For many people with bipolar disorder, taking medication can be a significant step in allowing them to improve their mental health. A common medication often used to treat bipolar disorder is lamotrigine (often known by the brand name Lamictal). On this page, we’ve outlined some important information about the drug.

What is lamotrigine (Lamictal)?

What is lamotrigine? How does it work?

Lamotrigine is a medication that is FDA-approved to treat the maintenance phase of bipolar disorder type I. The medication is also used in the control of epileptic seizures. It may sometimes be used off-label to treat schizophrenia, unipolar depression, acute bipolar depression, or fibromyalgia.

Lamotrigine belongs to a class of medications called antiepileptic drugs (AEDs) and in mental health, it is also considered a mood stabilizer. The drug produces its mood stabilizing effects by regulating the release and effects of chemicals in the brain called neurotransmitters. High levels of some of these neurotransmitters (e.g. glutamate) in the brain contribute to mood issues present in bipolar disorder. 

How is lamotrigine typically used?

For the maintenance treatment of bipolar disorder in adults who are not on carbamazepine, valproate (Depakote), birth control pills or certain other medications, a typical schedule for adults is 25 mg orally once daily for 2 weeks, then 50mg orally once daily for 2 weeks, then 100 mg orally once daily for 1-2 weeks, and 200 mg orally once daily thereafter. These dosages can be adjusted by your doctor depending on what is being treated, the severity of the condition, what other medications are being taken, and other factors. Doctors often start their patients off on lower doses to prevent side effects associated with abrupt changes in the body.  

Inform your doctor if you take any other medications before starting lamotrigine or if you plan to start any new medicines while already on lamotrigine.

Lamotrigine can cause skin changes like rash or blistering, from mild to life-threatening. If you notice any skin changes, seek medical attention urgently.

Inform your doctor before you stop taking lamotrigine. Stopping the medication all of a sudden can cause some negative reactions in your body.  If it makes sense for you to stop taking lamotrigine, your doctor will usually reduce your dose over some time in order to prevent any negative side effects associated with coming off of the medication too quickly.  However, if there is concern for a serious side effect, your doctor may recommend discontinuing the medication more quickly.

What are some possible side effects?

Some common side effects of lamotrigine include:

• Skin changes (rash)
• Blurred or double vision
• Difficulty concentrating
• Loss of balance or coordination
• Heartburn
• Weight loss

Some serious (but uncommon side effects) include:

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• Skin changes (rash or blistering)
• Difficulty swallowing or breathing
• Unusual bruising or bleeding 
• Bloody or painful urination
• Swelling of the face and throat
• Yellowing of the eyes or skin
• Abnormal movements

Call 911 or seek emergency care if you notice any severe side effects. You can see a fuller list of Lamotrigine side effects here. 

Why do these side effects occur? 

Any medication can potentially lead to side effects, and a person’s likelihood of having side effects depends on many factors, including age, lifestyle, and the type of medication itself. Side effects may occur because drugs often have broad or poorly targeted effects, or the drug target itself may have many downstream effects on the body. 

To produce its effect, lamotrigine inhibits receptors for some chemicals in the brain like dopamine and serotonin. These chemicals are involved in some other activities of the body e.g. movement, breathing, blood pressure, sleep, etc. Inhibiting the signaling activity of some of these chemicals can affect these areas in the body, creating some side effects. 

Many non-serious side effects of mental health medications like lamotrigine go away after a few weeks as your body gets used to the medication. However, if a side effect persists, is intolerable, or severely hinders your ability to go about your daily life, talk to your doctor, because this might be a sign that the medication is not a good fit. 

How do your genes relate to lamotrigine? 

Lamotrigine is broken down in the body by the liver through a process called glucuronidation. An individual’s liver function (impacted by their genes or otherwise) may have an effect on the way their body breaks down lamotrigine. 

In general, genetics can affect your body’s response to medication. One way to predict whether you’ll have a positive outcome while taking a mental health medication is by taking a genetic test to determine what genetic variations you have and how they affect medication metabolization. Your DNA can help your doctor rule out less suitable medications and make more informed decisions so that you can get better, faster.

Special Precautions

• Speak to your doctor about any medical condition that you have or have had in the past. Any history of rash, swelling, liver, kidney, mental health, metabolic and other conditions as well as many others need to be discussed with your doctor before starting lamotrigine.
• Inform your doctor if you are pregnant or plan on getting pregnant or breast-feeding to weigh the risks and benefits of this medication. 
• Lamotrigine can interact with many other medications and supplements. Examples of some of these medications include other anticonvulsant medications, birth control pills or other hormonal medications, mood stabilizers like valproic acid / Depakote, etc. You should inform your doctor before taking any medicine or supplements alongside lamotrigine. 
• Talk with your doctor about the safety of taking alcohol or any other medication alongside lamotrigine as the medication has been shown to increase the effects of alcohol and certain medication.
• Lamotrigine may affect your vision or cause you to feel drowsy. Avoid driving or handling heavy equipment if this medication makes you feel this way or are unsure about how the medication affects you. 
• If you notice a rash or blister when you use lamotrigine, it is important to notify your doctor immediately, as this might be a sign of a serious side effect. 
• Inform your doctor if you feel irritable or agitated, or notice any strange behaviors when you take lamotrigine.  

If you show signs of an allergic reaction to lamotrigine (hives, difficulty breathing, rash, swelling), call 911 or go to the nearest emergency department.

Some medications, vitamins, and herbs may interfere with how lamotrigine works. Make sure to tell your doctor about all medical conditions as well as other medications you are taking before or while taking lamotrigine to avoid negative interactions. For full details, see the FDA’s full list of precautions. 

Looking to find the right medication for your mental health? Join Prairie today to connect to expert providers and affordable medication options. 

Looking to find the right medication for your mental health? Join Prairie today to connect to expert providers and affordable medication options.