMICtal CD

What is lamotrigine?

Lamotrigine is an anti-epileptic medication, also called an anticonvulsant.

Lamotrigine is used either alone or in combination with other medications to treat epileptic seizures in adults and children. Lamotrigine is also used to delay mood episodes in adults with bipolar disorder (manic depression).

The immediate-release form of lamotrigine (Lamictal, Lamictal ODT) can be used in children as young as 2 years old when it is given as part of a combination of seizure medications. However, this form should not be used as a single medication in a child or teenager who is younger than 16 years old.

The extended-release form of lamotrigine (Lamictal XR) is for use only in adults and children who are at least 13 years old.

Lamotrigine may also be used for purposes not listed in this medication guide.

What is the most important information I should know about lamotrigine?

Before taking lamotrigine, tell your doctor if you have kidney or liver disease, a history of depression or suicidal thoughts, or if you are allergic to other seizure medications.

Lamotrigine may cause severe or life-threatening skin rash, especially in children and in people who take too high of a dose at the start of treatment with lamotrigine. Serious skin rash may also be more likely to occur if you are taking lamotrigine together with valproic acid (Depakene) or divalproex (Depakote).

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Seek emergency medical attention if you have: fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

You may have thoughts about suicide while taking this medication. Your doctor will need to check you at regular visits. Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, depression, anxiety, or if you feel agitated, hostile, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.

Do not stop taking lamotrigine without first talking to your doctor, even if you feel fine. You may have increased seizures if you stop using lamotrigine suddenly.

Contact your doctor if your seizures get worse or you have them more often while taking lamotrigine.

Taking this medication during early pregnancy can increase the risk of the baby being born with cleft lip or cleft palate. Tell your doctor if you are pregnant or if you become pregnant during treatment.

What should I discuss with my healthcare provider before taking lamotrigine?

You should not take lamotrigine if you are allergic to it.

To make sure you can safely take lamotrigine, tell your doctor if you have any of these other conditions:

  • kidney or liver disease;

  • a history of depression or suicidal thoughts or actions; or

  • if you are allergic to other seizure medications.

You may have thoughts about suicide while taking this medication. Tell your doctor if you have new or worsening depression or suicidal thoughts during the first several months of treatment, or whenever your dose is changed.

Your family or other caregivers should also be alert to changes in your mood or symptoms. Your doctor will need to check you at regular visits. Do not miss any scheduled appointments.

FDA pregnancy category C. It is not known whether lamotrigine will harm an unborn baby. Taking this medication during early pregnancy can increase the risk of the baby being born with cleft lip or cleft palate. Tell your doctor if you are pregnant or plan to become pregnant while taking lamotrigine.

Birth control pills can make lamotrigine less effective, resulting in increased seizures. Tell your doctor if you start or stop using birth control pills while you are taking lamotrigine. Your lamotrigine dose may need to be changed.

Tell your doctor if you plan to stop taking birth control pills.

Lamotrigine can pass into breast milk and may harm a nursing baby. Do not use this medication without telling your doctor if you are breast-feeding a baby.

How should I take lamotrigine?

Take exactly as prescribed by your doctor. Do not take in larger or smaller amounts or for longer than recommended. Taking too much lamotrigine at the start of treatment may increase your risk of a severe life-threatening skin rash. Follow the directions on your prescription label.

Your doctor may occasionally change your dose over several weeks or months to make sure you get the best results. Take only the amount prescribed by your doctor whenever your dose is changed.

To make sure you are taking the right dose of lamotrigine, your blood may need to be tested often. Visit your doctor regularly.

Extended-release lamotrigine (Lamictal XR) may be used for different conditions than immediate-release lamotrigine is used for. Always check your refills to make sure you have received the correct size, color, and shape of tablet. Ask the pharmacist if you have any questions about the medicine you receive at the pharmacy.

If you are switching to lamotrigine from another anticonvulsant medication, carefully follow your doctor's instructions about timing and dosage when switching from one drug to another.

Do not crush, chew, or break a regular lamotrigine tablet. Swallow it whole.

