lamotrigine (Rx)

Brand and Other Names:Lamictal, Lamictal XR, more...Lamictal ODT
  • Print

Dosing & Uses

AdultPediatric

Dosage Forms & Strengths

tablet

  • 25mg
  • 100mg
  • 150mg
  • 200mg

tablet, chewable

  • 2mg
  • 5mg
  • 25mg

tablet, oral-disintegrating

  • 25mg
  • 50mg
  • 100mg
  • 200mg

tablet, extended-release

  • 25mg
  • 50mg
  • 100mg
  • 200mg
  • 250mg
  • 300mg

Seizure Disorder

With enzyme-inducing AEDs but without valproic acid

  • Initial: 50 mg PO qDay for 2 weeks, THEN
  • 100 mg/day divided q12hr for 2 weeks
  • At week 5 and beyond, may increase by 100 mg/day PO q1-2Week to 300-500 mg/day PO divided q12hr
  • Lamotrigine XR: Start 50 mg PO qDay (weeks 1 and 2), THEN 100 mg qDay (weeks 3 and 4), THEN increase by 100 mg/day PO qWeek through week 7 (400 mg qDay); maintenance dose (week 8+): 400-600 mg PO qDay

With valproic acid

  • Initial: 25 mg PO qODay for 2 weeks, THEN
  • 25 mg PO qDay for 2 weeks
  • At 5 weeks may increase by 25-50 mg/day q1-2Week to 100-400 mg/day qDay or divided q12hr
  • With valproate alone: 100-200 mg/day PO
  • Lamotrigine XR: Start 25 mg PO qODay for 2 weeks, THEN 25 mg PO qDay for 2 weeks, THEN 50 mg PO qDay (week 5), 100 mg PO qDay (week 6), 150 mg PO qDay (week 7), to maintenance (200-250 mg PO qDay)

Without enzyme-inducing AEDs or valproic acid

  • Initial: 25 mg PO qDay for 2 weeks, THEN
  • 50 mg/day PO for 2 weeks
  • After 4 weeks may increase by 50 mg/day q1-2Week to 225-375 mg/day divided q12hr
  • Lamotrigine XR: Start 25 mg PO qDay for 2 weeks, THEN 50 mg PO qDay for 2 weeks, THEN 100 mg qDay (week 5), 150 mg qDay (week 6), 200 mg qDay (week 7), to maintenance (300-400 mg PO qDay)

Partial-Onset Seizures (Conversion to Monotherapy)

Taking valproic acid, conversion to immediate-release lamotrigine

  • Initiate and titrate to lamotrigine dose of 200 mg/day, THEN
  • Decrease valproic acid dose by 500 mg/day at intervals of 1 week or longer to valproic acid dose of 500 mg/day; maintain this dose for 1 week, THEN
  • Increase lamotrigine dose to 300 mg while valproic acid is decreased to 250 mg/day; maintain this dose for 1 week, THEN
  • Discontinue valproic acid
  • Increase lamotrigine dose by 100 mg/day at weekly intervals to achieve a maintenance dose of 500 mg/day

Taking valproic acid, conversion to extended-release lamotrigine

  • Conversion to monotherapy for patients taking 1 anticonvulsant drug
  • Weeks 1-2: 25 mg PO qODay
  • Weeks 3-4: 25 mg PO qDay
  • Week 5: 50 mg PO qDay
  • Week 6: 100 mg PO qDay
  • Weeks 7-10: 150 mg PO qDay; begin valproic acid withdrawal over 5-7 weeks to 500mg/day and maintain for 1 week
  • Week 11: 200 mg PO qDay; decrease valproic acid dose to 250 mg/day for 1 week
  • Weeks 12-23: 250-300 mg PO qDay; discontinue valproic acid

Taking carbamazepine, phenytoin, phenobarbital, or primidone (conversion to immediate-release lamotrigine)

  • Initiate and titrate to lamotrigine dose of 500 mg/day as per recommendations
  • Decrease concomitant enzyme-inducing AED by 20% each week over a 4-week period and then withdraw

Taking neutral AED, conversion to extended-release lamotrigine

  • Conversion to monotherapy for patients taking 1 anticonvulsant drug
  • Weeks 1-2: 25 mg PO qDay
  • Weeks 3-4: 50 mg PO qDay
  • Week 5: 100 mg PO qDay
  • Week 6: 150-200 mg PO qDay
  • Weeks 7-23: 250-300 mg PO qDay; begin AED withdrawal over 5-week period by weekly 20% decreases in daily dose

Conversion from immediate-release to extended-release lamotrigine

  • Dose of extended-release lamotrigine should equal the total daily dose of the immediate-release formulation
  • Adjust dose as needed within recommended dosing

Bipolar Disorder

Indicated for maintenance treatment of bipolar I disorder to delay the time to occurrence of mood episodes (depression, mania, hypomania, mixed episodes) in patients treated for acute mood episodes with standard therapy

Efficacy and safety have not been established for treatment of acute manic or mixed episodes

Monotherapy or without enzyme inducers or valproic acid

  • Initial: 25 mg PO qDay for 2 weeks, THEN
  • 50 mg PO qDay for 2 weeks
  • 100 mg PO qDay for 1 week
  • Double dose qWeek to maintenance at 200 mg/day PO

With AED regimen without valproic acid

  • Initial: 50 mg PO qDay for 2 weeks, THEN
  • 100 mg/day PO divided q12hr for 2 weeks
  • Increase by 100 mg qWeek to 400 mg/day PO divided q12hr

With valproic acid

  • Initial: 25 mg PO qODay for 2 weeks, THEN
  • 25 mg PO qDay for 2 weeks
  • Double dose qWeek to maintenance at 100 mg/day PO

