Jeffrey Panko NP Psychiatry · Patient education
Lamotrigine
Lamictal / Lamictal XR / Generic oral formulations
A guide for adults taking lamotrigine.
Follow the directions on your prescription and your provider's recommendations.
Formulations: Standard, chewable/dispersible, orally disintegrating, and extended-release tablets have different handling instructions. Extended-release indications differ from standard lamotrigine.
What it is used for
Lamotrigine is used for bipolar I maintenance treatment to delay future mood episodes and for certain seizures. It is often used in bipolar depression care, but is not an acute antimanic medicine.
How it works
It affects sodium channels and reduces release of excitatory messengers such as glutamate. Its mood and seizure uses have different dosing considerations.
What to expect over time
The dose is often increased gradually to balance benefit and side effects. Track the condition being treated and report changes after each adjustment.
Taking your medication
- Follow the slow titration schedule exactly. Do not increase faster even if you feel well.
- Use your formulation’s swallowing or dispersing instructions; swallow XR tablets whole.
- If you miss a dose, take it when you remember unless it is almost time for the next dose. Then skip it. Do not double a dose.
- After several missed days, contact your provider before restarting. Retitration may be required, and the gap that matters depends on other medicines.
When to get help
Emergency symptoms. Stop lamotrigine and seek prompt medical assessment for a new rash unless a clinician has clearly determined it is unrelated. Blistering, peeling, mouth or eye sores, fever, or swelling need urgent care. Call 911 for breathing difficulty or collapse.
Prompt medical advice. Seek prompt advice for fever, swollen glands, or a flu-like illness even without rash, or for severe dizziness, double vision, or unsteady walking. Do not restart after a suspected drug rash on your own.
If you feel unsafe or have thoughts of self-harm, call 911 or go to an emergency department.
Possible side effects
- Dizziness, sleepiness, or fatigue
- Nausea or stomach discomfort
- Problems with balance or coordination
Keeping track of treatment
Some side effects resolve with time; others may require a change of medication. Discuss persistent or bothersome side effects with your provider.
Report changes in mood, behavior, concentration, or suicidal thoughts. Antiseizure medicines carry a warning about suicidal thoughts and behavior.
Keep follow-up appointments. Your provider may adjust treatment based on symptoms, kidney or liver function, other medicines, and any recommended laboratory tests.
If you take too much
For a suspected overdose, call Poison Control at 1-800-222-1222 immediately, even if you feel well. Call 911 for a seizure, collapse, trouble breathing, or inability to wake.
Before you start
Discuss kidney or liver disease, previous medication rashes, depression, and the reason for treatment.
Discuss pregnancy, pregnancy plans, and breastfeeding with your provider. Treatment decisions should consider both the medication and the condition being treated.
Discuss prior antiseizure-drug rashes and significant heart disease or rhythm disorders. Some genetic factors may also affect rash risk.
Medicines and interactions
Review all your medications with your provider, including over-the-counter medicines and supplements. Have new medications checked before taking them.
Valproate raises lamotrigine exposure and requires a slower, lower-dose titration. Carbamazepine and some other seizure medicines lower exposure.
Estrogen-containing contraception can lower levels, and stopping estrogen can raise them. Pregnancy and the postpartum period can also change levels; coordinate dose review.
Everyday tips
Use reminders and arrange refills before you run out.
Avoid driving until you know how treatment affects you; seizure-related driving restrictions may also apply.
Your questions answered
Why does the dose increase so slowly?
A high starting dose or rapid increase raises the risk of serious rash. Valproate changes the schedule further.
Can I restart after missing a week?
Call first. Returning directly to the old dose may increase rash risk. Your provider decides how far back to restart.
Storage and safety
Keep medication in its labeled container, away from excess heat and moisture and out of reach of children and pets. Do not share it. Ask a pharmacy about disposal of unused medication.
Sources
About this information
Educational handout; does not replace your prescription or provider's recommendations.
Educational inclusion does not mean this medication or its indications are treated at this practice. Review the guide for your exact product with your prescriber or pharmacist.