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Lamictal

GENERIC NAME(S): Lamotrigine

Rarely, serious (sometimes fatal) skin rashes have occurred while taking this medication. These rashes are more common in children than in adults. Rashes may be more likely if you start at too high a dose, if you increase your dose too quickly, or if you take this medication with certain other anti-seizure medications (valproic acid, divalproex). These rashes may occur anytime during use, but most serious rashes have occurred within 2 to 8 weeks of starting lamotrigine.

Get medical help right away if you develop any type of skin rash, or if you have other signs of a serious allergic reaction such as hives, fever, swollen lymph nodes, painful sores in the mouth or around the eyes, swelling of the face/tongue/throat, trouble breathing, or liver problems (symptoms include stomach/abdominal pain, nausea/vomiting that continues, dark urine, yellowing eyes/skin). Your doctor will tell you if you should stop taking lamotrigine. Even after you stop taking this, it is still possible for a rash to become life-threatening or cause permanent scars or other problems.

  • Uses
  • Side Effects
  • Precautions
  • Interactions
  • Overdose
  • Images
  • Uses
  • Side Effects
  • Precautions
  • Interactions
  • Overdose
  • Images

Lamotrigine is used alone or with other medications to prevent and control seizures. It may also be used to help prevent the extreme mood swings of bipolar disorder in adults.

Lamotrigine is known as an anticonvulsant or antiepileptic drug. It is thought to work by restoring the balance of certain natural substances in the brain.

This drug is not approved for use in children younger than 2 years due to an increased risk of side effects (such as infections).

How to use Lamictal

Read the Medication Guide and, if available, the Patient Information Leaflet provided by your pharmacist before you start taking lamotrigine and each time you get a refill. If you have any questions, ask your doctor or pharmacist.

Take this medication by mouth with or without food as directed by your doctor. The chewable/dispersible tablets may be swallowed whole, chewed, or mixed in water or fruit juice. If the tablets are chewed, drink a small amount of water or juice to help you swallow all of the medication. To disperse the tablets, add your dose to a small amount of liquid (enough to cover the medication) in a glass or spoon. Wait 1 minute until the tablets are completely dissolved, stir, then drink the entire mixture right away. Use only whole tablets. Do not use partial tablets.

Dosage is based on your medical condition, response to treatment, and use of certain interacting drugs. (See also Drug Interactions section.) For children, the dosage is also based on weight.

It is very important to follow your doctor’s dosing instructions exactly. The dose must be increased slowly. It may take several weeks or months to reach the best dose for you and to get the full benefit from this medication. Take this medication regularly in order to get the most benefit from it. To help you remember, take it at the same time(s) each day.

Do not stop taking this medication without consulting your doctor. Some conditions may become worse when the drug is suddenly stopped. Your dose may need to be gradually decreased. Also, if you have stopped taking this medication, do not restart lamotrigine without consulting your doctor.

Tell your doctor if your condition does not improve or if it worsens.

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Side Effects

See also Warning section.

Dizziness, drowsiness, headache, vomiting, or upset stomach may occur. If any of these effects persist or worsen, tell your doctor or pharmacist promptly.

Remember that your doctor has prescribed this medication because he or she has judged that the benefit to you is greater than the risk of side effects. Many people using this medication do not have serious side effects.

A small number of people who take anticonvulsants for any condition (such as seizures, bipolar disorder, pain) may experience depression, suicidal thoughts/attempts, or other mental/mood problems. Tell your doctor right away if you or your family/caregiver notice any unusual/sudden changes in your mood, thoughts, or behavior including signs of depression, suicidal thoughts/attempts, thoughts about harming yourself.

Get medical help right away if any of these rare but serious side effects occur: fainting, fast/irregular/pounding heartbeat, easy or unusual bruising/bleeding, stiff neck, vision problems, loss of coordination, muscle pain/tenderness/weakness, signs of kidney problems (such as change in the amount of urine).

This is not a complete list of possible side effects. If you notice other effects not listed above, contact your doctor or pharmacist.

Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088 or at www.fda.gov/medwatch.

In Canada – Call your doctor for medical advice about side effects. You may report side effects to Health Canada at 1-866-234-2345.

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Precautions

Before taking lamotrigine, tell your doctor or pharmacist if you are allergic to it; or if you have any other allergies. This product may contain inactive ingredients, which can cause allergic reactions or other problems. Talk to your pharmacist for more details.

Before using this medication, tell your doctor or pharmacist your medical history, especially of: kidney disease, liver disease, a certain heart rhythm disorder (Brugada syndrome).

