LAMOTRIGINE (‘Lamictal’)
La – mot – ri – jeen
Why have I been prescribed lamotrigine?
Lamotrigine can be used for different reasons. Many people with epilepsy take it to stop them having fits. However, it also
has a mood stabilising action. This means that it can help treat those people with bipolar mood disorder or manic
depression, who get severe changes in their mood. Lamotrigine is only usually tried when other mood stabilisers, such as
lithium, carbamazepine or valproate, have not worked. Lamotrigine can be used on its own or with other mood stabilisers.
People with bipolar affective disorder have mood swings that are much more severe than the small changes in mood that
everybody experiences. With bipolar affective disorder, mood may be elevated or depressed (up or down).
When the mood is extremely elevated this is called hypomania or mania. People with hypomania feel very energetic and
elated but can be irritable and frustrated. They may talk very quickly, sleep very little and be full of ideas and plans. They
can be described as being “high”. Treatment is usually needed because when people are “high” they may make poor
judgements and can quickly become exhausted. Periods of depression will also occur in bipolar disorder. Symptoms
include feelings of sadness, tiredness and poor sleep. Antidepressants may be required to help lessen these obviously
unpleasant symptoms. Lamotrigine helps stabilise the mood: it reduces the highs and the lows.
What exactly is lamotrigine?
Lamotrigine can be classified as an anticonvulsant, and also as a mood stabiliser or antidepressant. The brand or trade
name for lamotrigine is ‘Lamictal’.
Is lamotrigine safe to take?
It is usually safe to have lamotrigine regularly as prescribed by your doctor, but it doesn’t suit everyone. Let your doctor
know if any of the following apply to you, as extra care may be needed:
a) if you suffer from kidney or liver trouble, or your family have a history of liver trouble;
b) if you are taking any other medication. This includes medicine from your pharmacist;
c) if you are pregnant, breast feeding, or wish to become pregnant.
What is the usual dose of lamotrigine?
The dose of lamotrigine may vary, depending on whether you are taking it on its own or with other mood stabilisers or
anticonvulsants.
Lamotrigine on its own: The starting dose is 25mg a day for two weeks. This is then increased to 50mg a day for two
weeks. The usual dose is between 100mg and 200mg a day.
Lamotrigine with valproate (e.g. ‘Epilim’, ‘Depakote’): The starting dose is 25mg every other day for two weeks. This is then
increased to 25mg every day for two weeks. The usual dose is between 100mg and 200mg a day.
Lamotrigine and carbamazepine (e.g. ‘Tegretol’): The starting dose is 50mg a day for two weeks. This is then increased to
50mg twice a day for two weeks. The usual dose is between 200mg and 400mg a day.
How should I take lamotrigine?
Look at the label on your medicine; it should have all the necessary instructions on it. Follow this advice carefully. If you
have any questions, speak to your doctor or pharmacist. Most medicines are now dispensed with an information leaflet for
you to read.
What should I do if I miss a dose?
Never change your dose without checking with your doctor. If you forget a dose, take it as soon as you remember, as long
as it is within a few hours of the usual time.
When I feel better, can I stop taking lamotrigine?
No. If you stop taking lamotrigine, your original symptoms may return. You should decide with your doctor when you can
come off it. Lamotrigine is not addictive.
What will happen to me when I start taking lamotrigine?
For most people with bipolar affective disorder highs and lows occur quite rarely. Lamotrigine should make these highs and
lows less extreme or less frequent. So, it may take months or years to appreciate the effects of lamotrigine. The best way
to know whether lamotrigine is working for you is to compare your highs and lows before and whilst taking it. Unfortunately,
you might get some side effects before your mood gets any better. Most of these are quite mild and should go away after a
few weeks.
Look at the table below. It tells you what to do if you get any side effects. Not everyone will get the side effects shown.
There are many other possible side effects. Ask your pharmacist, doctor or nurse if you are worried about anything else
that you think might be a side effect.
Side effect What is it? What should I do if it happens to me?
COMMON
DROWSINESS Feeling sleepy or sluggish. It can last for
a few hours after taking your dose
Don’t drive or use machinery. Ask your doctor if you can take your
lamotrigine at a different time.
HEADACHE When your head is painful and pounding. It should be safe to take aspirin or paracetamol.
LETHARGY You feel tired all the time and don’t feel
like doing anything.
This should wear off after a while. Contact your doctor if it is bad.
NAUSEA You feel sick or have an upset stomach. This should wear off after a while. Taking each dose with or after
food may help. Contact your doctor if it doesn’t.
RASH A rash seen anywhere on the skin. This is more common if the dose is increased too quickly. Contact
your doctor now. See also “rare” side effects.
UNCOMMON
BLURRED
VISION
Things look fuzzy and you can’t focus
properly.
Don’t drive or use machinery. You won’t need glasses. See your
doctor if you are worried.
DIPLOPIA Seeing double Don’t drive or use machinery. You won’t need glasses. See your
doctor if you are worried.
DIZZINESS You feel light headed and faint. Contact your doctor.
INSOMNIA You find it difficult to sleep at night. Contact your doctor.
PHOTO-
SENSITIVITY
Going blotchy in the sun. Avoid direct sunlight or sun-lamps. Use a high factor sun block
cream.
RARE
ATAXIA Being very unsteady on your feet. Your level may be too high. Contact your doctor.
CONFUSION Your mind is all mixed up. Your level may be too high. Contact your doctor.
IRRITABILITY
AGGRESSION,
AGITATION
You feel more on edge. Try and relax by taking deep breaths. Wear loose clothing. See
your doctor if it is bad.
BONE MARROW
DEPRESSION
This may show as anaemia, bruising or
infection.
Stop taking your lamotrigine and contact your doctor as soon as
possible.
STEVENS-
JOHNSON
SYNDROME
This may show as a rash or influenza-like
symptoms
Stop taking your lamotrigine and contact you doctor as soon as
possible, particularly if this occurs within the first eight weeks of
treatment.
If you are also taking valproate or carbamazepine, you are more likely to suffer from some of the uncommon side effects.
What about alcohol?
It is officially recommended that people taking lamotrigine should not drink alcohol. This is because both lamotrigine and
alcohol can cause drowsiness and if you taken both at the same time, severe drowsiness can result. This can lead to falls
or accidents. As well as this, drinking alcohol often makes your mood unstable. Excessive drinking is especially likely to do
this. Once people are used to taking medication, they can sometimes drink alcohol in small amounts without any harm.
Avoid alcohol altogether for the first one or two months. After this, if you want a drink, try a glass of your normal drink and
see how you feel. If this doesn’t make you feel drowsy, then it is probably OK to drink small amounts. It pays to be very
cautious because alcohol affects people in different ways, especially when they are taking medication.
Don’t stop taking your medication because you fancy a drink at the weekend. If you do drink alcohol, drink only small
amounts. Never drink any alcohol and drive while on lamotrigine. Discuss any concerns you may have with your
pharmacist, doctor or nurse.
Remember, leaflets like this can only describe some of the effects of medication. You may find other
books or leaflets also useful. If you have access to the internet you may find a lot of information
there as well, but be careful, as internet based information is not always accurate.
2001 United Kingdom Psychiatric Pharmacy Group www.ukppg.org.uk
This leaflet is to help you understand about your medicine. It is not an official manufacturer's Patient Information Leaflet.
For more information call the UKPPG National Telephone Helpline, 11am to 5pm, Monday to Friday on 020 7919 2999 or
visit www.nmhct.nhs.uk/pharmacy
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