To take the orally disintegrating tablet (Lamictal ODT), place the tablet on your tongue and move it around in your mouth. Do not swallow the tablet whole. Allow it to dissolve in your mouth without chewing. Swallow several times as the tablet dissolves. If desired, you may drink liquid to help swallow the dissolved tablet.

To take the chewable dispersible tablet, you may either swallow it whole with a glass of water, or chew it first and then swallow it. You may also place the tablet into 1 teaspoon of water or diluted fruit juice and allow it to disperse in the liquid for about 1 minute. Gently swirl the liquid and then swallow all of the mixture right away. Do not save it for later use.

Do not stop taking lamotrigine without first talking to your doctor, even if you feel fine. You may have increased seizures if you stop using lamotrigine suddenly. You may need to use less and less before you stop the medication completely.

Wear a medical alert tag or carry an ID card stating that you take lamotrigine. Any medical care provider who treats you should know that you take seizure medication.

Use lamotrigine regularly to get the most benefit. Get your prescription refilled before you run out of medicine completely.

Store at room temperature away from light and moisture.

What happens if I miss a dose?

Take the missed dose as soon as you remember. Skip the missed dose if it is almost time for your next scheduled dose. Do not take extra medicine to make up the missed dose.

What happens if I overdose?

Seek emergency medical attention or call the Poison Help line at 1-800-222-1222.

Overdose symptoms may include blurred vision, problems with coordination, increased seizures, feeling light-headed, or fainting.

What should I avoid while taking lamotrigine?

Lamotrigine may cause blurred vision or impair your thinking or reactions. Be careful if you drive or do anything that requires you to be alert and able to see clearly.

Lamotrigine side effects

Get emergency medical help if you have any of these signs of an allergic reaction: hives; fever; swollen glands; painful sores in or around your eyes or mouth; difficulty breathing; swelling of your face, lips, tongue, or throat.

Report any new or worsening symptoms to your doctor, such as: mood or behavior changes, depression, anxiety, or if you feel agitated, hostile, restless, hyperactive (mentally or physically), or have thoughts about suicide or hurting yourself.

Lamotrigine may cause severe or life-threatening skin rash, especially in children and in people who take too high of a dose at the start of treatment with lamotrigine. Serious skin rash may also be more likely to occur if you are taking lamotrigine together with valproic acid (Depakene) or divalproex (Depakote). Seek emergency medical attention if you have a fever, sore throat, swelling in your face or tongue, burning in your eyes, skin pain, followed by a red or purple skin rash that spreads (especially in the face or upper body) and causes blistering and peeling.

If you have to stop taking lamotrigine because of a serious skin rash, you may not be able to take it again in the future.

Call your doctor at once if you have any of these other serious side effects:

  • the first sign of any skin rash, no matter how mild;

  • fever, swollen glands, body aches, flu symptoms, headache, neck stiffness, increased sensitivity to light;

  • easy bruising or bleeding, severe tingling, numbness, pain, muscle weakness;

  • upper stomach pain, loss of appetite, dark urine, jaundice (yellowing of the skin or eyes);

  • chest pain, irregular heart rhythm, feeling short of breath;

  • confusion, nausea and vomiting, swelling, rapid weight gain, urinating less than usual or not at all;

  • pale skin, feeling light-headed or short of breath, rapid heart rate, trouble concentrating; or

  • increased seizures or worsening of your bipolar disorder.

Less serious side effects may include:

  • tremors, dizziness, tired feeling;

  • blurred vision, double vision;

  • loss of coordination;

  • dry mouth, mild nausea, stomach pain, upset stomach;

  • changes in your menstrual periods;

  • back pain;

  • sleep problems (insomnia); or

  • runny nose, sore throat.

