Lamictal Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Warnings:

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, severe dizziness, 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.

Warnings:

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, severe dizziness, 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.

… Show More

Uses

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 oral

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. Swallow the tablets whole since chewing them may leave a bitter taste.

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.

Side Effects

See also Warning section.

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

Remember that this medication has been prescribed because your doctor 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/slow/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.

In the US – 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.

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, heart problems (such as irregular heartbeat, heart block, heart failure).

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).

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

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

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. Discuss the risks and benefits with your doctor.

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

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, primidone, valproic acid), rifampin, ritonavir, 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.

Does Lamictal oral interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

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.

Do not share this medication with others.

Lab and/or medical tests (such as liver/kidney function, complete blood count) may be done while you are taking this medication. Keep all medical and lab appointments. 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.

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.

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

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Images

Lamictal 200 mg tablet

Color: blueShape: shieldImprint: LAMICTAL 200

This medicine is a blue, shield, scored, tablet imprinted with “LAMICTAL 200”.

Lamictal 100 mg tablet

Color: peachShape: shieldImprint: LAMICTAL 100

This medicine is a blue, shield, scored, tablet imprinted with “LAMICTAL 200”.

Lamictal 25 mg tablet

Color: whiteShape: shieldImprint: LAMICTAL 25

This medicine is a blue, shield, scored, tablet imprinted with “LAMICTAL 200”.

Lamictal 150 mg tablet

Color: creamShape: shieldImprint: LAMICTAL 150

This medicine is a blue, shield, scored, tablet imprinted with “LAMICTAL 200”.

Next

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Available coupons

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Are you currently using Lamictal oral?

This survey is being conducted by the WebMD marketing sciences department.

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

Lamotrigine Oral: Uses, Side Effects, Interactions, Pictures, Warnings & Dosing

Warnings:

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, severe dizziness, 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.

Warnings:

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, severe dizziness, 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.

… Show More

Uses

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 lamotrigine oral

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. Swallow the tablets whole since chewing them may leave a bitter taste.

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.

Side Effects

See also Warning section.

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

Remember that this medication has been prescribed because your doctor 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/slow/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.

In the US – 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.

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, heart problems (such as irregular heartbeat, heart block, heart failure).

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).

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

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

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. Discuss the risks and benefits with your doctor.

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

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, primidone, valproic acid), rifampin, ritonavir, 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.

Does lamotrigine oral interact with other drugs you are taking?

Enter your medication into the WebMD interaction checker

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.

Do not share this medication with others.

Lab and/or medical tests (such as liver/kidney function, complete blood count) may be done while you are taking this medication. Keep all medical and lab appointments. 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.

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.

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

Do not flush medications down the toilet or pour them into a drain unless instructed to do so. Properly discard this product when it is expired or no longer needed. Consult your pharmacist or local waste disposal company.

Images

lamotrigine 25 mg tablet

Color: whiteShape: roundImprint: ZC 79

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

lamotrigine 100 mg tablet

Color: whiteShape: triangularImprint: U U 112

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

lamotrigine 150 mg tablet

Color: off-whiteShape: roundImprint: logo and 62

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

lamotrigine 100 mg tablet

Color: off-whiteShape: roundImprint: logo and 61

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

lamotrigine 25 mg tablet

Color: off-whiteShape: roundImprint: logo 60

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

lamotrigine 25 mg tablet

Color: whiteShape: shieldImprint: 93 D

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

lamotrigine 200 mg tablet

Color: light blueShape: triangularImprint: U U 114

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

lamotrigine 200 mg tablet

Color: off-whiteShape: roundImprint: logo and 063

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

lamotrigine 200 mg tablet

Color: blueShape: shieldImprint: D 96

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: light pinkShape: oblongImprint: C148

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: light pinkShape: oblongImprint: C152

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: whiteShape: roundImprint: ZC 80