Dosing Modifications

Renal impairment

  • Use caution; may consider reduce the dose in significant renal impairment

Hepatic impairment

  • Limited data, various recommendations
  • Manufacturer: Decrease dose by 25% (moderate-severe without ascites) or by 50% (severe with ascites)
  • Other (eg, AHSP): Decrease dose by 50% (Child-Pugh class B) or by 75% (Child-Pugh class C)

Dosage Forms & Strengths

tablet

  • 25mg
  • 100mg
  • 150mg
  • 200mg

tablet, chewable

  • 2mg
  • 5mg
  • 25mg

tablet, oral-disintegrating

  • 25mg
  • 50mg
  • 100mg
  • 200mg

tablet, extended-release

  • 25mg
  • 50mg
  • 100mg
  • 200mg
  • 250mg
  • 300mg

Seizure Disorder

With enzyme-inducing AED and no valproic acid (age 2-12 yr)

  • Initial: 0.6 mg/kg/day PO divided q12hr for 2 weeks, THEN  
  • 1.2 mg/kg/day PO divided q12hr for 2 weeks
  • At 5 weeks increase by 1.2 mg/kg q1-2Week to maintenance dose of 5-15 mg/kg/day PO divided q12hr
  • Not to exceed 400 mg/day PO divided q12hr

With valproic acid (age <2 years)

  • Safety and efficacy has not been established

With valproic acid (age 2-12 yr)

  • Initial: 0.15 mg/kg/day PO qDay or divided q12hr for 2 weeks, THEN  
  • 0.3 mg/kg/day PO qDay or divided q12hr for 2 weeks
  • At 5 weeks increase by 0.3 mg/kg q1-2Week to maintenance dose of 1-5 mg/kg/day PO qDay or divided q12hr; not to exceed 200 mg/day
  • Alternatively, 1-3 mg/kg/day PO with valproic acid only

With valproic acid (age >12 yr)

  • Initial: 25 mg PO qOD for 2 weeks, THEN
  • 25 mg PO qDay for 2 weeks
  • At 5 weeks may increase by 25-50 mg/day q1-2Week to 100-400 mg/day PO qDay or divided q12hr
  • 100-200 mg/day PO with valproate alone
  • Lamotrigine XR: Start 25 mg PO qODay for 2 weeks, THEN 25 mg PO qDay for 2 weeks, THEN 50 mg qDay (week 5), 100 mg qDay (week 6), 150 mg qDay (week 7); THEREAFTER 200-250 mg PO qDay

Without valproic acid or AED (age <2 yr)

  • Safety and efficacy not established

Without valproic acid or AED (age 2-12 yr)

  • Initial: 0.3 mg/kg/day PO qDay or divided q12hr for 2 weeks, THEN  
  • 0.6 mg/kg/day PO qDay or divided q12hr for 2 weeks, THEN
  • At 5 weeks increase by 0.6 mg/kg q1-2Week to maintenance dose of 4.5-7.5 mg/kg/day PO qDay or divided q12hr; not to exceed 300 mg/day

Without valproic acid or AED (age >12 yr)

  • Initial: 25 mg PO qDay for 2 weeks, THEN
  • 50 mg/day PO for 2 weeks
  • At 5 weeks may increase by 50 mg/day q1-2Week to 225-375 mg/day PO divided q12hr
  • Lamotrigine XR: Start 25 mg PO qDay for 2 weeks, THEN 50 mg PO qDay for 2 weeks, THEN 100 mg qDay (week 5), 150 mg qDay (week 6), 200 mg qDay (week 7); THEREAFTER 300-400 mg PO qDay

Partial-Onset Seizures (Conversion to Monotherapy)

Taking valproic acid, conversion to immediate-release lamotrigine (age >16 yr)

  • Initiate and titrate to lamotrigine dose of 200 mg/day, THEN
  • Decrease valproic acid dose by 500 mg/day at intervals of 1 week or longer to valproic acid dose of 500 mg/day; maintain this dose for 1 week, THEN
  • Increase lamotrigine dose to 300 mg while valproic acid is decreased to 250 mg/day; maintain this dose for 1 week, THEN
  • Discontinue valproic acid
  • Increase lamotrigine dose by 100 mg/day at weekly intervals to achieve a maintenance dose of 500 mg/day

Taking valproic acid, conversion to extended-release lamotrigine (age >13 yr)

  • Conversion to monotherapy for patients taking 1 anticonvulsant drug
  • Weeks 1-2: 25 mg PO qODay
  • Weeks 3-4: 25 mg PO qDay
  • Week 5: 50 mg PO qDay
  • Week 6: 100 mg PO qDay; begin valproic acid withdrawal over 5-7 weeks
  • Weeks 7-10: 150 mg PO qDay
  • Week 11: 200 mg PO qDay
  • Weeks 12-23: 250-300 mg PO qDay

Taking carbamazepine, phenytoin, phenobarbital, or primidone (conversion to immediate-release lamotrigine)

  • Age >16 years: Initiate and titrate to lamotrigine dose of 500 mg/day as per recommendations; decrease concomitant enzyme-inducing AED by 20% each week over a 4-week period and then withdraw

Taking neutral AED, conversion to extended-release lamotrigine (age >13 yr)

  • Conversion to monotherapy for patients taking 1 anticonvulsant drug
  • Weeks 1-2: 25 mg PO qDay
  • Weeks 3-4: 50 mg PO qDay
  • Week 5: 100 mg PO qDay
  • Week 6: 150-200 mg PO qDay
  • Weeks 7-23: 250-300 mg PO qDay; begin AED withdrawal over 5-week period by weekly 20% decreases in daily dose

