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lamotrigine

Pronunciation

Generic Name: lamotrigine (la MOE tri jeen)
Brand Name: LaMICtal, LaMICtal ODT, LaMICtal XR, ...show all 13 brand names

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?

Lamotrigine may cause a severe or life-threatening skin rash, especially in children and in people who take too high of a starting a dose, or those who also take valproic acid (Depakene) or divalproex (Depakote).

Slideshow: Breaking Down Bipolar Disorder - 12 Things You Need To Know

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.

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

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

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

To make sure lamotrigine is safe for you, tell your doctor if you have:

  • kidney or liver disease;

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

  • if you are allergic to other seizure medications.

Some people have thoughts about suicide while taking this medicine. Your doctor will need to check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.

Do not start or stop taking seizure medication during pregnancy without your doctor's advice. Having a seizure during pregnancy could harm both mother and baby. Tell your doctor right away if you become pregnant.

If you are pregnant, your name may be listed on a pregnancy registry. This is to track the outcome of the pregnancy and to evaluate any effects of lamotrigine on the baby.

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.

Lamotrigine can pass into breast milk and may harm a nursing baby. Tell your doctor if you are breast-feeding a baby.

How should I take lamotrigine?

Follow all directions on your prescription label. Your doctor may occasionally change your dose to make sure you get the best results. Do not take this medicine 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.

You may need frequent blood tests to help your doctor make sure you are taking the right dose of lamotrigine.

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 switch to lamotrigine from another seizure medicine, carefully follow your doctor's instructions about the timing and dosage of your medications. Read all patient information, medication guides, and instruction sheets provided to you. Ask your doctor or pharmacist if you have any questions.

Do not crush, chew, or break the regular or the extended-release tablet. Swallow it whole.

Do not swallow the orally disintegrating tablet (ODT) whole. Place it on your tongue and move it around in your mouth. Allow the tablet 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 using lamotrigine suddenly, even if you feel fine. Stopping suddenly may cause increased seizures. Follow your doctor's instructions about tapering your dose.

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.

This medicine can cause you to have a false positive drug screening test. If you provide a urine sample for drug screening, tell the laboratory staff that you are taking lamotrigine.

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 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.

Seek emergency medical attention if you have signs of a life-threatening skin rash: 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.

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.

Call your doctor at once if you have:

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

  • changes in your menstrual periods;

  • low blood cell counts--flu-like symptoms, swollen gums, mouth sores, skin sores, rapid heart rate, pale skin, easy bruising, unusual bleeding, feeling light-headed;

  • possible signs of brain inflammation--fever, chills, headache, neck stiffness, increased sensitivity to light, purple spots on the skin, confusion, drowsiness; or

  • signs of inflammation in your body--swollen glands, severe tingling or numbness, muscle weakness, upper stomach pain, jaundice (yellowing of the skin or eyes), chest pain, new or worsening cough with fever, trouble breathing.

Common side effects may include:

  • headache, dizziness;

  • blurred vision, double vision;

  • tremor, loss of coordination;

  • dry mouth, nausea, vomiting, stomach pain, diarrhea;

  • fever, sore throat, runny nose;

  • drowsiness, tired feeling;

  • back pain; or

  • sleep problems (insomnia).

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 Epilepsy:

Specific dosing recommendations are provided depending upon concomitant AEDs or other concomitant medications (see manufacturer product information):

DOSAGE REGIMEN FOR ORAL TABLETS, CHEWABLE DISPERSIBLE TABLETS, AND ORALLY DISINTEGRATING TABLETS:
-IN PATIENTS TAKING VALPROATE:
Weeks 1 and 2: 25 mg orally every other day
Weeks 3 and 4: 25 mg orally per day
Week 5 to maintenance: Increase by 25 to 50 mg per day every 1 to 2 weeks
Usual maintenance dose:
1) 100 to 200 mg orally per day (1 or 2 divided doses) with valproate only
2) 100 to 400 mg orally per day (1 or 2 divided doses) with valproate and other drugs that induce glucuronidation
-IN PATIENTS NOT TAKING CARBAMAZEPINE, PHENYTOIN, PHENOBARBITAL, PRIMIDONE, OR VALPROATE:
Weeks 1 and 2: 25 mg orally per day
Weeks 3 and 4: 50 mg orally per day
Week 5 to maintenance: Increase by 50 mg per day every 1 to 2 weeks
Usual maintenance dose: 225 to 375 mg orally per day (in 2 divided doses)
-IN PATIENTS TAKING CARBAMAZEPINE, PHENYTOIN, PHENOBARBITAL, OR PRIMIDONE AND NOT TAKING VALPROATE:
Weeks 1 and 2: 50 mg orally per day
Weeks 3 and 4: 100 mg orally per day (in 2 divided doses)
Week 5 to maintenance: Increase by 100 mg orally per day every 1 to 2 weeks
Usual maintenance dose: 300 to 500 mg orally per day (in 2 divided doses)