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

lamotrigine 25 mg tablet

Color: whiteShape: oblongImprint: U U 111

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

lamotrigine 25 mg (84)-100 mg (14) tablets in a dose pack

Color: whiteShape: roundImprint: 45 or 1047

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

lamotrigine 25 mg (42)-100 mg (7) tablets in a dose pack

Color: whiteShape: roundImprint: 45 or 1047

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

lamotrigine 200 mg tablet

Color: whiteShape: roundImprint: L124

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

lamotrigine 150 mg tablet

Color: whiteShape: triangularImprint: U U 113

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

lamotrigine 100 mg tablet

Color: whiteShape: roundImprint: 1047

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: whiteShape: roundImprint: 1049

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: whiteShape: roundImprint: M L53

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: whiteShape: oblongImprint: L121

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: whiteShape: roundImprint: J 247

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: light yellowShape: roundImprint: RDY 22 2

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: light yellowShape: roundImprint: RDY 22 1

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: light yellowShape: roundImprint: RDY 22 0

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

lamotrigine 100 mg tablet

Color: whiteShape: roundImprint: L122

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

lamotrigine 150 mg tablet

Color: whiteShape: roundImprint: L123

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: light peachShape: roundImprint: TARO LMT 100

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: whiteShape: roundImprint: 45

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: whiteShape: roundImprint: J 248

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: whiteShape: roundImprint: J 246

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: whiteShape: roundImprint: J 245

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: whiteShape: roundImprint: 1048

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: greenShape: roundImprint: M L54

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: whiteShape: roundImprint: M L52

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: whiteShape: roundImprint: 45

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: peachShape: shieldImprint: D 94

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: whiteShape: roundImprint: TARO LMT 25

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: creamShape: shieldImprint: D 95

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: light blueShape: roundImprint: TARO LMT 200

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: creamShape: roundImprint: TARO LMT 150

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

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Color: light pinkShape: oblongImprint: C151

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

lamotrigine 25 mg tablet

Color: whiteShape: roundImprint: M L 51

This medicine is a white, round, scored, tablet imprinted with “ZC 79”.

Next

Save up to 80% on your prescriptions.

Available coupons

Save up to 80% on your prescription with WebMDRx

Drug Survey

Are you currently using lamotrigine oral?

This survey is being conducted by the WebMD marketing sciences department.

Selected from data included with permission and copyrighted by First Databank, Inc. This copyrighted material has been downloaded from a licensed data provider and is not for distribution, except as may be authorized by the applicable terms of use.

CONDITIONS OF USE: The information in this database is intended to supplement, not substitute for, the expertise and judgment of healthcare professionals. The information is not intended to cover all possible uses, directions, precautions, drug interactions or adverse effects, nor should it be construed to indicate that use of a particular drug is safe, appropriate or effective for you or anyone else. A healthcare professional should be consulted before taking any drug, changing any diet or commencing or discontinuing any course of treatment.

Lamotrigine in the treatment of adult epilepsy | Noskova T.Yu.

Epilepsy is the third most common neurological disease, with a frequency of 0.5–1.5%. On the one hand, this is a chronic disorder, often accompanied, in addition to seizures, by a whole range of disorders (cognitive, hormonal, psychological, mental), on the other hand, in most cases it is a curable disease [24].

