Lamotrigine

Lamotrigine is an anticonvulsant medication used to treat epilepsy and bipolar disorder. Common side effects include minor skin rashes, headaches, and nausea, and more serious side effects can include skin conditions and allergic reactions.

Lamotrigine brand names

Lamotrigine is sold under the brand name Lamictal in many countries worldwide.

What is lamotrigine prescribed for?

Lamotrigine is prescribed to treat epilepsy ^[1], however it is commonly used as an off-label medication to treat symptoms of depression within bipolar disorder ^[2]. You should only use lamotrigine as prescribed and with proper medical advice.

Epilepsy:

• Tonic-Clonic seizures
• Absence seizures
• Myoclonic seizures
• Atonic seizures
• Lennox-Gestaut syndrome, a very rare childhood form of epilepsy

Bipolar Disorder:

• Bipolar I disorder
• Bipolar II disorder

How does lamotrigine work?

Lamotrigine was originally prescribed as an anticonvulsant or antiepileptic drug. It works by reducing the amount of glutamate and aspartate, two neurotransmitters that are associated with seizures. It also increases the effects of a neurotransmitter called GABA, which is a calming neurotransmitter. When combined, these effects can help reduce the frequency and severity of seizures ^[3]. It works in a similar way to help to regulate mood and reduce depressive symptoms in people with bipolar disorder.

How is Lamotrigine usually taken?

Lamotrigine comes in different tablet forms. These include extended-release tablets, dissolving tablets, and chewable tablets. Lamotrigine usually comes in strengths of 25mg, 50mg, 100mg and 200mg, whereas chewable and dissolvable tablets usually come in 2mg, 5mg, 25mg and 100mg strengths. Make sure you check with your pharmacist or doctor which type you have been prescribed and the directions on how to take it. ^[2]

Your dosage will depend on how severe your condition is and if you are currently taking any other medications to treat epilepsy, bipolar disorder or depression. If you miss a lamotrigine dose then take it as soon as you realise, however if it is within a few hours of your next dose then it is okay to miss it. Never take multiple doses to catch up with forgotten doses. If you have not taken lamotrigine for a few days, you should contact your doctor or healthcare provider before resuming the medication. This is because stopping lamotrigine and then restarting your normal dose can increase the potential risk of a seizure, even if you do not have epilepsy.

Follow your doctor’s prescription exactly and don’t stop taking Lamotrigine even if your symptoms have completely stopped. Your doctor will likely want to gradually decrease your dosage over time. Suddenly stopping your prescription may cause seizures ^[2].

How long does Lamotrigine stay in your system?

How long lamotrigine stays in your system for can depend on your dosage, other medications you are currently taking and if you have any kidney issues. Speak to your doctor or pharmacist if you are concerned about how long it will stay in your system for or how long they will take to work.

Lamotrigine side-effects

Using lamotrigine can cause some side effects ^[2]. It is important that you speak to your doctor if any of them become severe or will not go away, as they may want to decrease your daily dose or take you off lamotrigine completely.

Psychological:

• Loss of coordination/balance
• Having difficulties concentrating or thinking
• Loss of appetite that can potentially lead to weight loss
• Difficulty speaking
• Insomnia
• Fatigue

Physical:

• Double or blurred vision
• Dry mouth
• Headaches and dizziness
• Diarrhoea or constipation
• Abdominal pain
• Heartburn or chest pain
• Nausea and vomiting
• Joint pains
• Stiff neck
• Missed or painful menstrual cycle
• Uncontrollable shaking (tremor)

During the first 2-8 weeks of taking lamotrigine, your physician might start you on a lower dose so that they can ensure you do not experience a rare allergic reaction called Stevens-Johnson Syndrome, commonly referred to as ‘lamotrigine rash’. If you are not experiencing any symptoms, they will increase your dose, however if you do experience symptoms, they will stop the medication immediately.

Early warning signs of Stevens-Johnson Syndrome include flu-like symptoms of fever, cough, or sore throat, followed by a rash or skin blistering. If left untreated, this adverse reaction can be fatal and so you must inform your physician immediately.

Rarely, other serious side effects can happen, including:

• Swelling and difficulty breathing
• Seizures more often than you experienced before
• Painful or bloody urination
• Unusual bleeding or bruising
• Changes in normal heart beat or blood pressure

If you experience any serious adverse effects then speak to your doctor urgently. If it is an emergency, such as a suspected allergic reaction or difficulty breathing then go to the hospital immediately.

Lamotrigine precautions

Your doctor will ask you some questions before prescribing lamotrigine. This is to make sure that this is the right drug for you and to see what dosage you should be taking. It is important to be thorough and find out any of the following information beforehand.

• Check if you are allergic to lamotrigine or any of the ingredients in it. Speak to your doctor or pharmacist for a full list of ingredients.
• Tell your doctor if you are currently taking any medication, specifically antibiotics or other medications for seizures. You should also inform them of any non-prescription drugs, vitamins, and supplements that you are taking.
• Tell your doctor if you are taking any hormonal medications such as birth control pills, implants, injections, and any hormone replacement therapies.
• Disclose any prior or current medical conditions including autoimmune diseases, depression, anxiety, heart-related issues, and kidney and liver diseases.
• Mention if you are currently pregnant, plan to become pregnant whilst taking it, or are breastfeeding. Research suggests that lamotrigine can be found in the breast milk of breastfeeding mothers. ^[4]
• Do not operate heavy machinery until you have been taking the drug consistently and are comfortable with any side-effects of lamotrigine you are experiencing.

Lamotrigine interactions

As certain drugs can decrease the effectiveness of lamotrigine, it is important you tell your doctor everything that you are currently taking.

Medication that is more likely to decrease the effectiveness of lamotrigine includes:

• Hormonal birth control methods and estrogen-containing contraceptives
• Hormone treatments
• Rifampin
• Phenobarbital
• Valproic acid
• Carbamazepine

Unless told otherwise by your doctor you do not need to change your diet whilst taking lamotrigine.

Lamotrigine storage

Lamotrigine should be stored in a dry environment at room temperature. Do not store it anywhere where there may be moisture or condensation like the bathroom.

Keep it in a secure box, preferably in a locked cupboard. It should be stored out of reach and sight of children and pets.

Your doctor should prescribe your exact dosage, however if you do have extra medication left over then do not dispose of it where children and pets may have access. Speak to your pharmacist about the best way to dispose of them, or they may be able to dispose of them for you.

What to do if you overdose on lamotrigine

Taking lamotrigine in high quantities can cause overdoses with severe consequences. The amount it takes to overdose on lamotrigine will depend on multiple risk factors including body weight, age, and how long you have been taking it for. Never take more than you have been told to by your doctor.

Lamotrigine overdose symptoms include: ^[5]

• Seizures
• Going in and out of consciousness
• Comas
• Loss of voluntary muscle movements
• Uncontrollable eye movements
• Death

If you suspect that you or a loved one is experiencing any of the above symptoms or have taken more than the prescribed dose of lamotrigine then seek urgent medical attention.

Can I drink alcohol when taking lamotrigine?

Yes, drinking alcohol whilst taking lamotrigine has not been shown to be dangerous or cause any more severe side-effects. However, it is important to note that lamotrigine may make your tolerance to alcohol weaker and make you more drowsy than normal. It is advised that you stop drinking until you are sure of any side-effects. ^[6]