Comments:
-As other drugs are subsequently introduced or withdrawn, the dose of lamotrigine may need to be adjusted.
-Safety and effectiveness have not been established:
1) As initial monotherapy
2) For conversion to monotherapy from AEDs other than carbamazepine, phenytoin, phenobarbital, primidone, or valproate
3) For simultaneous conversion to monotherapy from 2 or more concomitant AEDs

Uses: As adjunctive therapy for the following seizure types:
-Partial-onset seizures.
-Primary generalized tonic-clonic (PGTC) seizures.
-Generalized seizures of Lennox-Gastaut syndrome.

CONVERSION FOR ORAL TABLETS, CHEWABLE DISPERSIBLE TABLETS, AND ORALLY DISINTEGRATING TABLETS AS ADJUNCTIVE THERAPY WITH VALPROATE TO MONOTHERAPY IN PATIENTS AGED 16 YEARS AND OLDER WITH EPILEPSY:
The regimen for the withdrawal of the concomitant AED is based on experience from clinical trials:
-CONVERSION FROM ADJUNCTIVE THERAPY WITH CARBAMAZEPINE, PHENYTOIN, PHENOBARBITAL, OR PRIMIDONE TO MONOTHERAPY WITH LAMOTRIGINE: After achieving a dose of 500 mg per day according to the guidelines, the concomitant enzyme-inducing AED should be withdrawn by 20% decrements each week over a 4-week period.
-CONVERSION FROM ADJUNCTIVE THERAPY WITH VALPROATE TO MONOTHERAPY WITH LAMOTRIGINE:
1) Achieve a dose of 200 mg per day of lamotrigine; maintain stable dose of valproate.
2) Maintain lamotrigine dose at 200 mg per day; decrease valproate dose by decrements no greater than 500 mg per day and maintain for 1 week.
3) Increase lamotrigine dose to 300 mg per day and maintain for 1 week; decrease valproate dose to 250 mg per day and maintain for 1 week.
4) Increase lamotrigine dose by 100 mg per day every week to achieve a maintenance dose of 500 mg per day; discontinue valproate.
-CONVERSION FROM ADJUNCTIVE THERAPY WITH ANTIEPILEPTIC DRUGS (OTHER THAN CARBAMAZEPINE, PHENYTOIN, PHENOBARBITAL, PRIMIDONE, OR VALPROATE) TO MONOTHERAPY WITH LAMOTRIGINE:
-No specific dosing guidelines can be provided for conversion to monotherapy with lamotrigine with AEDs other than carbamazepine, phenytoin, phenobarbital, primidone, or valproate.

Comments:
-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.
-The recommended maintenance dose as monotherapy is 500 mg per day given in 2 divided doses.
-To avoid an increased risk of rash, the recommended initial dose and subsequent dose escalations should not be exceeded.
-The regimen for the withdrawal of the concomitant AED is based on experience from clinical trials.
-Safety and effectiveness have not been established:
1) As initial monotherapy
2) For conversion to monotherapy from AEDs other than carbamazepine, phenytoin, phenobarbital, primidone, or valproate
3) For simultaneous conversion to monotherapy from 2 or more concomitant AEDs

USES: For conversion to monotherapy in adults (aged 16 years and older) with partial-onset seizures who are receiving treatment with carbamazepine, phenytoin, phenobarbital, primidone, or valproate as the single antiepileptic drug (AED)


DOSAGE REGIMEN FOR ORAL EXTENDED RELEASE CAPSULES:
Initial: 200 mg orally 2 times a day
Increase at weekly intervals by adding up to 200 mg per day until the optimal response is obtained.
Maintenance dose: Adjust dosage to the minimum effective level, usually 800 to 1200 mg per day
Maximum dose: 1600 mg per day

Comments:
-The extended-release formulation is for twice a day administration. When converting patients from immediate release to extended-release capsules, the same total daily mg dose of carbamazepine should be administered.
-The extended-release formulation may be used alone or with other anticonvulsants. When added to existing anticonvulsant therapy, the drug should be added gradually while the other anticonvulsants are maintained or gradually decreased, except phenytoin, which may have to be increased.
-Safety and effectiveness of have not been established:
1) As initial monotherapy
2) For conversion to monotherapy from AEDs other than carbamazepine, phenytoin, phenobarbital, primidone, or valproate
3) For simultaneous conversion to monotherapy from 2 or more concomitant AEDs.

