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Lamictal® (lamotrigine)


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Lamictal® (lamotrigine)

Note: It is very important to check your medication each time it is filled. There have been errors reported in consumers receiving Lamisil instead of Lamictal.

Available dosage forms…

• Tablets (non–chewable): 25 mg, 100 mg, 150 mg, 200 mg

• Chewable tablets: 2 mg, 5 mg, 25 mg

• Two different dosing “starter” kits are also available. One is for patients who are already taking valproate (Depakote®); the other is for patients who are already taking carbamazepine (Tegretol®).
What is Lamictal and what does it treat?

Lamictal is an anticonvulsant drug approved for the treatment of seizures (epilepsy) in adults and children. It can be used alone, or in combination with other anticonvulsants. It has also been approved for the treatment of Bipolar disorder.

Bipolar disorder is also known as manic-depressive illness. A manic episode, or mania, is when a person experiences several of the following symptoms at the same time: “high” or irritable mood, very high self esteem, decreased need for sleep, pressure to keep talking, racing thoughts, being easily distracted, frequently involved in activities with a large risk for bad consequences (for example, excessive buying sprees). A depressive episode, or depression, is when a person experiences several of the following symptoms at the same time: “low” or depressed mood (for example, sad, empty, tearful), decreased interest in most or all activities, changes in appetite (usually decreased), changes in sleep (usually poor sleep), loss of energy, feeling worthless/guilty/ hopeless/ helpless, difficulty concentrating, thoughts of death (suicidal thinking).

For any of these illnesses Lamictal may or may not work for you. If you and your doctor decide to try Lamictal you should give the drug a good chance to work (at least two months) before deciding if it is right or wrong for you.
What is the most important information I should know about Lamictal?

Since bipolar disorder is a long–term illness, duration of treatment with mood stabilizers like Lamictal may also be long–term. It is very important to take Lamictal regularly and exactly as prescribed by your doctor. Not taking Lamictal on a daily basis not only increases your risk for a relapse in your mood symptoms, it may also increase the possibilities of troublesome side effects such as seizures.

• Lamictal may be prescribed by itself or along with other medications to manage your mood symptoms.

• Compared to lithium and valproic acid, Lamictal may not be as effective in stabilizing a manic episode, however, it may be more effective in treating depressive episodes experienced by individuals with bipolar disorder.

• Similar to lithium and valproate, Lamictal has demonstrated effectiveness in preventing relapses of depression and mania when taken daily as prescribed.

• For other medications used in the treatment of Bipolar disorder, medication blood levels are commonly done. However, blood levels of Lamictal do not appear to be linked to response in patients being treated for Bipolar disorder.

• Lamictal can be associated with side effects (see side effects section), but most can be minimized with regular monitoring and careful dose increases. Blood tests may be done in order to check for kidney abnormalities, which are rare.

• Lamictal should be used with caution in patients who have kidney disease.

• Lamictal can be associated with serious skin rashes, which are rare. If you experience a new rash while taking Lamictal, call your doctor immediately.

• Because Bipolar disorder is an illness that may have suicidal thinking as a possible symptom. You should report any new occurrence, or worsening, of suicidal thinking to your doctor.

• Lamictal can interfere with folic acid. Therefore, female patients who are thinking of becoming pregnant, should be aware that Lamictal may increase the chances of birth defects in babies. For female patients who become pregnant while taking Lamictal, you should talk with your doctor about the risks and benefits of discontinuing Lamictal.
What should I discuss with my healthcare provider before taking Lamictal?

• You should tell your doctor if you have taken Lamictal before and if you are allergic to it you should tell your doctor and pharmacy what exactly the drug did to you before taking even one dose.

• Medications you have taken in the past to treat bipolar disorder

• All other medications you are currently taking and any medication allergies you have

• Any medication side effects that you may have experienced in the past, or are currently experiencing

• If you drink alcohol or use illegal drugs

• Symptoms that are most bothersome to you about your condition

• If you have thoughts of suicide

• Any medical problems you have, especially involving the kidneys

• If you are pregnant, plan to become pregnant, or are breast-feeding
How should I take Lamictal?

The amount of Lamictal you take, and how quickly your dose will increase depends on whether or not you are taking other medications that may interact with Lamictal. The table that follows provides important information about dosing. The maximum Lamictal dose in the treatment of Bipolar disorder is different depending on other medications you are taking.

Schedule of lamotrigine dose increases in patients being treated for bipolar disorder.

Duration of Treatment No Other
Interacting Meds

For Patients
Taking Depakote
For Patients
Taking Tegretol
Weeks 1 & 2 25 mg daily 25 mg every other day 50 mg daily
Weeks 3 & 4 50 mg daily

25 mg daily
100 mg daily (in divided doses)
Week 5 100 mg daily 50 mg daily 200 mg daily (in divided doses)
Week 6 200 mg daily 100 mg daily 300 mg daily (in divided doses)
Week 7 200 mg daily 100 mg daily Up to 400 mg daily (in divided doses)

• Lamictal may be taken with food to minimize stomach cramping, nausea, and vomiting.