This drug may make you dizzy or drowsy or blur your vision. Alcohol or marijuana (cannabis) can make you more dizzy or drowsy. Do not drive, use machinery, or do anything that needs alertness or clear vision until you can do it safely. Limit alcoholic beverages. Talk to your doctor if you are using marijuana (cannabis).

Children may be at greater risk for skin rashes while taking this drug. See also Warning section.

Before having surgery, tell your doctor or dentist about all the products you use (including prescription drugs, nonprescription drugs, and herbal products).

Older adults may be more sensitive to the side effects of this drug, especially dizziness, loss of coordination, or fainting. These side effects can increase the risk of falling.

During pregnancy, this medication should be used only when clearly needed. It may harm an unborn baby. However, since untreated seizures or mental/mood problems (such as bipolar disorder) are serious conditions that can harm both a pregnant woman and her unborn baby, do not stop taking this medication unless directed by your doctor. If you are planning pregnancy, become pregnant, or think you may be pregnant, immediately talk to your doctor about the benefits and risks of using this medication during pregnancy. Since birth control pills, patches, implants, and injections may not work if taken with this medication (see also Drug Interactions section), discuss reliable forms of birth control with your doctor.

This drug passes into breast milk and may have undesirable effects on a nursing infant. Consult your doctor before breast-feeding.

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Interactions

Drug interactions may change how your medications work or increase your risk for serious side effects. This document does not contain all possible drug interactions. Keep a list of all the products you use (including prescription/nonprescription drugs and herbal products) and share it with your doctor and pharmacist. Do not start, stop, or change the dosage of any medicines without your doctor’s approval.

Some products that may interact with this drug include: dofetilide, orlistat.

Other medications can affect the removal of lamotrigine from your body, which may affect how lamotrigine works. Examples include hormonal birth control (such as pills, patches), estrogens, other medications to treat seizures (such as phenobarbital, phenytoin, primidone, valproic acid), certain HIV protease inhibitors (such as lopinavir/ritonavir, atazanavir/ritonavir), and rifampin, among others. Your doctor may need to adjust your dose of lamotrigine if you are on these medications.

This medication may decrease the effectiveness of hormonal birth control products (such as pills, patch, ring). This effect can result in pregnancy. Ask your doctor or pharmacist for details. Discuss whether you should use additional reliable birth control methods while using this medication. Also tell your doctor if you have any new spotting or breakthrough bleeding, because these may be signs that your birth control is not working well.

Tell your doctor or pharmacist if you are taking other products that cause drowsiness including alcohol, marijuana (cannabis), antihistamines (such as cetirizine, diphenhydramine), drugs for sleep or anxiety (such as alprazolam, diazepam, zolpidem), muscle relaxants, and opioid pain relievers (such as codeine).

Check the labels on all your medicines (such as allergy or cough-and-cold products) because they may contain ingredients that cause drowsiness. Ask your pharmacist about using those products safely.

This medication may interfere with certain laboratory tests (including urine drug screening tests), possibly causing false test results. Make sure laboratory personnel and all your doctors know you use this drug.

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Overdose

If someone has overdosed and has serious symptoms such as passing out or trouble breathing, call 911. Otherwise, call a poison control center right away. US residents can call their local poison control center at 1-800-222-1222. Canada residents can call a provincial poison control center. Symptoms of overdose may include: severe drowsiness, unusual eye movements, loss of consciousness.

Notes

Do not share this medication with others.

Laboratory and/or medical tests (such as liver and kidney function tests, complete blood count) may be performed periodically to monitor your progress or check for side effects. Consult your doctor for more details.

There are different types of this medication available. Some do not have the same effects. There are also some medications that sound the same as this product. Make sure you have the right product before taking it.

Missed Dose

It is important to take each dose at the scheduled time. If you miss a dose, take it as soon as you remember. If it is near the time of the next dose, skip the missed dose. Take your next dose at the regular time. Do not double the dose to catch up.

Storage

Store at room temperature away from light and moisture. Do not store in the bathroom. Keep all medications away from children and pets.

Find patient medical information for Lamictal Oral on WebMD including its uses, side effects and safety, interactions, pictures, warnings and user ratings.

Effective Medication to Treat Bipolar Disorder

Q1. My 22-year-old son has been diagnosed with a mild case of bipolar disorder. A psychiatrist prescribed Lamictal (lamotrigine; 300 mg daily). After one year, my son felt it was not helping him and caused his hands to shake. He slowly discontinued the medication and is now self-medicating by smoking marijuana a couple of nights a week. He tells me that it has a calming effect and that he sleeps better. What do you know about pot and bipolar disorder?