Uses:
-Partial seizures with complex symptomatology (psychomotor, temporal lobe). Patients with these seizures appear to show greater improvements than those with other types
-Generalized tonic-clonic seizures (grand mal)
-Mixed seizure patterns which include the above, or other partial or generalized seizures (absence seizures [petit mal] do not appear to be controlled by carbamazepine)

Usual Adult Dose for Bipolar Disorder:

ESCALATION REGIMEN FOR LAMOTRIGINE IN PATIENTS WITH BIPOLAR DISORDER:
-WEEKS 1 AND 2:
For patients taking valproate: 25 mg every other day
For patients not taking carbamazepine (or other enzyme-inducing drugs) or valproate: 25 mg daily
For patients taking carbamazepine (or other enzyme-inducing drugs) and not taking valproate: 50 mg daily
-WEEKS 3 AND 4:
For patients taking valproate: 25 mg daily
For patients not taking carbamazepine (or other enzyme-inducing drugs) or valproate: 50 mg daily
For patients taking carbamazepine (or other enzyme-inducing drugs) and not taking valproate: 100 mg daily in divided doses
-WEEK 5:
For patients taking valproate: 50 mg daily
For patients not taking carbamazepine (or other enzyme-inducing drugs) or valproate: 100 mg daily
For patients taking carbamazepine (or other enzyme-inducing drugs) and not taking valproate: 200 mg daily in divided doses
-WEEK 6:
For patients taking valproate: 100 mg daily
For patients not taking carbamazepine (or other enzyme-inducing drugs) or valproate: 200 mg daily
For patients taking carbamazepine (or other enzyme-inducing drugs) and not taking valproate: 300 mg daily in divided doses
-WEEK 7:
For patients taking valproate: 100 mg daily
For patients not taking carbamazepine (or other enzyme-inducing drugs) or valproate: 200 mg daily
For patients taking carbamazepine (or other enzyme-inducing drugs) and not taking valproate: up to 400 mg daily in divided doses

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

Use: For the maintenance treatment of bipolar I disorder to delay the time to occurrence of mood episodes (depression, mania, hypomania, mixed episodes) in adults treated for acute mood episodes with standard therapy. (The effectiveness in the acute treatment of mood episodes has not been established.)

DOSAGE ADJUSTMENTS TO LAMOTRIGINE IN PATIENTS WITH BIPOLAR DISORDER FOLLOWING DISCONTINUATION OF PSYCHOTROPIC MEDICATIONS:
-DISCONTINUATION OF PSYCHOTROPIC DRUGS (EXCLUDING VALPROATE, CARBAMAZEPINE, PHENYTOIN, PHENOBARBITAL, OR PRIMIDONE:
WEEK 1:
Maintain current dose of lamotrigine
WEEK 2:
Maintain current dose of lamotrigine
WEEK 3 ONWARD:
Maintain current dose of lamotrigine
-AFTER DISCONTINUATION OF VALPROATE AND CURRENT DOSE OF LAMOTRIGINE IS 100 MG PER DAY:
WEEK 1:
150 mg per day
WEEK 2:
200 mg per day
WEEK 3 ONWARD:
200 mg per day
-AFTER DISCONTINUATION OF CARBAMAZEPINE, PHENYTOIN, PHENOBARBITAL, OR PRIMIDONE AND CURRENT DOSE OF LAMOTRIGINE DOSE IS 400 MG PER DAY:
WEEK 1:
400 mg per day
WEEK 2:
300 mg per day
WEEK 3:
200 mg per day

Usual Pediatric Dose for Epilepsy:

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).

ESCALATION REGIMEN FOR LAMOTRIGINE IN PATIENTS AGED 2 TO 12 YEARS WITH EPILEPSY:

-IN PATIENTS TAKING VALPROATE:
WEEKS 1 and 2:
0.15 mg/kg/day in 1 or 2 divided doses, rounded down to the nearest whole tablet
WEEKS 3 and 4:
0.3 mg/kg/day, in 1 or 2 divided doses, rounded down to the nearest whole tablet
WEEK 5 ONWARD TO MAINTENANCE:
The dose should be increased every 1 to 2 weeks as follows: calculate 0.3 mg/kg/day, round this amount down to the nearest whole tablet, and add this amount to the previously administered daily dose
USUAL MAINTENANCE DOSE:
1 to 5 mg/kg/day (maximum 200 mg per day in 1 or 2 divided doses)
1 to 3 mg/kg/day with valproate alone
MAINTENANCE DOSE IN PATIENTS LESS THAN 30 KG:
May need to be increased by as much as 50%, based on clinical response