This is not a complete list of side effects and others may occur. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

See also: Side effects (in more detail)

Lamotrigine Dosing Information

Usual Adult Dose for Seizure Prophylaxis:

Added to an Antiepileptic Drug Regimen Containing Valproic Acid:
Weeks 1 and 2: 25 mg every other day
Weeks 3 and 4: 25 mg every day
Usual maintenance dose: 100 to 400 mg/day (1 or 2 divided doses). To achieve maintenance, doses may be increased by 25 to 50 mg/day every 1 to 2 weeks. The usual maintenance dose in patients adding lamotrigine to valproic acid alone ranges from 100 to 200 mg/day.

Added to Enzyme-Inducing Antiepileptic Drugs (Without Valproic Acid)
Weeks 1 and 2: 50 mg/day
Weeks 3 and 4: 100 mg/day in two divided doses
Usual maintenance dose: 300 to 500 mg/day (in two divided doses). To achieve maintenance, doses may be increased by 100 mg/day every 1 to 2 weeks.

For patients receiving enzyme-inducing AEDs but not valproate:
Initial dose: 50 mg orally once a day for 2 weeks, then increase to 50 mg orally twice a day for 2 weeks.
Maintenance dose: 150 to 250 mg orally twice a day.
Dose may be increased by 100 mg/day every week.
Maintenance doses as high as 700 mg/day have been used.


Escalation regimen for lamotrigine extended release:
For use in Primary Generalized Tonic-Clonic and Partial Onset Seizures

Treatment with lamotrigine is introduced based on concurrent medications.

Weeks 1 and 2:
For patients not taking Carbamazepine, Phenytoin, Phenobarbital, Primidone or Valproate: 25 mg daily
For patients taking Valproate: 25 mg every other day
For patients taking Carbamazepine, Phenytoin, Phenobarbital, or Primidone and not taking Valproate: 50 mg daily

Weeks 3 and 4:
For patients not taking Carbamazepine, Phenytoin, Phenobarbital, Primidone or Valproate: 50 mg daily
For patients taking Valproate: 25 mg daily
For patients taking Carbamazepine, Phenytoin, Phenobarbital, or Primidone and not taking Valproate: 100 mg daily

Week 5:
For patients not taking Carbamazepine, Phenytoin, Phenobarbital, Primidone or Valproate: 100 mg daily
For patients taking Valproate: 50 mg daily
For patients taking Carbamazepine, Phenytoin, Phenobarbital, or Primidone and not taking Valproate: 200 mg daily

Week 6:
For patients not taking Carbamazepine, Phenytoin, Phenobarbital, Primidone or Valproate: 150 mg daily
For patients taking Valproate: 100 mg daily
For patients taking Carbamazepine, Phenytoin, Phenobarbital, or Primidone and not taking Valproate: 300 mg daily

Week 7:
For patients not taking Carbamazepine, Phenytoin, Phenobarbital, Primidone or Valproate: 200 mg daily
For patients taking Valproate: 150 mg daily
For patients taking Carbamazepine, Phenytoin, Phenobarbital, or Primidone and not taking Valproate: up to 400 mg daily

Maintenance Range (Week 8 and onward):
For patients not taking Carbamazepine, Phenytoin, Phenobarbital, Primidone or Valproate: 300 mg to 400 mg daily
For patients taking Valproate: 200 mg to 250 mg daily
For patients taking Carbamazepine, Phenytoin, Phenobarbital, or Primidone and not taking Valproate: 400 mg to 600 mg daily

Dose increases at week 8 or later should not exceed 100 mg daily at weekly intervals.

As other drugs are subsequently introduced or withdrawn, the dose of lamotrigine may need to be adjusted.

Conversion from adjunctive therapy to monotherapy with lamotrigine extended-release:

The goal of the transition regimen is to attempt to maintain seizure control while mitigating the risk of serious rash associated with the rapid titration of lamotrigine extended-release.

The recommended maintenance dosage range of lamotrigine extended-release as monotherapy is 250 to 300 mg given once daily. The recommended initial dose and subsequent dose escalations for lamotrigine extended-release should not be exceeded.

