Epilepsy Support Group

Raising Awareness Through The Sharing Of Information

Lamictal / Lamotrigine

Lamictal (lah-MIK-tal) is the brand name used in the United States, Canada, the UK, Australia, and other countries for the seizure medicine lamotrigine (lah-MO-trih-jeen).

Lamictal was approved by the U.S. Food and Drug Administration (FDA) in 1994 for the treatment of partial seizures and secondarily generalized seizures in adults, and in 1998 as an add-on treatment for generalized seizures associated with Lennox-Gastaut syndrome. It is now approved for both these uses for children as young as 2 years old. More recently, the FDA approved Lamictal to be used alone under certain circumstances.

Forms
Lamictal is marketed in the United States by GlaxoSmithKline. The name or appearance may differ in other places. The dose (measured in milligrams, abbreviated "mg") will usually be the same. These descriptions apply to the U.S. versions:

Regular tablets

25-mg (white, scored, shield-shaped)
Tablets marked "LAMICTAL" and "25"
100-mg (peach-colored, scored, shield-shaped)
Tablets marked "LAMICTAL" and "100"
150-mg (cream-colored, scored, shield-shaped)
Tablets marked "LAMICTAL" and "150"

200-mg (blue, scored, shield-shaped)
Tablets marked "LAMICTAL" and "200"

 

Chewable Dispersible Tablets
All Lamictal tablets of this kind are small and white, but they have different shapes and markings:

2-mg (white to off-white, round)
Tablets marked with "LTG 2"
5-mg (white to off-white, caplet-shaped)
Tablets marked with "GX CL2"
25-mg (white, rounded-square-shaped)
Tablets marked with "GX CL5"

Lamictal is not available in generic formulations.

Follow your doctor's directions. Call if you have any questions. The doctor probably will prescribe a low dose (25 mg) to start with, and will create a schedule that gradually increases the dose until you reach the desired level. Make sure you follow the schedule closely to avoid the possibility of a serious rash. Ask the doctor what to do if you forget to take a dose.

It's OK to take Lamictal either with food or without food, but it's best to be consistent from day to day. People who usually take Lamictal with food should try to do that all the time, because it affects the way the medicine is used by the body.

If your prescription is for regular Lamictal tablets, swallow them whole. Chewing them may leave a bitter taste. All the tablets of this type are shaped like a shield and marked with the name "LAMICTAL" and the number of milligrams in the dose.

If your prescription is for chewable dispersible tablets, you can swallow them whole, chew them, or mix them in water or diluted fruit juice. If you chew these tablets, you probably will want to drink a little water or diluted juice to help you swallow. To mix them in liquid, add the tablets to a small amount of liquid (1 teaspoon, or enough to cover the tablets) in a glass or spoon. Wait about 1 minute, until the tablets are completely dispersed. Then mix the solution and drink the entire amount immediately.

Be careful if the doctor writes a new prescription using a different kind of pill. For example, if you've been taking 100-mg tablets and the new prescription is for 150-mg tablets, be careful to take the correct number. Don't automatically continue to take the same number of pills as before.

Take only the number of tablets that your doctor tells you to take. If you think you've taken one or two extra tablets, call the doctor for advice. For a larger overdose, call your local poison control center or emergency room right away.

Store Lamictal tablets at room temperature away from heat, light, and moisture. Always keep them out of the reach of children.

What if I forget?
In general, if you forget a dose, take it as soon as you remember. If it is almost time for the next dose, delay that dose for a few hours, instead of taking two doses very close together.

Do your best to follow the doctor's directions. If you forget doses often, it may be a good idea to get a special pillbox or watch with an alarm to remind you.

Taking the right amount of seizure medicine on time every single day is the most important step in preventing seizures!

Lamictal (lamotrigine) is successful at controlling a broad range of seizure disorders. It was first approved as adjunctive (add-on) therapy for adults with partial epilepsy, but now it is also approved for use by children over 2 years of age. Lamictal is also one of the few drugs approved by the U.S. Food and Drug Administration (FDA) as adjunctive therapy for the Lennox-Gastaut syndrome in children and adults. In September of 2006, Lamictal was approved as add-on therapy for primary generalized tonic-clonic seizures in adults and children 2 years and older. It is also used for atonic seizures, and juvenile myoclonic epilepsy syndromes.

Lamictal is also approved by the FDA when withdrawn to monotherapy for the treatment of partial seizures. This means that if someone already taking another seizure medicine starts taking Lamictal, then the first medicine can be gradually stopped, leaving the person taking Lamictal by itself.

Lamictal is also used to treat absence, myoclonic, and tonic-clonic seizures. It is effective against some seizure types in patients with Lennox-Gastaut syndrome and other forms of symptomatic generalized epilepsy. In one study using Lamictal as add-on therapy for patients with Lennox-Gastaut syndrome, 23% more patients who took Lamictal (compared to a placebo) had the number of their tonic-clonic seizures cut at least in half. Nearly half of the patients who took the Lamictal had less than a 25% decrease in these seizures, however.

No single combination of antiepileptic medications is perfect for everyone. Sometimes a series of combinations must be tried before finding what is best for the individual. Many seizure medicines affect the way the body metabolizes Lamictal, so the dosage must be adjusted if it is given as add-on therapy in combination with these medications.