IN PATIENTS NOT TAKING CARBAMAZEPINE, PHENYTOIN, PHENOBARBITAL, PRIMIDONE, OR VALPROATE:
WEEKS 1 and 2:
0.3 mg/kg/day in 1 to 2 divided doses, rounded down to nearest whole tablet
WEEKS 3 and 4:
0.6 mg/kg/day in 2 divided doses, rounded down to nearest whole tablet
WEEK 5 ONWARD TO MAINTENANCE:
The dose should be increased every 1 to 2 weeks as follows: calculate 0.6 mg/kg/day, round this amount down to the nearest whole tablet, and add this amount to the previously administered daily dose
USUAL MAINTENANCE DOSE:
4.5 to 7.5 mg/kg/day (maximum 300 mg per day in 2 divided doses)
MAINTENANCE DOSE IN PATIENTS LESS THAN 30 KG:
May need to be increased by as much as 50%, based on clinical response

IN PATIENTS TAKING CARBAMAZEPINE, PHENYTOIN, PHENOBARBITAL, OR PRIMIDONE AND NOT TAKING VALPROATE:
WEEKS 1 and 2:
0.6 mg/kg/day in 1 to 2 divided doses, rounded down to nearest whole tablet
WEEKS 3 and 4:
1.2 mg/kg/day in 2 divided doses, rounded down to nearest whole tablet
WEEK 5 ONWARD TO MAINTENANCE:
The dose should be increased every 1 to 2 weeks as follows: calculate 1.2 mg/kg/day, round this amount down to the nearest whole tablet, and add this amount to the previously administered daily dose
USUAL MAINTENANCE DOSE:
5 to 15 mg/kg/day (maximum 400 mg per day in 2 divided doses)
MAINTENANCE DOSE IN PATIENTS LESS THAN 30 KG:
May need to be increased by as much as 50%, based on clinical response

WEIGHT BASED DOSING FOR PATIENTS 2 TO 12 YEARS TAKING VALPROATE:
PATIENT WEIGHT: GREATER THAN 6.7 KG AND LESS THAN 14 KG:
WEEKS 1 and 2: 2 mg every other day
WEEKS 3 and 4: 2 mg every day
PATIENT WEIGHT: GREATER THAN 14.1 KG AND LESS THAN 27 KG:
WEEKS 1 and 2: 2 mg every day
WEEKS 3 and 4: 4 mg every day
PATIENT WEIGHT: GREATER THAN 27.1 KG AND LESS THAN 34 KG:
WEEKS 1 and 2: 4 mg every other day
WEEKS 3 and 4: 8 mg every day
PATIENT WEIGHT: GREATER THAN 34.1 KG AND LESS THAN 40 KG:
WEEKS 1 and 2: 5 mg every day
WEEKS 3 and 4: 10 mg every day

CONVERSION FROM ADJUNCTIVE THERAPY WITH VALPROATE TO MONOTHERAPY WITH LAMOTRIGINE IN PATIENTS AGED 16 YEARS AND OLDER WITH EPILEPSY:
STEP 1:
Lamotrigine: Achieve a dose of 200 mg/day according to guidelines
Valproate: Maintain established stable dose
STEP 2:
Lamotrigine: Maintain dose at 200 mg per day
Valproate: Decrease dose by decrements no greater than 500 mg/day/week to 500 mg per day and then maintain for 1 week
STEP 3:
Lamotrigine: Increase dose to 300 mg per day and maintain for 1 week
Valproate: Decrease dose to 250 mg per day and maintain for 1 week
STEP 4:
Lamotrigine: Increase dose by 100 mg per day every week to achieve maintenance dose of 500 mg per day
Valproate: Discontinue

CONVERSION FROM ADJUNCTIVE THERAPY WITH ANTIEPILEPTIC DRUGS OTHER THAN CARBAMAZEPINE, PHENYTOIN, PHENOBARBITAL, PRIMIDONE, OR VALPROATE TO MONOTHERAPY WITH LAMOTRIGINE:
No specific dosing guidelines can be provided for conversion to monotherapy with lamotrigine other than carbamazepine, phenytoin, phenobarbital, primidone, or valproate.


Use: As adjunctive therapy for the following seizure types in patients aged 2 years and older:
-Partial-onset seizures
-Primary generalized tonic-clonic (PGTC) seizures
-Generalized seizures of Lennox-Gastaut syndrome

What other drugs will affect lamotrigine?

Other drugs may interact with lamotrigine, including prescription and over-the-counter medicines, vitamins, and herbal products. Tell each of your health care providers about all medicines you use now and any medicine you start or stop using.

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: 17.03. Revision Date: 2015-04-30, 12:06:50 PM.

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