According to modern concepts, epilepsy is a heterogeneous group of syndromes that have different clinical, neurophysiological, neuroimaging characteristics and differ in course and prognosis. The treatment of epilepsy is based on rational pharmacotherapy, which is impossible without diagnosing the form of the disease. The present classification of epilepsy is based on the etiology and nature of epileptic activity (focal or generalized). Thus, neurologists working with adult patients most often encounter partial symptomatic or presumably symptomatic (cryptogenic) epilepsy, the proportion of which is 60–70% [24]. This form is characterized by partial (simple partial, complex partial and secondary generalized seizures). The proportion of idiopathic generalized epilepsy in the adult population reaches 15% [21]. The clinical core of this form is generalized seizures (convulsive, absences, myoclonus, myoclonic-astatic seizures). In cases where it is impossible to establish the form according to the available clinical and paraclinical data, unclassified epilepsy is diagnosed.
The tactics of treating a particular patient depends on many parameters, such as the form of the disease, age, gender, comorbidity, the need for concomitant use of other drugs, the presence of a newly diagnosed disease or assessment of previous antiepileptic therapy (ineffectiveness or poor tolerance), the likely duration of treatment.
For almost all forms of epilepsy (with the exception of epileptic encephalopathies), initial monotherapy is accepted. And the response to the first monotherapy is an important prognostic factor. Thus, 50% of patients go into remission against the background of the first monotherapy, and in 31% of patients, complete remission occurs literally after the first dose of the drug. If the first is unsuccessful, a second monotherapy follows, and only then one or, if necessary, two duotherapy, and in some cases a combination of three drugs. But, nevertheless, up to 30% of patients remain resistant to treatment. Based on the foregoing, the acuteness of the choice problem facing the specialist is understandable [24].
In the last 10–15 years, a number of new antiepileptic drugs have been introduced into everyday clinical practice. One of the first in the world and in Russia in the 90s of the last century, lamotrigine was registered. And today we can say with confidence that lamotrigine is the most well studied, and vast experience has been accumulated in the use of this drug in various clinical situations. Recently, Convulsan, a lamotrigine manufactured by Actavis, has appeared on the Russian pharmaceutical market, the pharmaceutical products of which are traditionally distinguished by a combination of good quality and affordable prices.
The main mechanism of action of lamotrigine is associated with the blocking of sodium channels. In addition, the effects on calcium channels, GABAergic and serotonergic component are described. It is likely that the complex mechanism of action determines the wide spectrum of activity of lamotrigine in epilepsy and a positive effect on mood, which is used in the treatment of bipolar disorders. A wide spectrum of action implies the possibility of use in all forms of epilepsy. Lamotrigine is registered in mono- and additional therapy for partial, generalized convulsive seizures, monotherapy for typical absences. Prescribing the drug requires great care when prescribing to patients with myoclonic seizures. The literature describes aggravation and the appearance of negative myoclonus under the influence of lamotrigine in Rolandic epilepsy, Unferricht-Lundborg disease, and idiopathic generalized epilepsy [8,11,13].
Features of pharmacokinetics
and interdrug
lamotrigine
interactions
The drug is almost completely absorbed from the gastrointestinal tract, has a linear pharmacokinetics, is metabolized in the liver by glucuronization using the enzyme glucuronyltransferase (UGT1A4) without the participation of the cytochrome P450 system. Lamotrigine does not change the pharmacokinetics and blood concentrations of other anticonvulsants and oral contraceptives.
But the concentration of lamotrigine in the blood varies in many ways during polytherapy, requiring adjustment of the daily dose. So, the concentration of lamotrigine in the blood is increased by drugs – inhibitors of glucuronization (the most striking example is valproates), and stimulants – phenytoin, carbamazepine, phenobarbital, primidone decrease. Oral contraceptives also have a pronounced stimulating effect on glucoronization, so dose adjustment is also necessary. The induction of metabolism by oral contraceptives has been proven in a double-blind, placebo-controlled study, and an increase in the concentration of lamotrigine occurs as early as the first week after discontinuation of oral contraceptives [9].