Dosing Considerations

Approved indications

  • Lamictal XR (>13 years): Add-on therapy for primary generalized tonic-clonic seizures or partial seizures
  • Lamictal XR (>13 years): Partial seizures; conversion to monotherapy in patients >13 years with partial seizures taking 1 AED; safety and efficacy has not been established as initial monotherapy or for simultaneous conversion to monotherapy from 2 or more concomitant AEDs
  • Lamictal tablets, chewable tablet, or ODT (>2 years): Adjunctive treatment for partial seizures, primary generalized tonic-clonic seizures, generalized seizures of Lennox-Gastaut syndrome
  • Lamictal tablets, chewable tablet, or ODT (>16 years): Conversion to monotherapy in partial seizures
  • Lamictal tablets, chewable tablet, or ODT (>18 years): Bipolar I disorder
Next:

Interactions

Interaction Checker

and lamotrigine

No Results

     activity indicator 
    No Interactions Found
    Interactions Found

    Contraindicated

      Serious - Use Alternative

        Significant - Monitor Closely

          Minor

            All Interactions Sort By:
             activity indicator 

            Contraindicated (2)

            • cabotegravir

              lamotrigine will decrease the level or effect of cabotegravir by increasing metabolism. Contraindicated. Cabotegravir is metabolized by UGT1A1 and UGT1A9. Strong UGT1A1 or UGT1A9 inducers decrease cabotegravir systemic exposure, thereby increasing potential for loss of virologic response.

            • dofetilide

              lamotrigine will increase the level or effect of dofetilide by Other (see comment). Contraindicated. Lamotrigine may significantly increase dofetilide serum concentrations by inhibiting OCT2

            Serious - Use Alternative (1)

            • metoclopramide intranasal

              lamotrigine, metoclopramide intranasal. Either increases effects of the other by Other (see comment). Avoid or Use Alternate Drug. Comment: Avoid use of metoclopramide intranasal or interacting drug, depending on importance of drug to patient.

            Monitor Closely (56)

            • atazanavir

              atazanavir will decrease the level or effect of lamotrigine by increasing metabolism. Use Caution/Monitor. Interaction is of greater clinical significance with ritonavir-boosted atazanavir than with unboosted atazanavir

            • bazedoxifene/conjugated estrogens

              bazedoxifene/conjugated estrogens decreases levels of lamotrigine by increasing hepatic clearance. Use Caution/Monitor.

            • brexanolone

              brexanolone, lamotrigine. Either increases toxicity of the other by sedation. Use Caution/Monitor.

            • cannabidiol

              cannabidiol will increase the level or effect of lamotrigine by Other (see comment). Modify Therapy/Monitor Closely. Cannabidiol may potentially inhibit UGT2B7 activity. Consider reducing the dose when concomitantly using UGT2B7 substrates.

            • carbamazepine

              carbamazepine decreases levels of lamotrigine by increasing metabolism. Use Caution/Monitor.

            • cenobamate

              cenobamate will decrease the level or effect of lamotrigine by unspecified interaction mechanism. Modify Therapy/Monitor Closely. Based on population PK analyses, coadministration of lamotrigine with cenobamate may lead to a 21-52% decrease in lamotrigine concentration. Increase lamotrigine dosage as needed when used concomitantly with cenobamate.

            • citalopram

              lamotrigine increases toxicity of citalopram by unspecified interaction mechanism. Modify Therapy/Monitor Closely. CNS depressants may increase the toxic effects of selective serotonin reuptake inhibitors; psychomotor impairment may be enhanced.

            • conjugated estrogens

              conjugated estrogens decreases levels of lamotrigine by increasing hepatic clearance. Use Caution/Monitor.

            • conjugated estrogens, vaginal

              conjugated estrogens, vaginal decreases levels of lamotrigine by increasing hepatic clearance. Use Caution/Monitor.

            • daridorexant

              lamotrigine and daridorexant both increase sedation. Modify Therapy/Monitor Closely. Coadministration increases risk of CNS depression, which can lead to additive impairment of psychomotor performance and cause daytime impairment.

            • desogestrel

              desogestrel will decrease the level or effect of lamotrigine by increasing hepatic clearance. Use Caution/Monitor. Combination oral contraceptives have been shown to significantly decrease plasma concentrations of lamotrigine, likely due to induction of lamotrigine glucuronidation.

            • deutetrabenazine

              lamotrigine and deutetrabenazine both increase sedation. Use Caution/Monitor.

            • dienogest/estradiol valerate

              dienogest/estradiol valerate decreases levels of lamotrigine by Other (see comment). Use Caution/Monitor. Comment: Mechanism: likely due to induction of lamotrigine glucuronidation; dosage adjustments may be necessary for proper seizure control.

              dienogest/estradiol valerate will decrease the level or effect of lamotrigine by increasing hepatic clearance. Use Caution/Monitor. Combination oral contraceptives have been shown to significantly decrease plasma concentrations of lamotrigine, likely due to induction of lamotrigine glucuronidation.

            • difelikefalin

              difelikefalin and lamotrigine both increase sedation. Use Caution/Monitor.

            • divalproex sodium

              divalproex sodium will increase the level or effect of lamotrigine by decreasing metabolism. Modify Therapy/Monitor Closely.

            • drospirenone

              drospirenone will decrease the level or effect of lamotrigine by increasing hepatic clearance. Use Caution/Monitor. Combination oral contraceptives have been shown to significantly decrease plasma concentrations of lamotrigine, likely due to induction of lamotrigine glucuronidation.

            • escitalopram

              lamotrigine increases toxicity of escitalopram by unspecified interaction mechanism. Modify Therapy/Monitor Closely. CNS depressants may increase the toxic effects of selective serotonin reuptake inhibitors; psychomotor impairment may be enhanced.

            • esketamine intranasal

              esketamine intranasal, lamotrigine. Either increases toxicity of the other by sedation. Use Caution/Monitor.

            • estradiol

              estradiol decreases levels of lamotrigine by increasing hepatic clearance. Use Caution/Monitor.

            • estrogens conjugated synthetic

              estrogens conjugated synthetic decreases levels of lamotrigine by increasing hepatic clearance. Use Caution/Monitor.