Conversion from adjunctive therapy with carbamazepine, phenytoin, phenobarbital, or primidone to monotherapy with lamotrigine extended-release: After achieving a dosage of 500 mg/day the concomitant enzyme-inducing AED should be withdrawn by 20% decrements each week over a 4-week period. Two weeks after completion of withdrawal of the enzyme-inducing AED, the dosage of lamotrigine extended-release should be decreased no faster than 100 mg/day each week to achieve the monotherapy maintenance dosage range of 250 to 300 mg/day.

Conversion from adjunctive therapy with valproate to monotherapy with lamotrigine extended-release: The conversion regimen involves 4 steps:
Step 1: Achieve a lamotrigine extended-release dosage of 150 mg/day according to dosing guidelines. Maintain established stable dose of valproate.
Step 2: Maintain lamotrigine extended-release dosage at 150 mg/day and decrease valproate dosage by decrements no greater than 500 mg/day/week to 500 mg/day and then maintain for 1 week.
Step 3: Increase lamotrigine extended-release dosage to 200 mg/day and simultaneously decrease valproate dosage to 250 mg/day and maintain for 1 week.
Step 4: Increase lamotrigine extended-release dosage to 250 or 300 mg/day and discontinue valproate.

Usual Adult Dose for Bipolar Disorder:

Treatment with lamotrigine is introduced based on concurrent medications.

Weeks 1 and 2
For patients not taking carbamazepine (or other enzyme-inducing drugs) or valproate: 25 mg daily
For patients taking valproate: 25 mg every other day
For patients taking carbamazepine (or other enzyme-inducing drugs) and not taking valproate: 50 mg daily

Weeks 3 and 4
For patients not taking carbamazepine (or other enzyme-inducing drugs) or valproate: 50 mg daily
For patients taking valproate: 25 mg daily
For patients taking carbamazepine (or other enzyme-inducing drugs) and not taking valproate: 100 mg daily in divided doses

Weeks 5
For patients not taking carbamazepine (or other enzyme-inducing drugs) or valproate: 100 mg daily
For patients taking valproate: 50 mg daily
For patients taking carbamazepine (or other enzyme-inducing drugs) and not taking valproate: 200 mg daily in divided doses

Weeks 6
For patients not taking carbamazepine (or other enzyme-inducing drugs) or valproate: 200 mg daily
For patients taking valproate: 100 mg daily
For patients taking carbamazepine (or other enzyme-inducing drugs) and not taking valproate: 300 mg daily in divided doses

Weeks 7
For patients not taking carbamazepine (or other enzyme-inducing drugs) or valproate: 200 mg daily
For patients taking valproate: 100 mg daily
For patients taking carbamazepine (or other enzyme-inducing drugs) and not taking valproate: up to 400 mg daily in divided doses

As other drugs are subsequently introduced or withdrawn, the dose of lamotrigine may need to be adjusted.

Usual Pediatric Dose for Seizure Prophylaxis:

Dosage depends on patient's concomitant medications (i.e., valproic acid, enzyme-inducing AEDs specifically phenytoin, phenobarbital, carbamazepine, and primidone), or AEDs other than carbamazepine, phenytoin, phenobarbital, primidone, or valproic aced. Patients receiving concomitant rifampin or other drugs that induce lamotrigine glucuronidation and increase clearance should follow the same dosing regimen as that used with anticonvulsants that have this effect (e.g., phenytoin, phenobarbital, carbamazepine, and primidone).

Added to an antiepileptic drug regimen therapy:
Children 2 to 12 years: Immediate release formulation: (only whole tablets should be used for dosing): children 2 to 6 years will likely require maintenance doses in the higher end of recommended range; patients weighing less than 30 kg may need as much as a 50% increase in maintenance dose, compared with patients weighing greater than 30 kg; titrate dose to clinical effect.