The main advantage of the drug is its good tolerability. The greatest danger is the appearance of a rash, which in most cases is not dangerous, but may be the initial sign of the development of such severe syndromes as Stevens-Johnson syndrome, Lyell’s syndrome, hypersensitivity syndrome to anticonvulsants, and therefore requires discontinuation of the drug. The most common rash occurs in children (up to 10%), as well as against the background of duotherapy (valproate + lamotrigine). The rash is usually morbilliform and appears within the first 8 weeks of treatment. An effective preventive measure is a slow increase in the dose of lamotrigine. Skin rashes, as a manifestation of idiosyncrasy, often occur while taking other anticonvulsants. In the article by Arif H. et al. the incidence of rash on the background of different drugs in adults over 16 years of age is given, which was most common on the background of phenytoin (5.9%), lamotrigine (4.8%), carbamazepine (3.7%) [5]. Only one predictor of rash has been identified – the presence of rashes on another drug. According to other authors, rash is more common in women of childbearing age than in men; this may be due to hormonal factors [4].
Stevens-Johnson syndrome and toxic epidermal necrolysis are rare but severe skin reactions that occur with various medications. From 1997 to 2001, a case-control study was conducted in Europe to determine the occurrence and frequency of such reactions. This study recorded a clear relationship between the intake and development of Stevens-Johnson syndrome and epidermal necrolysis of the following anticonvulsants: lamotrigine, carbamazepine, phenobarbital, phenytoin [20].
Serious negative psychiatric side effects (psychosis, suicide) are very rare with lamotrigine compared with other drugs. There is an indication of the association of rare psychotogenic effects of lamotrigine with a history of mental disorders and pathology of the temporal lobe [7].
Lamotrigine in treatment
partial epilepsy
For a long time, carbamazepine remained the main drug of choice for the treatment of partial epilepsy. Therefore, the introduction of new drugs into practice passed through studies of their efficacy and tolerability in comparison with carbamazepine, first as an additional, and then as monotherapy during controlled randomized trials, which demonstrated sufficient efficacy with good tolerability. Similar results were obtained in the course of post-marketing studies.
So, Steinhoff BJ et al in an open randomized multicenter study (LAM-SAFE) compared lamotrigine with carbamazepine and valproate as initial monotherapy in adolescents and adults with focal (partial) and generalized epilepsy. The authors concluded that the efficacy and tolerability of lamotrigine is consistent with the first choice drug [26].
It has also been shown that switching from monotherapy with a less effective and less well tolerated standard drug (carbamazepine or valproate) to lamotrigine is associated with better clinical and psychosocial outcomes compared with switching to an alternative standard drug [16].
The results of the SANAD randomized controlled trial of standard and new antiepileptic drugs (carbamazepine, gabapentin, lamotrigine, oxcarbazepine and topiramate) in the treatment of partial epilepsy have recently been published. The aim of this study was to identify a new drug that can replace carbamazepine in terms of a number of clinical characteristics, quality of life parameters, and price-effectiveness ratio. Such a drug was recognized as lamotrigine, which surpassed carbamazepine in time to drug withdrawal, i.e., showed good tolerance and was not inferior in time to 12-month remission [19].
Lamotrigine in treatment
idiopathic generalized epilepsy
Idiopathic generalized epilepsy is characterized by relatively good sensitivity to anticonvulsants; valproates are traditionally considered the drug of choice for this form, the effectiveness of which in children approaches 90%. But against the background of valproate monotherapy, side effects occur, such as weight gain, hair loss, acne, liver damage, which often leads to drug withdrawal. Therefore, an alternative to valproates is often needed [24]. According to ILAE data obtained in randomized clinical trials, lamotrigine is effective even in initial monotherapy in adults with generalized tonic-clonic seizures (level of evidence – C), in children with absence seizures (level of evidence – C) [15].
In a twenty-year follow-up by Mohanraj R. and Brodie M.J. in the adult population of patients with generalized epilepsy, valproate has been shown to be more effective than lamotrigine, but worse tolerability [21].