• Always take Lamictal at the same time every day

• Use a pillbox or a calendar as a reminder to take your medications. If needed, have a family member or friend check-in with you to help you take your medications.
What happens if I miss a dose?

If you miss a dose of Lamictal, take it as soon as you remember to, but only if it is not too close to when your next dose is due – discuss this with your healthcare provider. If it is close to your next dose, wait until then to take the medication and skip the missed dose. Do not double your next dose or take more than what you have been told to take.
What should I avoid while taking lamotrigine?

• Avoid drinking alcohol while taking Lamictal because it can increase the effects of alcohol and lead to significant drowsiness.

• Avoid using illegal drugs while taking Lamictal because they may counteract Lamictal’s effect and increase your risk of developing seizures.

• As Lamictal may cause drowsiness, make sure you know how it will affect you before you begin driving or operating any machinery.
What happens if I overdose?

There have been reports of people who have overdosed with Lamictal. Some of the overdoses resulted in death. Overdose has resulted in dizziness, abnormal eye movements, seizures, sleepiness or loss of consciousness, and abnormal heart rhythms. If an overdose occurs, whether intentional or accidental, immediate medical attention is necessary. Call your doctor or emergency medical service (911).
What are the possible side effects of Lamictal?

Patients being treated with Lamictal for bipolar disorder should report to their doctor if suicidal thinking starts or worsens. They should also report to their doctor if their mood symptoms begin to “switch”. So, for example, if your symptoms of mania change and become symptoms of depression.

Common side effects reported by people who have taken Lamictal alone for the treatment of bipolar disorder include: nausea, insomnia, daytime sleepiness, feeling physically tired (fatigue), runny nose, and non–serious rash.

Common side effects reported by people who were taking Lamictal in combination with another treatment or treatments for bipolar disorder include: headache, rash, dizziness, diarrhea, abnormal dreams, and itchy skin.

A serious, life threatening rash (also known as Stevens–Johnson Syndrome) may occur with the use of Lamictal. Although this rash is believed to be rare, any patient who develops a rash while taking Lamictal (or any other medication) should report this to their doctor quickly. Extra caution is needed in patients who are younger than the age of 16 and receiving Lamictal – these patients may be at an increased risk of developing this life threatening rash.

Other rare, but serious, side effects that may occur with Lamictal treatment include: blood cell abnormalities, acute multi–organ failure (when more than one organ in the body, such as your liver or kidneys, stops working), and sudden death.

Seizures may occur if a patient taking Lamictal suddenly stops taking it.
Are there any risks for taking Lamictal for long periods of time?

None are known, however, Lamictal is meant to be taken for a long time. In fact, you should not suddenly stop taking Lamictal without talking to your doctor first.

What other drugs interact with lamotrigine?

• Medications that may increase levels of Lamictal in your body: valproic acid/valproate/divalproex (Depakene®/Depakote®).

• Medications that may decrease levels of Lamictal in your body: carbamazepine (Tegretol®), ethinyl estradiol/levonorgestrel (multiple brand names: Alesse®, Aviane®, Enpresse®, Lessina-28®, Levlen®, Levlite®, Levora®, Nordette®, Portia®, Seasonale®, Tri-Levlen®, Triphasil®, Trivora-28®), phenytoin (Dilantin®), rifampin (Rifadin®).

• Clozapine blood levels may become too high, or “toxic”, when Lamictal therapy is added.
How long does it take for Lamictal to work?

It is very important to tell your doctor how you feel things are going during the first two months after you start taking Lamictal, or after your dose has been changed. It will probably take several weeks for you and your doctor to see big enough changes in your symptoms before you decide if Lamictal is the right drug for you.

Updated by Charles F. Caley, Pharm.D., BCPP
(February 2006)

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NAMI wishes to thank the College of Psychiatric and Neurological Pharmacists for producing this fact sheet.

Reviewed by Dr. Ken Duckworth, NAMI Medical Director

For further information. Please contact the pharmaceutical company listed below.

GlaxoSmithKline
Bridges to Access

Bridges to Access
PO Box 29038
Phoenix, AZ 85038-9038

1-866-728-4368

http://bridgestoaccess.gsk.com/

Free or low-cost medications provided by pharmaceutical companies

Some pharmaceutical companies offer medication assistance programs to low-income individuals and families. These programs typically require a doctor’s consent and proof of financial status. They may also require that you have either no health insurance, or no prescription drug benefit through your health insurance. Please contact the pharmaceutical company directly for specific eligibility requirements and application information.

Lamictal Rx Assistance Program: 1-866-728-4368

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