Lamictal (lamotrigine) is an anticonvulsant and mood-stabilizing medication approved by the FDA for the treatment of epilepsy and bipolar disorder. It functions by stabilizing electrical activity in the brain and modulating the release of neurotransmitters, which helps to prevent seizures and manage mood swings. As a first-line treatment option, it is widely prescribed due to its efficacy and generally favorable side effect profile when titrated appropriately under medical supervision.

Features

• Active ingredient: Lamotrigine
• Available in various formulations: tablets, chewable dispersible tablets, and orally disintegrating tablets
• Multiple strengths: 2 mg, 5 mg, 25 mg, 100 mg, 150 mg, 200 mg
• Mechanism of action: Sodium channel blockade and inhibition of glutamate release
• FDA-approved for epilepsy (partial seizures, generalized seizures of Lennox-Gastaut syndrome) and bipolar I disorder (maintenance treatment)

Benefits

• Reduces the frequency and severity of epileptic seizures
• Helps prevent or delay mood episodes in bipolar disorder, particularly depressive episodes
• Generally well-tolerated with a lower risk of weight gain or sedation compared to some alternatives
• Can be used as both monotherapy and adjunctive therapy
• Offers flexible dosing regimens to tailor treatment to individual patient needs
• May improve overall quality of life by providing stable neurological and psychiatric symptom control

Common use

Lamictal is primarily indicated for the treatment of epilepsy in adults and pediatric patients aged 2 years and older. It is used for partial-onset seizures, primary generalized tonic-clonic seizures, and seizures associated with Lennox-Gastaut syndrome. In psychiatric practice, it is approved for the maintenance treatment of bipolar I disorder to delay the onset of mood episodes (depression, hypomania, mania, or mixed episodes). Off-label uses may include adjunctive treatment in other forms of epilepsy, neuropathic pain conditions, and as augmentation in treatment-resistant depression, though these should only be pursued under strict clinical guidance.

Dosage and direction

Dosage must be individualized based on indication, patient age, concomitant medications, and clinical response. For epilepsy in patients taking valproate, the initial dose is 25 mg every other day for weeks 1-2, then 25 mg daily for weeks 3-4, with gradual increases every 1-2 weeks. For patients taking enzyme-inducing antiepileptic drugs without valproate, the initial dose is 50 mg daily for weeks 1-2, then 100 mg daily in two divided doses for weeks 3-4, with subsequent increases. For bipolar disorder, the initial dose is 25 mg daily for weeks 1-2, then 50 mg daily for weeks 3-4, 100 mg daily for week 5, and 200 mg daily thereafter. Doses may be adjusted based on therapeutic response and tolerability, not to exceed recommended maximums. Tablets should be swallowed whole; chewable tablets may be swallowed whole, chewed, or dispersed in liquid.

Precautions

Patients should be closely monitored for signs of serious skin rashes, including Stevens-Johnson syndrome and toxic epidermal necrolysis, especially during the initial titration period. Blood dyscrasias, including leukopenia and anemia, have been reported; periodic blood counts may be advisable. Lamictal may cause dizziness, drowsiness, or blurred vision—caution is advised when operating machinery. Suicidal thoughts or behavior may occur; patients should be monitored for emergence or worsening of depression or unusual changes in mood or behavior. Use with caution in patients with renal, hepatic, or cardiac impairment. Abrupt withdrawal may increase seizure frequency; discontinue gradually unless safety concerns require immediate cessation.

Contraindications

Hypersensitivity to lamotrigine or any component of the formulation. History of serious rash or hypersensitivity reaction to Lamictal.

Possible side effect

Common: dizziness, headache, diplopia, ataxia, nausea, drowsiness, blurred vision, rash.
Serious: Stevens-Johnson syndrome, toxic epidermal necrolysis, drug reaction with eosinophilia and systemic symptoms (DRESS), hemophagocytic lymphohistiocytosis, aseptic meningitis, multiorgan failure, blood dyscrasias, suicidal behavior and ideation. Patients should seek immediate medical attention for rash, fever, swollen lymph nodes, or signs of hypersensitivity.

Drug interaction

Valproate increases lamotrigine concentrations—dose adjustments are necessary. Carbamazepine, phenytoin, phenobarbital, primidone, rifampin, and oral contraceptives containing estrogen may decrease lamotrigine levels. Lamotrigine may reduce concentrations of valproate. Use with other CNS depressants may enhance sedative effects. Caution with other sodium channel blockers.

Missed dose

If a dose is missed, take it as soon as remembered unless it is almost time for the next dose. Do not double the dose to catch up. Resume the regular dosing schedule. Consult a healthcare provider if multiple doses are missed, as retitration may be necessary.

Overdose

Symptoms may include ataxia, nystagmus, increased seizures, decreased level of consciousness, coma, intraventricular conduction delay. Management is supportive; gastric lavage may be beneficial if performed soon after ingestion. Hemodialysis may be of limited utility due to high protein binding. Contact a poison control center immediately.

Storage

Store at 20°C to 25°C (68°F to 77°F); excursions permitted between 15°C and 30°C (59°F and 86°F). Keep in original container, tightly closed, and protect from light and moisture. Keep out of reach of children and pets.

Disclaimer

This information is for educational purposes only and is not a substitute for professional medical advice, diagnosis, or treatment. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition or medication. Do not disregard professional medical advice or delay in seeking it because of something you have read here.

Reviews

Clinical studies and patient reports generally indicate that Lamictal is effective in reducing seizure frequency and stabilizing mood in bipolar disorder. Many patients appreciate its relatively favorable side effect profile compared to older anticonvulsants. However, the risk of serious rash requires careful titration and monitoring. Individual experiences may vary, and adherence to prescribed dosing under medical supervision is critical for optimal outcomes.