According to Coppola G. et al., lamotrigine is effective as initial monotherapy for absence epilepsy in children in 50% of cases, and leads to normalization of interictal EEG in all patients [10].
Thus, lamotrigine loses to valproates in idiopathic generalized epilepsy in terms of effectiveness, the speed of onset of remission due to prolonged titration, but surpasses valproates in tolerability. Therefore, lamotrigine can be recommended as an alternative in selected clinical situations and as adjunctive therapy.
Effect of lamotrigine
for cognitive functions
Cognitive impairment is an acute problem in epileptology. The main factors leading to cognitive impairment include seizures, especially generalized and partial seizures with impaired consciousness, with a tendency to serial and status course, drug resistance, and side effects of antiepileptic drugs. The negative effect of phenobarbital is especially emphasized. Due to many factors, it is sometimes difficult to isolate the immediate cause in a particular patient and identify a negative iatrogenic effect. The main tools to assess the state of cognitive functions are neuropsychological testing, EEG analysis data (a-rhythm parameters, spectral and power mapping, assessment of interictal epileptic activity), the study of cognitive evoked potentials P300, neuroimaging diagnostics of the atrophic process of the brain is of secondary importance.
In patients with idiopathic generalized epilepsy, a normalizing effect of lamotrigine on the spectrum of background activity, a dose-dependent decrease in pathological thalamocortical synchronization, and the absence of negative quantitative EEG changes were shown, which underlies a moderate psychostimulating effect [3]. The cognitive effects of lamotrigine and topiramate used as add-on therapy (carbamazepine or phenytoin were used as monotherapy) in partial epilepsy were compared in a double-blind, randomized trial. Its results indicate a higher incidence of cognitive side effects against the background of topiramate, the premature cancellation of which was required in 6% of cases [6]. A positive cognitive profile of lamotrigine has also been demonstrated in healthy volunteers [2].
Anxiolytic and antidepressant
properties of lamotrigine
Depression and fear of recurrence of seizures are the main factors that worsen the quality of life of patients with epilepsy. Mood disorders in epilepsy are quite common, and their causes are premorbid personality traits, and the influence of the disease itself, and social causes, and the influence of anticonvulsants. Mula M. and Sander J.W. in their review, they identified the following likely mechanisms for the negative effects of drugs on mood and behavior: potentiation of GABA neurotransmission, folic acid deficiency, pharmacodynamic interactions, forced EEG normalization. The authors also indicated the drugs that most often cause mood disorders (in 10% of patients and more often): barbiturates, vigabatrin, topiramate, drugs associated with a low risk of developing depression and even improving mood: phenytoin, gabapentin, pregabalin, carbamazepine, oxcarbazepine, ethosuximide, valproate, lamotrigine [23]. In an open study by Fakhoury T.A. et al. the effectiveness of lamotrigine has been proven and its antidepressant properties have been confirmed when used as an additional and monotherapy in patients with a combination of epilepsy and mild to moderate depression [12].
Lamotrigine in the treatment of epilepsy in women
Lamotrigine has positive characteristics that make it attractive for use in women of childbearing age: this is the absence of an effect on the level of sex hormones and oral contraceptives, minimization of cosmetic effects, a positive effect on mood, metabolic neutrality, low teratogenic potential.
The use of antiepileptic drugs during pregnancy is vital for most patients and is the key to the very possibility of bearing. But, unfortunately, antiepileptic drugs have a potential teratogenic effect, and can also affect the intellectual abilities of the child. It is clear that conducting randomized clinical trials of antiepileptic drugs in pregnant women is not possible for ethical reasons. Therefore, the maintenance of national and transnational Pregnancy Registries with the fixation of possible side effects of anticonvulsants is essential. According to the British Pregnancy Registry, the incidence of malformations while taking lamotrigine was 3.2%, for comparison, the average frequency for anticonvulsants in general was 4.2%, for polytherapy – 6.0%, against the background of valproate – 6.2% , in women with epilepsy who do not take antiepileptic drugs – 3.5%. On the other hand, a dose-dependent effect is shown, i.e. with increasing doses, the frequency of developmental anomalies increases. So, the risk when taking lamotrigine in doses up to 200 mg is 1.9%; in doses exceeding 200 mg / day, leads to an increase in the frequency of anomalies up to 5. 4%, taking valproates in a daily dose exceeding 1000 mg – up to 9.1% [22]. Therefore, for prevention before pregnancy, it is important to optimize therapy using, if possible, one drug at the lowest effective doses.