            • estrogens esterified

              estrogens esterified decreases levels of lamotrigine by increasing hepatic clearance. Use Caution/Monitor. Concurrent use may cause lamotrigine levels to decrease by almost 50%. Dose adjustment is required.

            • estropipate

              estropipate decreases levels of lamotrigine by increasing hepatic clearance. Use Caution/Monitor.

            • ethinylestradiol

              ethinylestradiol decreases levels of lamotrigine by increasing hepatic clearance. Use Caution/Monitor. Combination oral contraceptives have been shown to significantly decrease plasma concentrations of lamotrigine, likely due to induction of lamotrigine glucuronidation.

            • ethotoin

              ethotoin decreases levels of lamotrigine by increasing metabolism. Use Caution/Monitor.

            • etonogestrel

              etonogestrel will decrease the level or effect of lamotrigine by increasing hepatic clearance. Use Caution/Monitor. Combination oral contraceptives have been shown to significantly decrease plasma concentrations of lamotrigine, likely due to induction of lamotrigine glucuronidation.

            • fluoxetine

              lamotrigine increases toxicity of fluoxetine by unspecified interaction mechanism. Modify Therapy/Monitor Closely. CNS depressants may increase the toxic effects of selective serotonin reuptake inhibitors; psychomotor impairment may be enhanced.

            • fluvoxamine

              lamotrigine increases toxicity of fluvoxamine by serotonin levels. Modify Therapy/Monitor Closely. psychomotor impairment may be enhanced.

            • fosphenytoin

              fosphenytoin decreases levels of lamotrigine by increasing metabolism. Use Caution/Monitor.

            • ganaxolone

              lamotrigine and ganaxolone both increase sedation. Use Caution/Monitor.

            • lasmiditan

              lasmiditan, lamotrigine. Either increases effects of the other by sedation. Use Caution/Monitor. Coadministration of lasmiditan and other CNS depressant drugs, including alcohol have not been evaluated in clinical studies. Lasmiditan may cause sedation, as well as other cognitive and/or neuropsychiatric adverse reactions.

            • lemborexant

              lemborexant, lamotrigine. Either increases effects of the other by sedation. Modify Therapy/Monitor Closely. Dosage adjustment may be necessary if lemborexant is coadministered with other CNS depressants because of potentially additive effects.

            • levonorgestrel intrauterine

              levonorgestrel intrauterine will decrease the level or effect of lamotrigine by increasing hepatic clearance. Use Caution/Monitor. Combination oral contraceptives have been shown to significantly decrease plasma concentrations of lamotrigine, likely due to induction of lamotrigine glucuronidation.

            • levonorgestrel oral

              levonorgestrel oral will decrease the level or effect of lamotrigine by increasing hepatic clearance. Use Caution/Monitor. Combination oral contraceptives have been shown to significantly decrease plasma concentrations of lamotrigine, likely due to induction of lamotrigine glucuronidation.

            • levonorgestrel oral/ethinylestradiol/ferrous bisglycinate

              levonorgestrel oral/ethinylestradiol/ferrous bisglycinate decreases levels of lamotrigine by unspecified interaction mechanism. Use Caution/Monitor. Significant decrease in plasma concentration of lamotrigine when concomitantly used with combined hormonal contraceptives (CHCs) containing EE, likely due to induction of lamotrigine glucuronidation. This may reduce seizure control; therefore, dosage adjustments of lamotrigine may be necessary.

            • lopinavir

              lopinavir will decrease the level or effect of lamotrigine by increasing metabolism. Use Caution/Monitor. Combination may decrease lamotrigine levels by 50%. Adjust lamotrigine dose as needed when starting, stopping, or changing lopinavir/ritonavir dose.

            • lurasidone

              lurasidone, lamotrigine. Either increases toxicity of the other by Other (see comment). Use Caution/Monitor. Comment: Potential for increased CNS depressant effects when used concurrently; monitor for increased adverse effects and toxicity.

            • medroxyprogesterone

              medroxyprogesterone will decrease the level or effect of lamotrigine by increasing hepatic clearance. Use Caution/Monitor. Combination oral contraceptives have been shown to significantly decrease plasma concentrations of lamotrigine, likely due to induction of lamotrigine glucuronidation.

            • mestranol

              mestranol decreases levels of lamotrigine by increasing hepatic clearance. Use Caution/Monitor.

            • midazolam intranasal

              midazolam intranasal, lamotrigine. Either increases toxicity of the other by pharmacodynamic synergism. Modify Therapy/Monitor Closely. Concomitant use of barbiturates, alcohol, or other CNS depressants may increase the risk of hypoventilation, airway obstruction, desaturation, or apnea and may contribute to profound and/or prolonged drug effect.

            • norelgestromin

              norelgestromin will decrease the level or effect of lamotrigine by increasing hepatic clearance. Use Caution/Monitor. Combination oral contraceptives have been shown to significantly decrease plasma concentrations of lamotrigine, likely due to induction of lamotrigine glucuronidation.

            • norethindrone

              norethindrone will decrease the level or effect of lamotrigine by increasing hepatic clearance. Use Caution/Monitor. Combination oral contraceptives have been shown to significantly decrease plasma concentrations of lamotrigine, likely due to induction of lamotrigine glucuronidation.

            • norgestimate

              norgestimate will decrease the level or effect of lamotrigine by increasing hepatic clearance. Use Caution/Monitor. Combination oral contraceptives have been shown to significantly decrease plasma concentrations of lamotrigine, likely due to induction of lamotrigine glucuronidation.

            • norgestrel

              norgestrel will decrease the level or effect of lamotrigine by increasing hepatic clearance. Use Caution/Monitor. Combination oral contraceptives have been shown to significantly decrease plasma concentrations of lamotrigine, likely due to induction of lamotrigine glucuronidation.