There is a very high rate of substance abuse among people with bipolar disorder. Probably this is no accident, because drugs like marijuana can be a means of self-medication, of escaping unpleasant bipolar symptoms, including anxiety and depression.

Unfortunately, marijuana is not an effective solution. While it doesn’t typically become physiologically addictive, as do cocaine and heroin — that is, marijuana doesn’t cause physical symptoms of withdrawal when you stop using it — it is highly psychologically addictive. Long-term complications of chronic marijuana use include problems with memory and concentration, apathy (a lack of motivation and emotion), reduced libido, and loss of interest in other activities. Because of this, using marijuana frequently is probably sapping your son’s motivation to get effective treatment for his bipolar disorder and lead a productive life. Over time, he’ll need to use more to achieve the same effect.

I highly recommend that your son get back into active treatment for bipolar disorder with a psychiatrist or psychologist — the doctor can also help him determine whether specialized treatment for marijuana addiction is indicated.

Q2. I’m on various meds for bipolar I. I was recently told by my doctor that my triglycerides are very high because of the medications I’m taking (she put me on Tricor/fenofibrate). She suggested I come off some of them but could not tell me which ones. As of right now, I am pretty stable with what I’m taking, but I fear a relapse should they take me off meds. What do you suggest I do? She suggested I have a consultation with an endocrinologist and/or a psychiatrist, so they could tell me which ones to come off. I have to schedule an appointment. In the meanwhile, these are my meds: Seroquel, Abilify, Lamictal, Lexapro, Wellbutrin, Lunesta (eszopiclone), Chantix (varenicline), and Ritalin (methylphenidate). Do you know which ones could cause extremely high triglycerides? Do you know which ones could cause blood sugar issues? Thank you for your time.

Certain atypical anti-psychotics – particularly olanzapine and clozapine, but also Seroquel (quetiapine), which you are currently taking – have been associated with elevated triglyceridelevels, as well as elevated levels of sugar in the blood, which can lead to a state of insulin resistance. These adverse side effects may be related to an increased risk of developing adult-onset (type 2) diabetes in people taking these medications.

While there are some anecdotal reports of elevated triglycerides associated with Lamictal (lamotrigine), this is not a common side effect of this drug or the other medications you are taking. So, my first rough guess would be the Seroquel. However, there could also be complex medication interactions that are causing the problem, particularly given the number of medications you are taking.

It’s important that you discuss the target symptoms of each of these medications with your treating physician. For example, why did he/she prescribe two different atypical anti-psychotics (Seroquel, Abilify/aripiprazole) and two different anti-depressants (Lexapro/escitalopram, Wellbutrin/bupropion)? It sounds like coming off of some of these would be a good idea, for a variety of reasons. The first step is to understand what each of these medications is doing for you. You can do some of your own research by using drug databases on the Web, but you should definitely discuss this with your prescribing physician.

Q3. I am a 35-year-old woman with bipolar disorder who wants to become pregnant. I am currently taking Seroquel 300 mg, one pill every night before bed. I am aware that this drug is a class C drug, which may or may not cause damage to the unborn child. With this in mind, what are some other class A or B medications I could take temporarily while trying to conceive and during pregnancy?

This is a question which definitely needs to be addressed with your prescribing physician. There is considerable controversy about the relative risks and benefits of taking anti-depressant medications during pregnancy. To my knowledge, there are only individual case studies on the safety of Seroquel (quetiapine) during pregnancy (as opposed to large-scale studies). While there is no clear evidence of adverse effects on the fetus, clearly more information is required regarding both safety of use during pregnancy, as well as the long-term effects on children exposed to class C drugs in utero.

Generally speaking, drugs in either class A or B are considered safe and are routinely used. However, there may be exceptions. The American College of Obstetricians and Gynecologists’ Committee on Obstetric Practice recently issued a consensus opinion regarding the use of selective serotonin reuptake inhibitors (SSRIs) during pregnancy. It states that while numerous studies have not found an increased risk of major birth defects associated with the use of SSRIs during pregnancy, their use should be carefully considered for each patient, based on the relative risks and benefits.

In addition, there is some unpublished data suggesting that the use of Paxil (paroxetine) during the first trimester of pregnancy may be associated with an increased risk of congenital heart malformations. Among mood stabilizers, lithium consistently shows minimal risks to the fetus, although some anti-convulsants (such as Depakote/divalproex and Tegretol/carbamazepine) have been proven harmful to fetuses, possibly contributing to neural tube defects and other birth defects.