It is also important to consider fluctuations in blood levels of lamotrigine during pregnancy and after childbirth. During pregnancy, there is a decrease in the concentration of lamotrigine in the blood, mainly for two reasons: an increase in body weight and an increase in clearance under the influence of estrogen due to the activation of glucuronidation. Clearance of lamotrigine differs markedly in different trimesters of pregnancy, reaches a maximum by the 32nd week, may be more than 330% of pre-pregnancy values. This circumstance can lead to a worsening of the course of the disease. On the other hand, after childbirth, due to the reverse development of the above processes, physiological conditions are created for the appearance of signs of intoxication. Therefore, when planning pregnancy in women taking lamotrigine, it is advisable to determine the level of the drug in the blood and monitor it during pregnancy and after childbirth [1].
There is preliminary evidence that breastfeeding while taking lamotrigine is reasonably safe. Despite the fact that the concentration of lamotrigine in breast milk is quite high (according to various sources, from 10 to 50–60% of the plasma concentration in the mother), side effects are not observed in infants [24].
In addition to preserving the reproductive function for women, it is important that the drugs do not affect other organs and systems. So, in the world today much attention is paid to the problem of metabolic syndrome – an important risk factor for the development of cerebrovascular and cardiovascular complications. A survey of women with epilepsy aged 18–45 years showed an increase in the incidence of metabolic syndrome while taking valproate, while this pathology was not recorded while taking lamotrigine and topiramate. In this regard, these drugs are preferred in patients with increased body weight, impaired glucose and lipid metabolism, and arterial hypertension [18].
Lamotrigine in the treatment of epilepsy in the elderly
In the elderly, there is an increase in the incidence of epilepsy. Of all age groups, people over 75 years of age have a higher risk of developing epilepsy. This fact can be easily explained by the high prevalence of cerebrovascular pathology in the population, the growth of oncological diseases. With the improvement of the macroeconomic situation and the increase in life expectancy, the number of elderly patients with epilepsy will continue to grow. In this regard, the development of management of this category of patients is an important problem. Drugs used in the elderly should combine high efficacy with minimized side effects, low potential for drug-drug interactions, metabolic neutrality, and be affordable.
Gilad R. et al. conducted a comparison of carbamazepine and lamotrigine in patients with post-stroke epilepsy, it turned out that the tolerability of lamotrigine was statistically significantly better; thus, due to poor tolerability, carbamazepine was canceled in 31%, lamotrigine – in 3% [14].
In July 2006, the Guidelines for the Treatment of ILAE: An Evidence-Based Analysis of the Efficacy and Efficacy of Antiepileptic Drugs as Monotherapy was published. This guideline is the result of 4 years of work by the ILAE Therapeutic Strategy Committee to review the compliance of data from randomized clinical trials with new unified requirements. Only lamotrigine and gabapentin appeared to have proven efficacy as drugs for the treatment of new-onset epilepsy in the elderly, thus being first-line drugs of choice (level of evidence A) [15].
In 2007, the results of a double-blind controlled trial comparing the efficacy of extended-release carbamazepine and lamotrigine in patients over 65 years of age are presented. The results showed comparable efficacy of both drugs with a trend towards a higher rate of complete remission in the presence of carbamazepine and a better tolerability of lamotrigine [25].
In 2005, the opinion of experts (leading epileptologists of the world) on the use of anticonvulsants in women of childbearing age was published, lamotrigine was named the drug of first choice for idiopathic generalized and partial epilepsy, and lamotrigine was also named the drug of choice in the elderly [17].
Thus, lamotrigine (Convulsan) is a well-studied, effective, well-tolerated broad-spectrum drug, both in mono- and adjunctive therapy, with a positive effect on cognitive function and mood.