            • orlistat

              orlistat decreases levels of lamotrigine by inhibition of GI absorption. Applies only to oral form of both agents. Modify Therapy/Monitor Closely. Risk of convulsions.

            • paroxetine

              lamotrigine increases toxicity of paroxetine by unspecified interaction mechanism. Modify Therapy/Monitor Closely. CNS depressants may increase the toxic effects of selective serotonin reuptake inhibitors; psychomotor impairment may be enhanced.

            • phenobarbital

              phenobarbital decreases levels of lamotrigine by increasing hepatic clearance. Use Caution/Monitor.

            • phenytoin

              phenytoin decreases levels of lamotrigine by increasing metabolism. Use Caution/Monitor.

            • primidone

              primidone decreases levels of lamotrigine by increasing hepatic clearance. Use Caution/Monitor.

            • rifampin

              rifampin decreases levels of lamotrigine by increasing metabolism. Use Caution/Monitor.

              rifampin decreases levels of lamotrigine by increasing hepatic clearance. Use Caution/Monitor.

            • ritonavir

              ritonavir will decrease the level or effect of lamotrigine by increasing metabolism. Use Caution/Monitor. Combination may decrease lamotrigine levels by 50%. Adjust lamotrigine dose as needed when starting, stopping, or changing ritonavir dose. Similar interactions are possible with other RTV-boosted PIs.

            • segesterone/ethinyl estradiol

              segesterone/ethinyl estradiol will decrease the level or effect of lamotrigine by increasing hepatic clearance. Use Caution/Monitor. Combination oral contraceptives have been shown to significantly decrease plasma concentrations of lamotrigine, likely due to induction of lamotrigine glucuronidation.

            • sertraline

              lamotrigine increases toxicity of sertraline by unspecified interaction mechanism. Modify Therapy/Monitor Closely. CNS depressants may increase the toxic effects of selective serotonin reuptake inhibitors; psychomotor impairment may be enhanced.

            • sevelamer

              sevelamer decreases levels of lamotrigine by increasing elimination. Use Caution/Monitor.

            • stiripentol

              stiripentol, lamotrigine. Either increases effects of the other by sedation. Use Caution/Monitor. Concomitant use stiripentol with other CNS depressants, including alcohol, may increase the risk of sedation and somnolence.

            • valproic acid

              valproic acid increases levels of lamotrigine by decreasing metabolism. Modify Therapy/Monitor Closely.

            • vilazodone

              lamotrigine increases toxicity of vilazodone by unspecified interaction mechanism. Modify Therapy/Monitor Closely. CNS depressants may increase the toxic effects of selective serotonin reuptake inhibitors; psychomotor impairment may be enhanced.

            Minor (19)

            • acetaminophen

              lamotrigine decreases levels of acetaminophen by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • acetaminophen IV

              lamotrigine decreases levels of acetaminophen IV by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • acetaminophen rectal

              lamotrigine decreases levels of acetaminophen rectal by increasing metabolism. Minor/Significance Unknown. Enhanced metabolism incr levels of hepatotoxic metabolites.

            • atracurium

              lamotrigine decreases effects of atracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

            • biotin

              lamotrigine decreases levels of biotin by unspecified interaction mechanism. Minor/Significance Unknown. Biotin supplementation may be necessary.

            • cisatracurium

              lamotrigine decreases effects of cisatracurium by pharmacodynamic antagonism. Minor/Significance Unknown.

            • cyanocobalamin

              lamotrigine decreases levels of cyanocobalamin by inhibition of GI absorption. Applies only to oral form of both agents. Minor/Significance Unknown.

            • dexmethylphenidate

              dexmethylphenidate increases effects of lamotrigine by decreasing metabolism. Minor/Significance Unknown.

            • ezogabine

              ezogabine decreases levels of lamotrigine by Other (see comment). Minor/Significance Unknown. Comment: Ezogabine may induce glucuronidation that results in small decreases of trough levels.

            • levocarnitine

              lamotrigine decreases levels of levocarnitine by unspecified interaction mechanism. Minor/Significance Unknown.

            • onabotulinumtoxinA

              lamotrigine decreases effects of onabotulinumtoxinA by pharmacodynamic antagonism. Minor/Significance Unknown.

            • pancuronium

              lamotrigine decreases effects of pancuronium by pharmacodynamic antagonism. Minor/Significance Unknown.

            • perampanel

              perampanel increases levels of lamotrigine by affecting hepatic/intestinal enzyme CYP3A4 metabolism. Minor/Significance Unknown.

            • rapacuronium

              lamotrigine decreases effects of rapacuronium by pharmacodynamic antagonism. Minor/Significance Unknown.

            • rocuronium

              lamotrigine decreases effects of rocuronium by pharmacodynamic antagonism. Minor/Significance Unknown.

            • sage

              sage decreases effects of lamotrigine by pharmacodynamic antagonism. Minor/Significance Unknown. Theoretical interaction; some species of sage may cause convulsions.

            • serdexmethylphenidate/dexmethylphenidate

              serdexmethylphenidate/dexmethylphenidate increases effects of lamotrigine by decreasing metabolism. Minor/Significance Unknown.

            • succinylcholine

              lamotrigine decreases effects of succinylcholine by pharmacodynamic antagonism. Minor/Significance Unknown.

            • vecuronium

              lamotrigine decreases effects of vecuronium by pharmacodynamic antagonism. Minor/Significance Unknown.

