Lamotrigine (Lamictal® and generic forms) belongs to a group of medications called “anticonvulsants” and “mood stabilizers.”

What is this medication used for?

Lamotrigine is approved by Health Canada for the treatment of seizure disorders (epilepsy) in children 2 years of age and older.

When potential benefits outweigh risks, lamotrigine may be prescribed “off-label” for treatment of episodes of depression (low mood) associated with bipolar disorder, and preventing future depressive or manic episodes associated with bipolar disorder. Learn more about off-label medication use: http://bit.ly/KMH-off-label-use

Tell your doctor or pharmacist if you:

• Have allergies or bad reactions to a medication
• Take (or plan to take) other prescription or non- prescription medications, including natural medicines. Some medications interact with lamotrigine. Your doctor may adjust medication doses or monitor for side effects
• Have a history of heart, kidney or liver disease, seizures, blood disorders, or skin reactions to medications
• Miss a menstrual period, are pregnant, breast-feeding or planning a pregnancy
• Use alcohol or drugs. Taking lamotrigine together with certain substances may cause a bad reaction. Learn more at www.DrugCocktails.ca

When will the medication start to work?

When used to control a depressive episode, lamotrigine needs to be taken for several weeks before you notice an improvement in symptoms. A delay in response is normal.

It is important that you continue taking lamotrigine regularly, even if you are feeling well or there are no improvements in the first few weeks. Talk with your doctor if you feel that lamotrigine has not been helpful after 8 weeks of therapy or if side effects are too bothersome. Your doctor may recommend switching you to a different medication.

This medication is not addictive. Do not stop taking it before talking to your doctor.

How do I take this medication?

Lamotrigine is usually taken once or twice a day, at the same time(s) each day. You may take it with or without food. Usually, you will start with a low dose and slowly increase this dose over several days or weeks, based on how you tolerate it. It is important to follow the dosing schedule given by your doctor to decrease your risk of severe reactions.

There are several forms of lamotrigine: regular tablets and chewable / dispersible tablets. The regular tablets should be swallowed whole with water, and not chewed, crushed or split. The chewable/dispersible tablet may be swallowed whole, chewed or dissolved in liquid. To dissolve the tablet, place it in a glass with a teaspoon of water or diluted fruit juice. Wait 1 minute until the tablets are dissolved and then mix the solution well and drink immediately.

Possible common or serious side effects:

Side effects may be more common when starting a medication or after a dose increase. Talk to your doctor, nurse or pharmacist if any side effect concerns you.

• Dizziness, drowsiness, poor coordination or headache
• Double vision or blurred vision
• Flu-like symptoms
• Nasal congestion
• Stomach ache, nausea, vomiting or diarrhea

Contact your doctor immediately if you experience:

• Rash, swollen glands, hives, sore mouth or eyes, swelling of lips or tongue
• Appearance of worsening of vocal or motor tics, such as shrugging, blinking, head turning or muscle twitches
• Fever, nausea, vomiting, headache or stiff neck
• Increased agitation or nervousness
• Increased frequency of seizures
• Thoughts of hurting yourself, suicide, increased hostility or worsening symptoms

What precautions should my doctor and I be aware of when taking this medication?

• Lamotigine can cause a rare side effect developing a serious rash that may involve larger areas of the body or mucus membranes (such as eyelids, nostrils, mouth, genitals). This usually also includes a fever. It is important to seek medical advice immediately if you develop any rash or skin reaction while taking lamotrigine.
• To reduce the risk of developing a rash, during the first 3 months after starting lamotrigine take some precautions. Do not start any new medications, eating new or unfamiliar foods, or using new cosmetics, conditioners, deodorants, detergents or fabric softeners. Use sunscreen to avoid sunburn. Do not start lamotrigine within 2 weeks of having a rash, viral illness or vaccination. Be careful to avoid poison oak/ivy exposure.
• Many medications may interact with lamotrigine, including birth control pills, acetaminophen, anticonvulsants, antidepressants, caffeine and several others. If you are (or begin) taking any other prescription, over-the-counter medication, natural health product or supplement, check with your doctor or pharmacist to see if they are safe to use.
• While taking this medication, if you feel dizzy, drowsy or slowed down, do not drive a car or operate heavy machinery. Alcohol could make this worse. Try to avoid alcohol while taking lamotrigine.

How does this medication work?

Lamotrigine affects levels of the brain chemical glutamate. This has a “stabilizing” effect on nerves, which helps reduce the spread of seizure activity in the brain and severe mood fluctuations (such as mania or depression) associated with bipolar disorder. The exact way that lamotrigine improves symptoms of bipolar disorder is not fully known.

What special instructions should I follow while using this medication?

• Keep all appointments with your doctor and the lab. Your doctor may order lab tests to check how you are responding to lamotrigine.
• Your doctor may want to talk to you within a few weeks of starting lamotrigine, and meet with you over time to make sure it’s working well for you and check for side effects.
• Do not allow anyone else to use your medication.

What should I do if I forget to take a dose of this medication?

If you take lamotrigine regularly and forget to take a dose, take the missed dose as soon as you remember. However, if it is within 4 hours of your next scheduled dose, skip the missed dose and continue with your regular schedule. DO NOT double your next dose to try to ‘catch up’. If you miss taking lamotrigine for more than 3 days, contact your doctor.

How do I store this medication?

Keep this medication in the original container, stored at room temperature away from moisture and heat and protected from light. Keep this medication out of reach and sight of children.

How well does the medication work in children and adolescents?

Evidence from adults shows that lamotrigine may be especially helpful for treating and preventing depressive episodes associated with bipolar disorder. It may also prevent future episodes of depression or mania from occurring. Lamotrigine may be used alone or in combination with other mood stabilizers to manage bipolar disorder. When effective, lamotrigine helps to stabilize mood, control motions and improve overall functioning. It may be particularly helpful for people who have more than four mood episodes per year (rapid cycling) or those who have aggressive behaviours.

How long should I take the medication for?

This depends on the symptoms you have, how frequently they occur, and how long you have had them. Most people who have bipolar disorder need to take lamotrigine for at least 6 months. This allows time for symptoms to stabilize and for function to improve.

Your doctor will discuss the benefits and risks of taking lamotrigine with you. At this time, you can also discuss how long you might need to take this medication. If you have had several episodes of depression or mania and you tolerate this medication well, you may be asked to take this medication on an ongoing basis.

Do not increase, decrease, or stop taking this medication without discussing it with your doctor. If you stop taking lamotrigine suddenly, it is possible that your symptoms may return or you may experience a seizure.