Literature
1. Adab N. Therapeutic monitoring of antiepileptic drugs during pregnancy and in the postpartum period: is it useful? CNS Drugs. 2006;20(10):791–800.
2. Aldenkamp AP, Arends J, Bootsma HP, Diepman L, Hulsman J, Lambrechts D, Leenen L, Majoie M, Schellekens A, de Vocht J. Randomized double-blind parallel-group study comparing cognitive effects of a low-dose lamotrigine with valproate and placebo in healthy volunteers. epilepsy. 2002 Jan;43(1):19-26.
3. Aldenkamp AP, De Krom M, Reijs R. Newer antiepileptic drugs and cognitive issues. epilepsy. 2003;44 Suppl 4:21–9.
4. Alvestad S, Lydersen S, Brodtkorb E. Rash from antiepileptic drugs: influence by gender, age, and learning disability. epilepsy. 2007 Jul;48(7):1360–5.
5. Arif H, Buchsbaum R, Weintraub D, Koyfman S, Salas-Humara C, Bazil CW, Resor SR Jr, Hirsch LJ. Comparison and predictors of rash associated with 15 antiepileptic drugs. Neurology. 2007 May 15;68(20):1701–9.
6. Blum D, Meador K, Biton V, Fakhoury T, Shneker B, Chung S, Mills K, Hammer A, Isojarvi J. Cognitive effects of lamotrigine compared with topiramate in patients with epilepsy. Neurology. 2006 Aug 8;67(3):400–6.
7. Brandt C, Fueratsch N, Boehme V, Kramme C, Pieridou M, Villagran A, Woermann F, Pohlmann–Eden B. Development of psychosis in patients with epilepsy treated with lamotrigine: report of six cases and review of the literature. Epilepsy Behav. 2007 Aug;11(1):133–9.
8. Cerminara C, Montanaro ML, Curatolo P, Seri S. Lamotrigine-induced seizure aggravation and negative myoclonus in idiopathic rolandic epilepsy. Neurology. 2004 Jul 27;63(2):373–5.
9. Christensen J, Petrenaite V, Atterman J, Sidenius P, Ohman I, Tomson T, Sabers A. Oral contraceptives induce lamotrigine metabolism: evidence from a double-blind, placebo-controlled trial. epilepsy. 2007 Mar;48(3):484–9.
10. Coppola G, Licciardi F, Sciscio N, Russo F, Carotenuto M, Pascotto A. Lamotrigine as first-line drug in childhood absence epilepsy: a clinical and neurophysiological study. braindev. 2004 Jan;26(1):26–9.
11. Crespel A, Genton P, Berramdane M, Coubes P, Monicard C, Baldy-Moulinier M, Gelisse P. Lamotrigine associated with exacerbation or de novo myoclonus in idiopathic generalized epilepsies. Neurology. 2005 Sep 13;65(5):762–4.
12. Fakhoury TA, Barry JJ, Mitchell Miller J, Hammer AE, Vuong A. Lamotrigine in patients with epilepsy and comorbid depressive symptoms. Epilepsy Behav. 2007 Feb;10(1):155–62.
13. Genton P, Gelisse P, Crespel A. Lack of efficacy and potential aggravation of myoclonus with lamotrigine in Unverricht–Lundborg disease. epilepsy. 2006 Dec;47(12):2083–5.
14. Gilad R, Sadeh M, Rapoport A, Dabby R, Boaz M, Lampl Y. Monotherapy of lamotrigine versus carbamazepine in patients with poststroke seizure. Clinic Neuropharmacol. 2007 Jul–Aug;30(4):189–95.
15. Glauser T, Ben–Menachem E, Bourgeois B, Cnaan A, Chadwick D, Guerreiro C, Kalviainen R, Mattson R, Perucca E, Tomson T. ILAE treatment guidelines: evidence–based analysis of antiepileptic drug efficacy and effectiveness as initial monotherapy for epileptic seizures and syndromes. epilepsy. 2006 Jul;47(7):1094–120.