            Previous
            Next:

            Adverse Effects

            >10%

            Dizziness (38%)

            Diplopia (26-30%)

            Headache (29%)

            Ataxia (22%)

            Blurred vision (16-20%)

            Rhinitis (11-15%)

            Somnolence (14%)

            1-10%

            Insomnia (6-10%)

            Fatigue (8%)

            Chest pain (5%)

            Peripheral edema (2-5%)

            Suicidal ideation (2-5%)

            Dermatitis (2-5%)

            Dry skin (2-5%)

            Increased libido (2-5%)

            Rectal hemorrhage (2-5%)

            Weakness (2-5%)

            Agitation (1-5%)

            Dysarthria (1-5%)

            Edema (1-5%)

            Fever (1-5%)

            Migraine (1-5%)

            Abnormal thoughts (1-5%)

            Urinary frequency (1-5%)

            Tremor (4%)

            Frequency Not Defined

            Palpitations

            Anxiety

            Chills

            Depression

            Decreased memory

            Emotional lability

            Incoordination

            Malaise

            Seizure exacerbation

            Vertigo

            Pruritus

            Rash

            Amenorrhea

            Hot flashes

            Abdominal pain

            Constipation

            Diarrhea

            Dyspepsia

            Nausea

            Vomiting

            Arthralgia

            Neck pain

            Cough

            Flu syndrome

            Infection

            Vaginitis

            Nystagmus

            Postmarketing Reports

            Agranulocytosis, hemolytic anemia, lymphadenopathy not associated with hypersensitivity disorder

            Esophagitis

            Aseptic meningitis

            Pancreatitis

            Lupus-like reaction

            Vasculitis

            Apnea

            Rhabdomyolysis observed in patients experiencing hypersensitivity reactions

            Aggression

            Exacerbation of Parkinsonian symptoms in patients with pre-existing Parkinson’s disease, tics

            Progressive immunosuppression

            Cardiac rhythm and conduction abnormalities

            Previous
            Next:

            Warnings

            Black Box Warnings

            Serious rashes requiring hospitalization (including Stevens-Johnson syndrome) and discontinuation of treatment have occurred in 0.3-0.8% of pediatric patients (aged 2-17 yr) and in 0.08-0.3% of adult patients who have received the drug as adjunctive therapy for epilepsy with valproic acid

            The risk of serious rash caused by treatment with lamotrigine XR is not expected to differ from that with the immediate-release formulation; however, the relatively limited treatment experience with lamotrigine XR makes it difficult to characterize the frequency and risk of serious rashes caused by treatment with the drug; lamotrigine XR is not approved for patients younger than 13 years

            Almost all life-threatening rashes have occurred within 2- 8 weeks of lamotrigine therapy, but they have also occurred after prolonged treatment; duration cannot be relied on as a means to predict the potential risk heralded by the first appearance of a rash

            Although benign rashes also occur with lamotrigine, it is not possible to predict reliably which rashes will prove to be serious or life threatening. Thus, the drug should be discontinued at the first sign of rash unless the rash is clearly not drug related

            Discontinuation of treatment may not prevent a rash from becoming life threatening or permanently disabling or disfiguring

            Contraindications

            Hypersensitivity to any component of formulation

            Cautions

            See FDA Warning on potential suicidal behavior

            Clinical worsening, emergence of new symptoms, and suicidal ideation/behaviors may be associated with treatment of bipolar disorder; patients should be closely monitored, particularly early in treatment or during dosage changes

            Use caution in renal impairment and hepatic impairment; dose adjustments may be necessary

            Risk of serious rash; discontinue at first sign of rash (see Black Box Warnings)

            Rare cases of toxic epidermal necrolysis have been reported in worldwide postmarketing experience

            May cause CNS depression; use caution operating heavy machinery

            Multiorgan hypersensitivity reactions, also known as drug reaction with eosinophilia and systemic symptoms (DRESS), have been reported, with possible multiorgan failure (see Black Box Warning)

            Round pediatric dose downward to nearest 5 mg

            Do not withdraw abruptly

            Need to modify dosage if adding or discontinuing hepatic enzyme-inducing anticonvulsant drugs or valproic acid

            Increased risk of hematologic effects (eg, neutropenia, anemia, leukopenia, thrombocytopenia, aplastic anemia) in patients with previous history of adverse hematologic reactions to any drug

            Need to modify dosage if taking or stopping estrogen plus oral contraceptives

            Risk of isolated oral clefts if used in early pregnancy

            Aseptic meningitis cases reported; symptoms may include headache, fever, stiff neck, nausea, vomiting, rash, and sensitivity to light

            May interfere with the assay used in some rapid urine drug screens, which can result in false-positive readings, particularly for phencyclidine (PCP); use a more specific analytical method to confirm a positive result

            Increased risk of arrhythmias

            • March 31, 2021: The FDA issued a safety alert regarding an increased risk or arrhythmias when lamotrigine is given to patients with heart disease
            • Consider potential benefits of lamotrigine outweigh the potential risk of arrhythmias
            • Could slow ventricular conduction (widen QRS) and induce proarrhythmia, which can lead to sudden death, in patients with clinically important structural or functional heart disease (eg, patients with heart failure, valvular heart disease, congenital heart disease, conduction system disease, ventricular arrhythmias, cardiac channelopathies [eg, Brugada syndrome], clinically important ischemic heart disease, or multiple risk factors for coronary artery disease)
            • Any expected or observed benefit of drug in an individual patient with clinically important structural or functional heart disease must be carefully weighed against risks for serious arrythmias and/or death for that patient; concomitant use of other sodium channel blockers may further increase risk of proarrhythmia
            • Risk of arrhythmias may increase further coadministered with other medicines that block sodium channels in the heart