Q4. I have been living with bipolar disorder, untreated, for the last 15 years. Will I have a shorter life expectancy because of this?

Your question is very challenging because I have such limited information about you. The best answer I can offer is a qualified “I don’t know.”

It is complicated, because I don’t know how you have lived these last 15 years. I don’t know if you have bipolar I or bipolar II disorder. I don’t know if your symptoms have been severe enough to impair your social and occupational functioning, or if you have attempted suicide. I don’t know if you have been able to maintain a job that comes with health care benefits, or how many times you have been married or divorced. I don’t know if you smoke, abuse alcohol or drugs, have unprotected sex, or go on gambling binges. I don’t know if you have annual physicals. I don’t know how often you go for long periods of time with little or no sleep, or if you have experienced psychotic episodes.

I do know that the items listed above — whether directly or indirectly — have all been shown to contribute to early mortality. So, if you can respond favorably to the above items, then you have not experienced significant negative consequences of your untreated bipolar disorder. And that would be a very fortunate thing.

Q5. I have been successfully treated for bipolar disorder for the past five years. I take my meds (Prozac/fluoxetine and Neurontin/gabapentin) faithfully. I know bipolar disorder has no cure; however, I’m wondering if it would be possible for me to gradually be weaned off the meds. I am able to take a lower dosage of the Neurontin than I previously took. I was first treated with Depakote (divalproex) following a psychotic episode that resulted from misdiagnosis and incorrect meds. The Depakote made me feel zombie-like. With the Neurontin and Prozac, I’ve had to also take Adderall (amphetamine-dextroamphetamine) to keep from feeling scatterbrained. I guess I also have attention deficit disorder. Should I just count my blessings and continue these three meds for the rest of my life? Thanks.

It is certainly possible to gradually discontinue medications, with very careful monitoring by a good physician. The important thing to keep in mind is that it should be gradual, and done according to a specific plan made with your doctor. Don’t attempt this on your own!

If your symptoms start to recur once your dosages have been substantially reduced or discontinued, don’t be too disappointed – you may just need to maintain a minimal dosage of a mood stabilizer or anti-depressant, but you should not assume you need to be on those medications for the rest of your life.

Q6. My brother has recently been diagnosed with bipolar disorder. Are there any other drugs to treat it besides lithium? Also, can manic depression be caused by excessive drug abuse (he’s just recently been put in rehab) or is it just something that you’re born with?

There are many other medications which effectively treat bipolar disorder, the most common of these are valproate (Depakote), carbamazepine (Tegretol) and lamotrigine (Lamictal), which can be prescribed as single-drug therapy or in combination with other medications. Although lithium happens to be the oldest medication for bipolar disorder, it also remains one of the most effective. (The links below have more information about the medicines mentioned here.)

Currently, there is little evidence that manic depression can be caused by excessive drug abuse in the absence of a genetic predisposition to the disorder. However, bipolar disorder and substance abuse (particularly alcohol abuse) frequently occur together, and drug or alcohol abuse can certainly contribute to mood instability, particularly in vulnerable individuals. In some cases, bipolar disorder clearly develops before the substance abuse begins; but in others, it’s not so clear which came first.

Nevertheless, when bipolar disorder and drug or alcohol abuse co-occur, each can worsen the severity of the other, and can complicate treatment efforts for both conditions. So it is very important that treatment addresses both conditions.

Q7. I have manic depression and take 20 mg of Lexapro. I would like to get off the prescription and take natural vitamins instead. What vitamins should I take, and how much would I need?

While some people with bipolar disorder have been able to successfully reduce their medication dosages or even discontinue them altogether, this is not something I would recommend to anyone unless it is done with very careful monitoring by a physician or psychiatrist.

First, what are the reasons that you would like to stop taking your medication? Of course, there are plenty of reasons I can imagine why you may be motivated to try this switch. I suggest you discuss your goals of discontinuing Lexapro (escitalopram) with your doctor, and if he or she deems it appropriate, you can gradually decrease the dosage. The other important thing to note is that abrupt discontinuation of Lexapro frequently results in some adverse “withdrawal” effects, so gradual dose reduction is advised. Another consideration is whether you are only taking Lexapro or if you are taking it in combination with a mood stabilizer. There would need to be a good reason why you would not be taking a mood stabilizer, such as if you had very mild symptoms of mania and/or very few episodes of mania. Otherwise, the typical primary treatment for bipolar disorder is mood stabilizers, sometimes in combination with antidepressants.