16. Kaminow L, Schimschock JR, Hammer AE, Vuong A. Lamotrigine monotherapy compared with carbamazepine, phenytoin, or valproate monotherapy in patients with epilepsy. Epilepsy Behav. 2003 Dec;4(6):659–66.
17. Karcerski S., Morrell M.J., Carpenter D. Treatment of epilepsy in adults: expert opinion, 2005. Epilepsy & Behavior 7 (2005) S1–S64
18. Kim JY, Lee HW. Metabolic and hormonal disturbances in women with epilepsy on antiepileptic drug monotherapy. epilepsy. 2007 Jul;48(7):1366–70.
19. Marson AG, Al-Kharusi AM, Alwaidh M, Appleton R, Baker GA, Chadwick DW, Cramp C, Cockerell OC, Cooper PN, Doughty J, Eaton B, Gamble C, Goulding PJ, Howell SJ, Hughes A, Jackson M, Jacoby A, Kellett M, Lawson GR, Leach JP, Nicolaides P, Roberts R, Shackley P, Shen J, Smith DF, Smith PE, Smith CT, Vanoli A, Williamson PR; SANAD Study group. The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblended randomized controlled trial. Lancet. 2007 Mar 24;369(9566):1000–15.
20. Mockenhaupt M, Viboud C, Dunant A, Naldi L, Halevy S, Bavinck JN, Sidoroff A, Schneck J, Roujeau JC, Flahault A. Stevens–Johnson Syndrome and Toxic Epidermal Necrolysis: Assessment of Medication Risks with Emphasis on Recently Marketed drugs. The EuroSCAR–Study. J Invest Dermatol. 2007 Sep 6; [Epub ahead of print]
21 Mohanraj R, Brodie MJ. Outcomes of newly diagnosed idiopathic generalized epilepsy syndromes in a non-pediatric setting. Acta Neurol Scand. 2007 Mar;115(3):204–8.
22. Morrow J., Russel A., Guthrie E. at al. Malformation risk of antiepileptic drugs in pregnancy: a prospective study from the UK Epilepsy and Pregnancy Register. J. Neurol. neurosurgery. Psychiatry, 2006; 77:193-8.
23Mula M, Sander JW. Negative effects of antiepileptic drugs on mood in patients with epilepsy. drug safe. 2007;30(7):555–67.
24. Panayiotopoulos C.P. THE EPILEPSIES: Seizures, Syndromes and Management. 2005. Bladon. Medical Publishing .541p.
25. Saetre E, Perucca E, Isojarvi J, Gjerstad L; LAM40089study group. An international multicenter randomized double–blind controlled trial of lamotrigine and sustained–release carbamazepine in the treatment of newly diagnosed epilepsy in the elderly.
26. Steinhoff BJ, Ueberall MA, Siemes H, Kurlemann G, Schmitz B, Bergmann L; LAM–SAFE Study Group. The LAM–SAFE Study: lamotrigine versus carbamazepine or valproic acid in newly diagnosed focal and generalized epilepsies in adolescents and adults. Seizure. 2005 Dec;14(8):597–605.

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Lamotrigine is approved for the treatment of bipolar I disorder and a wide range of seizure disorders, including Lennox-Gastaut syndrome, primary generalized tonic-clonic seizures, and partial seizures. The drug is used to treat migraine, trigeminal neuralgia and the treatment of refractory depression. Lamotrigine inhibits the release of glutamate (an excitatory amino acid) and voltage-sensitive sodium channels to stabilize neuronal membranes; it also weakly inhibits the 5-HT3 (serotonin) receptor.

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