For patients taking enzyme-inducing antiepileptic drugs (AEDs) other than carbamazepine, phenytoin, phenobarbital, primidone, or valproic acid:
Weeks 1 and 2: 0.3 mg/kg/day in 1 to 2 divided doses; round dose down to nearest whole tablet.
Weeks 3 and 4: 0.6 mg/kg/day in two divided doses; round dose down to nearest whole tablet.
Maintenance dose: Titrate dose to effect; after week 4, increases dose every 1 to 2 weeks by a calculated increment; calculate increment as 0.6 mg/kg/day rounded down to the nearest whole tablet; add this amount to the previously administered daily dose; usual maintenance: 4.5 to 7.5 mg/kg/day in 2 divided doses.
Maximum dose: 300 mg/day

Patients receiving AED regimens containing valproic acid:
Weeks 1 and 2: 0.15 mg/kg/day in 1 to 2 divided doses; round dose down to the nearest whole tablet; use 2 mg every other day for patients weighing greater than 6.7 kg and less than 14 kg.
Weeks 3 and 4: 0.3 mg/kg/day in 1 to 2 divided doses; round dose down to the nearest whole tablet.
Maintenance dose: Titrate dose to effect; after week 4, increase dose every 1 to 2 weeks by a calculated increment; calculate increment as 0.3 mg/kg/day rounded down to the nearest whole tablet; add this amount to the previously administered daily dose; usual maintenance: 1 to 5 mg/kg/day in 1 to 2 divided doses.
Maximum dose: 200 mg/day. Note: Usual maintenance dose in children adding lamotrigine to valproic acid alone: 1 to 3 mg/kg/day

For patients receiving AED regimens without valproic acid:
Weeks 1 and 2: 0.6 mg/kg/day in 2 divided doses; round dose down to the nearest whole tablet.
Weeks 3 and 4: 1.2 mg/kg/day in 2 divided doses; round dose down to the nearest whole tablet.
Maintenance dose: titrate dose to effect; after week 4, increase dose every 1 to 2 weeks by a calculated increment; calculate increment as 1.2 mg/kg/day rounded down to the nearest whole tablet; add this amount to the previously administered daily dose; usual maintenance dose is 5 to 15 mg/kg/day in 2 divided doses.
Maximum dose: 400 mg/day

What other drugs will affect lamotrigine?

Tell your doctor about all other medicines you use, especially:

  • hormonal forms of birth control (pills, injections, implants, or skin patches);

  • carbamazepine (Carbatrol, Equetro, Tegretol);

  • divalproex (Depakote);

  • oxcarbazepine (Trileptal);

  • phenobarbital (Solfoton);

  • primidone (Mysoline);

  • phenytoin (Dilantin);

  • rifampin (Rifadin, Rifater, Rifamate, Rimactane); or

  • valproic acid (Depakene, Stavzor).

This list is not complete and other drugs may interact with lamotrigine. Tell your doctor about all medications you use. This includes prescription, over-the-counter, vitamin, and herbal products. Do not start a new medication without telling your doctor.

Where can I get more information?

  • Your pharmacist can provide more information about lamotrigine.
  • Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use this medication only for the indication prescribed.
  • Disclaimer: Every effort has been made to ensure that the information provided by Cerner Multum, Inc. ('Multum') is accurate, up-to-date, and complete, but no guarantee is made to that effect. Drug information contained herein may be time sensitive. Multum information has been compiled for use by healthcare practitioners and consumers in the United States and therefore Multum does not warrant that uses outside of the United States are appropriate, unless specifically indicated otherwise. Multum's drug information does not endorse drugs, diagnose patients or recommend therapy. Multum's drug information is an informational resource designed to assist licensed healthcare practitioners in caring for their patients and/or to serve consumers viewing this service as a supplement to, and not a substitute for, the expertise, skill, knowledge and judgment of healthcare practitioners. The absence of a warning for a given drug or drug combination in no way should be construed to indicate that the drug or drug combination is safe, effective or appropriate for any given patient. Multum does not assume any responsibility for any aspect of healthcare administered with the aid of information Multum provides. The information contained herein is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. If you have questions about the drugs you are taking, check with your doctor, nurse or pharmacist.

Copyright 1996-2012 Cerner Multum, Inc. Version: 16.02. Revision Date: 2012-04-18, 3:09:41 PM.

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