Studies have also looked at the effectiveness of Lamictal used alone. In one study, patients with newly diagnosed epilepsy were treated with either Lamictal or carbamazepine (Tegretol, Carbatrol). A similar study compared Lamictal to phenytoin (Dilantin, Phenytek). The patients in these studies had partial seizures with or without secondary generalization, or they had primary generalized tonic-clonic seizures. In each study, the effect on the frequency of each seizure type was almost the same for both medications, but the patients taking Lamictal had fewer problems with side effects.

Most people who take Lamictal don't have too much trouble with side effects. The most common complaints include:

  • dizziness
  • upset stomach
  • headache
  • unsteadiness
  • double vision
  • rash


Most of these problems are mild to moderate.

On the positive side, people who take Lamictal report less tiredness than with all but a few other seizure medicines. In fact, it's slightly stimulating for many people, which is usually a welcome side effect. It could be a problem, however, if it causes insomnia (sleeplessness), which can trigger seizures.

About 10% of patients experience a rash. The vast majority of these rashes are not serious. They most often occur in the first 6 weeks of treatment, so during this time, patients should be aware of any skin problems.

Some other side effects mentioned even less often were:

  • serious rash
  • insomnia (sleeplessness)
  • poor concentration
  • loss of appetite
  • vision problems

If you notice problems like any of these while you are taking Lamictal, it's probably a good idea to discuss them with your doctor or nurse. Sometimes the doctor can help with side effects by changing the prescription:

  • reducing the overall amount of Lamictal
  • changing the amount taken at certain times, such as taking a greater proportion of the Lamictal in the morning to reduce nighttime sleeplessness
  • prescribing smaller doses, to be taken more often Don't stop taking Lamictal or change the amount you take or when you take it without your doctor's guidance.

Some people who take Lamictal together with carbamazepine (Tegretol, Carbatrol) or oxcarbazepine (Trileptal) find they have fewer side effects if they take the two medicines 1 to 2 hours apart instead of at the same time. Check with your doctor to see if this is advisable for you.

Allergic reactions
Approximately 1 in 10 people who take Lamictal have a red rash within the first 6 weeks of taking it. If this happens, tell the doctor or nurse right away, to be sure that it's not the beginning of a serious problem. It's rare for the rash to be serious, but don't ignore it. It's often necessary to switch to a different seizure medicine.

Long-term side effects
The long-term side effects of Lamictal are unknown.

More serious reactions do occur very rarely. The most important is a serious rash that may need to be treated in the hospital. Some patients develop a rash called Stevens-Johnson syndrome, which can be fatal.

Here's a list of symptoms that may be the start of a serious problem. If you notice any of these symptoms, call your doctor right away:

  • Rash or hives
  • Fever and swollen lymph glands
  • Painful sores in the mouth or around the eyes
  • Swelling of lips or tongue

 

Common off-label uses of Lamictal include:

  • certain kinds of pain directly involving nerves
  • a type of facial pain called trigeminal neuralgia

 

Any time a doctor suggests a new prescription, be sure to talk about what other medicines, supplements, herbs, and vitamins are already being taken. Sometimes one kind of medicine changes the way another kind of medicine works in the body. If two kinds of medicine affect each other, the doctor may prescribe something else or change the amount to be taken.

How does Lamictal affect other medicines?
Lamictal has no effect on other seizure medicines.

How do other seizure medicines affect Lamictal?
Some other seizure medicines do affect the level of Lamictal in the body, either raising it or lowering it. Many of these interactions vary from person to person, however. Some may even vary from time to time for the same person. Make sure that your doctor is aware of all the seizure medicines you're using.

A few seizure medicines may reduce the level of Lamictal in the blood (only if valproate is not also being taken):

  • carbamazepine (Tegretol, Tegretol XR, Carbatrol)
  • phenytoin (Dilantin, Phenytek)
  • phenobarbital
  • primidone (Mysoline)

 

The seizure medicine that increases the blood level of Lamictal is:

 

  • valproate (Depakote, Depakene, valproic acid)

 

IMPORTANT!!!

Recently, the North American AED Pregnancy Registry, located at Massachusetts General Hospital in Boston, Massachusetts, found that infants who are exposed to lamotrigine as monotherapy during pregnancy (lamotrigine was used as the only AED by the mother) have a much higher risk of having an oral cleft problem, than infants born to women in a comparison group and who were not exposed to lamotrigine during pregnancy. Oral cleft problems are birth defects that may involve the lip (cleft lip), the palate (cleft palate), or both. During pregnancy, the normal openings between the upper lip and the nose (seen with cleft lip) or between the roof or back of the mouth and the nose (seen in cleft palate) may not close properly. These problems can often be seen with ultrasound testing and can usually be corrected after birth with surgery.

In this study, of 564 women who received lamotrigine alone, 5 instances of isolated cleft lip or palate (not seen as part of any specific syndrome) were seen in the babies. This data gives a prevalence rate of 8.9 per 1000, which means that oral cleft problems may occur in 8.9 of 1000 women treated with lamotrigine monotherapy. This number is 24 times higher than the risk of oral cleft problems seen in babies from the comparison group used in the study.

This information should be interpreted with caution and further analysis is underway. Women taking lamotrigine should talk to their doctors if they become pregnant or are considering pregnancy, and discuss the risks and benefits of taking lamotrigine during pregnancy. The manufacturer of Lamictal, the brand name version of lamotrigine, has stated that "Lamictal should be used during pregnancy only if the potential benefit justifies the potential risk to the fetus".

Pregnancy Category C. This indicates that caution is advised, but the benefits of the medication may outweigh the potential risks. So far there is no indication that Lamictal causes serious birth defects, but there have been no well-controlled studies in women, and studies in animals have shown some harm to the fetus.