            Hemophagocytic lymphohistiocytosis

            • April 25, 2018: The FDA issued a safety alert regarding the risk for lamotrigine to cause hemophagocytic lymphohistiocytosis (HLH), a rare, but serious immune system reaction
            • HLH may be confused with other serious immune-related adverse reactions such as Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
            • Evaluate patients who develop fever or rash promptly, and discontinue lamotrigine if HLH or another serious immune-related adverse reaction is suspected and an alternative etiology for the signs and symptoms cannot be established
            • Advise patients to seek immediate medical attention if they experience symptoms (eg, fever, enlarged liver, swollen lymph nodes, skin rash, yellow skin or eyes, unusual bleeding, CNS effect [seizures, ataxia, visual disturbances])
            • HLH diagnosis is established if a patient presents with at least 5 of the following 8 signs or symptoms
              • Fever and rash
              • Enlarged spleen
              • Cytopenias
              • Elevated TG or low fibrinogen levels
              • High blood ferritin levels
              • Hemophagocytosis identified through bone marrow, spleen, or lymph node biopsy
              • Decreased or absent natural killer cell activity
              • Elevated CD24 levels showing prolonged immune cell activation
            Previous
            Next:

            Pregnancy & Lactation

            Pregnancy

            A pregnancy exposure registry monitors pregnancy outcomes in women exposed to AEDs, including lamotrigine, during pregnancy; encourage women who are taking lamotrigine during pregnancy to enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry by calling 1-888-233-2334 or visiting http://www.aedpregnancyregistry.org/

            Data from several prospective pregnancy exposure registries and epidemiological studies of pregnant women have not detected increased frequency of major congenital malformations or consistent pattern of malformations among women exposed to lamotrigine compared with the general population; the majority of exposure data are from women with epilepsy

            As with other AEDs, physiological changes during pregnancy may affect lamotrigine concentrations and/or therapeutic effect; there have been reports of decreased lamotrigine concentrations during pregnancy and restoration of pre-pregnancy concentrations after delivery; dose adjustments may be necessary to maintain clinical response

            Animal data

            • In animal studies, administration of lamotrigine during pregnancy resulted in developmental toxicity (increased mortality, decreased body weight, increased structural variation, neurobehavioral abnormalities) at doses lower than those administered clinically
            • Drug decreased fetal folate concentrations in rats, an effect known to be associated with adverse pregnancy outcomes in animals and humans

            Lactation

            Drug is present in milk from lactating women receiving therapy; neonates and young infants are at risk for high serum levels because maternal serum and milk levels can rise to high levels postpartum if lamotrigine dosage has been increased during pregnancy but is not reduced to pre-pregnancy dosage after delivery

            Glucuronidation is required for drug clearance; glucuronidation capacity is immature in the infant and this may also contribute to level of lamotrigine exposure; events including rash, apnea, drowsiness, poor sucking, and poor weight gain (requiring hospitalization in some cases) reported in infants who have been human milk-fed by mothers using lamotrigine; whether or not these events were caused by lamotrigine is unknown; no data are available on effects of drug on milk production

            Developmental and health benefits of breastfeeding should be considered along with mother’s clinical need for therapy and any potential adverse effects on breastfed infant from drug or from the underlying maternal condition

            Human milk-fed infants should be closely monitored for adverse events resulting from lamotrigine; measurement of infant serum levels should be performed to rule out toxicity if concerns arise; human milk-feeding should be discontinued in infants with lamotrigine toxicity

            Pregnancy Categories

            A: Generally acceptable. Controlled studies in pregnant women show no evidence of fetal risk.

            B: May be acceptable. Either animal studies show no risk but human studies not available or animal studies showed minor risks and human studies done and showed no risk.

            C: Use with caution if benefits outweigh risks. Animal studies show risk and human studies not available or neither animal nor human studies done.

            D: Use in LIFE-THREATENING emergencies when no safer drug available. Positive evidence of human fetal risk.

            X: Do not use in pregnancy. Risks involved outweigh potential benefits. Safer alternatives exist.

            NA: Information not available.

            Previous
            Next:

            Pharmacology

            Mechanism of Action

            Antiepileptic of phenyltriazine class

            Inhibits release of excitatory amino acid glutamate and inhibits voltage-sensitive sodium channel, which stabilizes neuronal membranes

            Absorption

            Bioavailability: 98%

            Peak plasma time: 1-1.5 hr (immediate release); 4-11 hr (extended release)

            Distribution

            Protein bound: 55%

            Vd: 0.9-1.3 L/kg

            Metabolism

            Hepatic and renal through glucuronidation

            Metabolites: Inactive

            Elimination

            Total body clearance: 0.4-1.1 mL/min/kg

            Excretion: Renal

            Half-life

            • 25-33 hr (adults); 25-43 hr (elderly)
            • 26-66 hr (mild hepatic impairment); 28-116 hr (moderate hepatic impairment); 56-78 hr (severe hepatic impairment without ascites); 52-148 hr (severe hepatic impairment with ascites)
            • 43 hr (chronic renal failure)
            • Approximately halved if taking enzyme-inducing drugs
            • Approximately doubled if also taking valproic acid
            Previous
            Next:

