Lamictal: 7 things you should know
Medically reviewed by Carmen Fookes, BPharm. Last updated on Nov 20, 2019.
1. How it works
- Lamictal is a brand (trade) name for lamotrigine which may be used either alone or in combination with other anticonvulsants to treat epilepsy. It may also be used to stabilize mood in people with bipolar disorder.
- Experts are not sure exactly how lamotrigine works but some have suggested that it inhibits voltage-sensitive sodium channels, stabilizing nerve membranes and moderating the release of excitatory amino acids such as glutamate and aspartate.
- Lamictal belongs to the class of medicines known as triazine anticonvulsants.
- May be used in combination with other anticonvulsants for the treatment of partial-onset seizures, primary generalized tonic-clonic seizures, and generalized seizures associated with Lennox-Gastaut syndrome. May be used as the sole therapy for treatment of partial onset seizures.
- May be used as maintenance treatment and to stabilize mood and delay the occurrence of depression, mania, hypomania, or mixed episodes of bipolar I disorder.
- Blood levels of Lamictal do not require monitoring.
- Lamictal is available as a generic under the name lamotrigine.
If you are between the ages of 18 and 60, take no other medication or have no other medical conditions, side effects you are more likely to experience include:
- Dizziness, coordination problems, sleepiness, headache, double or blurred vision, nausea, vomiting, and rash. Risk of side effects increases at higher dosages and with concomitant carbamazepine.
- Rarely, life-threatening skin rashes that require hospitalization and discontinuation of Lamictal treatment. The risk is higher in younger children and possibly with higher Lamictal dosages or co-administration with valproate. Most, but not all, cases occur within two to eight weeks of treatment initiation. Lamictal may also cause a benign, non-problematic rash and distinguishing between different rashes caused by Lamictal may be difficult. Seek urgent medical advice at first sign of a rash with Lamictal, unless the rash is clearly not drug-related. Discontinuation of Lamictal may be needed.
- Rarely, potentially fatal hypersensitivity reactions, hemophagocytic lymphohistiocytosis (a life-threatening syndrome of immune activation characterized by extreme inflammation), and blood disorders may also occur. Seek medical advice with any sign of fever or swollen lymph nodes.
- As with other anti-epileptics, Lamictal may increase the risk of suicidal thoughts or behavior; monitor for worsening depression or mood changes.
- May interact with several drugs including other anticonvulsants (such as carbamazepine and phenytoin), estrogen-containing oral contraceptives, and some HIV antivirals.
- Rarely, has been associated with sudden unexplained death.
- Caution may be needed when using in people with renal or hepatic impairment and some other medical conditions.
Notes: In general, seniors or children, people with certain medical conditions (such as liver or kidney problems, heart disease, diabetes, seizures) or people who take other medications are more at risk of developing a wider range of side effects. For a complete list of all side effects, click here.
- May be taken with or without food. If you develop a stomach upset after taking Lamictal, taking it with food may help.
- Lamictal chewable dispersible tablets may be swallowed whole, chewed or dispersed in water or dilute fruit juice. Lamictal orally disintegrating tablets should be placed on the tongue and moved around the mouth. Do not attempt to administer partial quantities of the dispersed tablets.
- Take exactly as directed by your doctor. Do not stop taking Lamictal suddenly without your doctor's advice. The dosage will need tapering off on discontinuation as directed by your doctor.
- May cause drowsiness and affect your ability to drive or operate machinery. Avoid alcohol.
- Risk of rash may be decreased by lower starting dosages and a slower upward titration of dose as prescribed by your doctor. If possible (unless safety concerns dictate otherwise), Lamictal should be discontinued in a step-wise fashion (suggested decrease 50% per week) over at least two weeks.
- Seek urgent medical advice if you develop a severe rash or reaction after taking Lamictal. Symptoms may include red, swollen, blistered, or peeling skin (with or without fever); red or irritated eyes; or sores in your mouth, throat, nose, or eyes. The risk of a severe skin reaction is greater in children aged 2 to 17 years; when taken in conjunction with valproate, with higher dosages of Lamictal, or if the dosage of Lamictal is increased too fast.
- The extended-release form, Lamictal XR, should only be used in adults and children aged 13 years or older. The immediate release form (Lamictal, Lamictal ODT) can be used in children aged 2 years or older as long as it is used in combination with other seizure medications. When used alone, this form can only be used in adults and teenagers over the age of 16.
- May interfere with some hormonal contraceptives. Let your doctor know if you are taking birth control.
- May cause a false-positive result on a drug test for phencyclidine (PCP). More specific analytical testing should be undertaken if this occurs.
- Always check that your Lamictal looks the same as it always does. Medication errors have been reported with Lamictal and lamotrigine and with their different formulations. Talk to your pharmacist if you are unsure.
6. Response and Effectiveness
- Lamictal is rapidly absorbed and peak levels are reached within 1.7 to 4.8 hours of administration. The effects of Lamictal last for over 24 hours and once-daily dosing is often prescribed. However, some doctors prefer to split the dose to decrease the risk of side effects such as drowsiness.
Medicines that interact with Lamictal may either decrease its effect, affect how long it works for, increase side effects, or have less of an effect when taken with Lamictal. An interaction between two medications does not always mean that you must stop taking one of the medications; however, sometimes it does. Speak to your doctor about how drug interactions should be managed.
Common medications that may interact with Lamictal include:
- estrogen-containing oral contraceptives
- anticonvulsants such as carbamazepine, phenytoin, and phenobarbitone
- HIV medications such as indinavir and ritonavir
- medications that cause drowsiness, such as benzodiazepines, sedating antihistamines, and sleeping pills
- opioid analgesics such as fentanyl, oxycodone, and morphine
Alcohol may worsen the side effects of Lamictal such as drowsiness, dizziness, and liver toxicity.
Note that this list is not all-inclusive and includes only common medications that may interact with Lamictal. You should refer to the prescribing information for Lamictal for a complete list of interactions.
Lamictal (lamotrigine) [Package Insert]. Revised 09/2019. GlaxoSmithKline LLC https://www.drugs.com/pro/lamictal.html
Remember, keep this and all other medicines out of the reach of children, never share your medicines with others, and use Lamictal only for the indication prescribed.
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- Drug class: triazine anticonvulsants
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Other brands: Subvenite