In terms of which herbal remedies you should try, St. John’s wort has probably been the best researched as an antidepressant. While there is some evidence that it’s effective in treating milder depressions, it doesn’t appear to work as well for severe depression. I am not aware of any published studies on its effectiveness in treating bipolar disorder. Kava, valerian root and ginkgo biloba are other herbal remedies commonly used to treat mood symptoms, although again, there are no published data on their effectiveness in treating bipolar disorder.

If you do decide to try herbal remedies, make sure to pick a brand with high quality control and keep track of your symptoms to see whether or not it’s working. However, keep in mind that no herbal remedies or supplements are approved by the Food and Drug Administration, and that they may also have adverse side effects. You can read more about clinical studies of herbal medicines in “The Handbook of Clinically Tested Herbal Remedies” By Marilyn Barrett, Ph.D.

Q8. I don’t know what is happening to me. In the last year all things have changed for me. I have gained 50 pounds, I sleep almost 18 to 20 hours a day, I have hot flashes all the time, I can’t remember things, I can’t think, I have quit my job with no income, and my boyfriend has moved in with me but I attempted suicide twice because of his actions. I cannot get back to me. Approximately a year ago I changed some meds. The most was changing from Effexor (venlafaxine) to Cymbalta (duloxetine). Could this one drug change have all of these effects on me? I have been checked for perimenopause and thyroid problems and all came back normal. I am at a loss.

It is surprising that this single medication switch could have such a profound effect, but it sounds like — regardless of the causes — Cymbalta is not working well for you. What were the reasons for the medication switch? I ask because the evidence for Cymbalta’s effectiveness for depression is not overwhelming. A meta-analysis of placebo-controlled trials, published earlier this year in the New England Journal of Medicine, concluded that the effect size of duloxetine as compared with placebo was weak to moderate, and similar to other 11 anti-depressants studied.

While the difficulties you’re describing would not be common side effects, you might consider a medication switch. Based on the symptoms you are describing, I would also suspect thyroid and/or perimenopause, so it is good you got this checked.

Also, you don’t mention whether Cymbalta is the only medication you are taking or if this is just one of several. Weight gain can be associated with some of the medications prescribed for bipolar disorder. Are you taking a mood stabilizer in addition to the antidepressant? Mood stabilizers are usually the cornerstone of bipolar treatment.

It sounds like you are feeling things spiraling out of control right now, and so the best thing for you to do would be to discuss your current treatment plan with your doctor. A medication switch may be helpful but I would highly recommend psychosocial therapy as well, if that is not already part of your treatment.

Q9. My psychopharmacologist, Dr. X, took me off many unnecessary medications this past spring, and he’s reduced the dosage of the last two, Topamax (topiramate) 200 mg at night (I formerly was taking 300 mg morning and night) and Seroquel (quetiapine) 50 mg. I have maintained stability and perfect mental health now for 21 weeks, since the end of the longest and severest depression I ever experienced. Do you think, as I do, that Dr. X should wean me off the remainder of Topamax and Seroquel before Daylight Savings ends this autumn? Thank you; I truly appreciate this.

I am glad to hear you are doing so much better now. However, if the worst depressive episode you have ever experienced ended just 21 weeks ago, it may be premature to discontinue all medications this soon.

Why is the end of Daylight Saving Time your deadline? If your depression tends to have a seasonal pattern it might be a problem to stop taking your medications while the days are getting shorter. But certainly, if this is something you feel strongly about, the important thing is that your mood symptoms are monitored very closely. You may wish to keep a daily log to track your symptoms over time, so you can see how reducing or discontinuing your medication is affecting things.

Q10. Is it fair that I have asked to be taken off of Geodon and put on Topamax or another mood stabilizer and my doctor will not agree? He assumes I might get manic, but my opinion is if I am on a mood stabilizer, that won’t happen. I dislike Geodon and the long-term side effects.

It is critical to have a good working relationship with your doctor. It sounds like he has some legitimate concerns about the possible implications of switching medications. Although Topamax (topiramate) is an approved treatment for seizure disorders and migraine, it is now commonly prescribed for bipolar disorder, often in addition to other medications.

What are the long-term side effects of Geodon (ziprasidone) that trouble you? It is possible that your doctor does not really understand the reasons you dislike your current medications. If you clearly have researched the issues and can document exactly why you feel like a medication switch would be beneficial for you, your doctor is more likely to listen. Hopefully this strategy will be helpful in finding a solution that works well for both of you.

"My 22-year-old son has been diagnosed with a mild case of bipolar disorder. He is self-medicating by smoking marijuana. What do you know about pot and bipolar disorder?"