Lamotrigine – Versatile antiepileptic for seizures and mood stabilization.
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What is Lamotrigine?
Lamotrigine is a versatile antiepileptic drug that’s highly effective for both seizure control and mood stabilization in bipolar disorder. Its relatively favorable side effect profile and safety in pregnancy make it a valuable option, though it requires careful dose titration to minimize the risk of serious skin reactions.
Book an online consultation if you’re experiencing seizures, have been diagnosed with epilepsy or bipolar disorder, or have chronic pain conditions that may benefit from antiepileptic treatment. Our GPs can assess your condition and determine if Lamotrigine is appropriate, with proper referral to specialists when needed.
What is Lamotrigine used for?
- Epilepsy (partial and generalized seizures)
- Bipolar disorder (mood stabilization)
- Trigeminal neuralgia (facial pain)
- Lennox-Gastaut syndrome (in children)
- Prevention of depressive episodes in bipolar disorder
- Migraine prevention (off-label use)
How does Lamotrigine work?
An antiepileptic drug that stabilizes neuronal membranes by blocking voltage-sensitive sodium channels, reducing abnormal electrical activity in the brain and providing mood stabilization.
Dosage and Administration
Adults
Starting dose 25mg daily, gradually increased over weeks to 100-400mg daily. Dose depends on other medications taken.
Children
Weight-based dosing starting from 0.15mg/kg daily—specialist supervision required.
Important Notes
- Must be started at low dose and increased very gradually.
- Take at the same time each day with or without food.
- Dosing schedule depends on other medications (especially valproate).
- Never stop suddenly—gradual dose reduction required.
Side Effects
Common Side Effects
- Skin rash (can be serious)
- Headache
- Dizziness
- Nausea and vomiting
- Double vision or blurred vision
- Coordination problems
- Tremor
- Insomnia
Serious Side Effects
Seek immediate medical attention if you experience:
- Serious skin reactions (Stevens-Johnson syndrome)
- Aseptic meningitis
- Blood disorders
- Liver problems
- Severe mood changes or suicidal thoughts
- Severe allergic reactions
Important Warnings
- CRITICAL: Report any skin rash immediately—can progress to life-threatening reactions.
- Dose escalation must be slow—rapid increases greatly increase rash risk.
- Tell your GP if you take valproate—requires different (slower) dosing schedule.
- Never stop suddenly—can trigger severe seizures or mood episodes.
- Regular blood tests may be needed to monitor for side effects.
Drug Interactions
Tell your GP if you're taking any of the following medications:
- Valproate—significantly increases lamotrigine levels, requiring much lower doses.
- Carbamazepine—reduces lamotrigine levels, higher doses may be needed.
- Oral contraceptives—may reduce lamotrigine effectiveness.
- Paracetamol—may slightly reduce lamotrigine levels with regular use.
- Other antiepileptic drugs—complex interactions requiring specialist management.
Frequently Asked Questions
Why is the skin rash so concerning with Lamotrigine?
About 10% of people develop a rash, and while most are mild, some can progress to serious conditions like Stevens-Johnson syndrome. Any rash should be reported immediately.
How slowly must Lamotrigine be started?
Very slowly—typically starting at 25mg daily and increasing by 25-50mg every 1-2 weeks. This gradual approach significantly reduces the risk of serious skin reactions.
Can Lamotrigine be used in pregnancy?
Yes, it's one of the safer antiepileptic drugs in pregnancy, but requires specialist monitoring and possible dose adjustments due to pregnancy-related changes in metabolism.
How effective is Lamotrigine for bipolar disorder?
Lamotrigine is particularly effective for preventing depressive episodes in bipolar disorder and is often chosen when mood stabilizers like lithium aren't suitable.
Medically Reviewed by: Mohammed Hassan - Independent Prescriber
Last Updated: 2025-01-14