            Images

            BRAND FORM. UNIT PRICE PILL IMAGE
            Lamictal oral
            -
            200 mg tablet
            Lamictal oral
            -
            100 mg tablet
            Lamictal oral
            -
            25 mg tablet
            Lamictal oral
            -
            25 mg tablet
            Lamictal oral
            -
            5 mg tablet
            Lamictal oral
            -
            150 mg tablet
            Subvenite Starter (Blue) Kit oral
            -
            25 mg (35) tablet
            Subvenite oral
            -
            25 mg tablet
            Lamictal Starter (Orange) Kit oral
            -
            25 mg (42) -100 mg (7) tablet
            Lamictal Starter (Blue) Kit oral
            -
            25 mg (35) tablet
            Lamictal Starter (Green) Kit oral
            -
            25 mg (84) -100 mg (14) tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            100 mg tablet
            lamotrigine oral
            -
            100 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            25 mg (42) -100 mg (7) tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            150 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            25 mg (84) -100 mg (14) tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            100 mg tablet
            lamotrigine oral
            -
            50 mg tablet
            lamotrigine oral
            -
            100 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            100 mg tablet
            lamotrigine oral
            -
            300 mg tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            100 mg tablet
            lamotrigine oral
            -
            50 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            100 mg tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            100 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            150 mg tablet
            lamotrigine oral
            -
            150 mg tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            50 mg tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            100 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            50 mg tablet
            lamotrigine oral
            -
            250 mg tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            100 mg tablet
            lamotrigine oral
            -
            150 mg tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            25 mg (35) tablet
            lamotrigine oral
            -
            150 mg tablet
            lamotrigine oral
            -
            100 mg tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            100 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            50 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            100 mg tablet
            lamotrigine oral
            -
            300 mg tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            50 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            100 mg tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            50 mg tablet
            lamotrigine oral
            -
            150 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            100 mg tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            150 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            150 mg tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            5 mg tablet
            lamotrigine oral
            -
            25 mg(14)-50 mg (14)-100 mg (7) tablet
            lamotrigine oral
            -
            50 mg (42) -100 mg (14) tablet
            lamotrigine oral
            -
            50 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            50 mg tablet
            lamotrigine oral
            -
            300 mg tablet
            lamotrigine oral
            -
            250 mg tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            100 mg tablet
            lamotrigine oral
            -
            150 mg tablet
            lamotrigine oral
            -
            5 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            100 mg tablet
            lamotrigine oral
            -
            150 mg tablet
            lamotrigine oral
            -
            250 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            5 mg tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            100 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            250 mg tablet
            lamotrigine oral
            -
            300 mg tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            50 mg tablet
            lamotrigine oral
            -
            100 mg tablet
            lamotrigine oral
            -
            25 mg tablet
            lamotrigine oral
            -
            100 mg tablet
            lamotrigine oral
            -
            200 mg tablet
            lamotrigine oral
            -
            150 mg tablet
            Lamictal ODT oral
            -
            25 mg tablet
            Lamictal ODT oral
            -
            200 mg tablet
            Lamictal ODT oral
            -
            100 mg tablet
            Lamictal ODT oral
            -
            50 mg tablet
            Lamictal ODT Starter (Green) oral
            -
            50 mg (42) -100 mg (14) tablet
            Lamictal ODT Starter (Blue) oral
            -
            25 mg (21) -50 mg (7) tablet
            Lamictal ODT Starter (Orange) oral
            -
            25 mg(14)-50 mg (14)-100 mg (7) tablet
            Lamictal XR Starter (Blue) oral
            -
            25 mg (21) -50 mg (7) tablet
            Lamictal XR Starter (Green) oral
            -
            50 mg(14)-100mg (14)-200 mg (7) tablet
            Lamictal XR Starter (Orange) oral
            -
            25mg (14)-50 mg (14)-100mg (7) tablet
            Lamictal XR oral
            -
            200 mg tablet
            Lamictal XR oral
            -
            100 mg tablet
            Lamictal XR oral
            -
            50 mg tablet
            Lamictal XR oral
            -
            25 mg tablet
            Lamictal XR oral
            -
            250 mg tablet
            Lamictal XR oral
            -
            300 mg tablet

            Copyright © 2010 First DataBank, Inc.

            Previous
            Next:

            Patient Handout

            Patient Education
            lamotrigine oral

            LAMOTRIGINE CHEWABLE/DISPERSIBLE TABLET - ORAL

            (lam-OH-try-jeen)

            COMMON BRAND NAME(S): Lamictal

            WARNING: 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.

            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: 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.

            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).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. 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.

            DRUG 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), 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.

            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.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.

            MEDICAL ALERT: Your condition can cause complications in a medical emergency. For information about enrolling in MedicAlert, call 1-888-633-4298 (US) or 1-800-668-1507 (Canada).

            Information last revised March 2022. Copyright(c) 2022 First Databank, Inc.

            IMPORTANT: HOW TO USE THIS INFORMATION: This is a summary and does NOT have all possible information about this product. This information does not assure that this product is safe, effective, or appropriate for you. This information is not individual medical advice and does not substitute for the advice of your health care professional. Always ask your health care professional for complete information about this product and your specific health needs.

            Previous
            Next:

            Formulary

            FormularyPatient Discounts

            Adding plans allows you to compare formulary status to other drugs in the same class.

            To view formulary information first create a list of plans. Your list will be saved and can be edited at any time.

            Adding plans allows you to:

            • View the formulary and any restrictions for each plan.
            • Manage and view all your plans together – even plans in different states.
            • Compare formulary status to other drugs in the same class.
            • Access your plan list on any device – mobile or desktop.

            The above information is provided for general informational and educational purposes only. Individual plans may vary and formulary information changes. Contact the applicable plan provider for the most current information.

            Tier Description
            1 This drug is available at the lowest co-pay. Most commonly, these are generic drugs.
            2 This drug is available at a middle level co-pay. Most commonly, these are "preferred" (on formulary) brand drugs.
            3 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs.
            4 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            5 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            6 This drug is available at a higher level co-pay. Most commonly, these are "non-preferred" brand drugs or specialty prescription products.
            NC NOT COVERED – Drugs that are not covered by the plan.
            Code Definition
            PA Prior Authorization
            Drugs that require prior authorization. This restriction requires that specific clinical criteria be met prior to the approval of the prescription.
            QL Quantity Limits
            Drugs that have quantity limits associated with each prescription. This restriction typically limits the quantity of the drug that will be covered.
            ST Step Therapy
            Drugs that have step therapy associated with each prescription. This restriction typically requires that certain criteria be met prior to approval for the prescription.
            OR Other Restrictions
            Drugs that have restrictions other than prior authorization, quantity limits, and step therapy associated with each prescription.
            Additional Offers
            Email to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Email Forms to Patient

            From:

            To:

            The recipient will receive more details and instructions to access this offer.

            By clicking send, you acknowledge that you have permission to email the recipient with this information.

            Previous
            Medscape prescription drug monographs are based on FDA-approved labeling information, unless otherwise noted, combined with additional data derived from primary medical literature.