side effects, dosage, how to take & discontinue, uses, pros & cons, and more
> Lamictal (lamotrigine) Overview
Lamictal Article Index | Brand and Generic Availability ›
Brand & Generic Names; Drug Class
US FDA Approved Treatment(s)
Bipolar 1 - maintenance treatment
. Epilepsy - by itself or with other meds, for adults & children
Initial therapy for bipolar disorder
. Bipolar 2
(best treatment, hands down - or maybe not
). Treatment-resistant depression / misdiagnosed bipolar 2
. SUNCT syndrome headaches
Learn More about Lamictal’s Approved & Off-label Uses
How Long Until Lamictal Starts Working (Onset of Action)
If you’re using Lamictal as directed it should work immediately, as you would transition from a working to Lamictal and, in theory, never lose control over your symptoms. If you’re using it off-label as initial therapy or replacing something that doesn’t work …
Usually whenever you reach a dosage of 200–400mg a day.
If you’re in the depressed phase of bipolar disorder,it can sometimes work within two-four days of your first 25 mg tablet. The average dosage that works for depression is 100 mg, and it typically takes 2–4 weeks to reach that dosage.
For mania/true mood stabilization it depends the average therapeutic dosage is around 150–200mg a day. But, like everything else, it depends. This one is a lot harder to nail down, but a month is the closest thing to an average that we have.
Likelihood of Working
The odds are decent that it will work for epilepsy, especially if you follow the PI sheet and add it to, or convert from another AED.
Generally considered to be the best drug on the market for bipolar 2. While there are always conflicting data, your mileage may vary, yadda yadda yadda, with its track record for efficacy and other factors, Lamictal should be the first med considered, but not necessarily the first med used, by many, if not most people diagnosed with bipolar 2.
If you take it like the FDA tells you to - after being stable on another med - the chances are pretty good you’ll stay stable. If you start it while manic1 or only mild-to-moderately depressed and aren’t taking, let alone stable, on another med, expect to be bouncing off the ceiling and have your cycling sped up.
Learn how Lamictal Compares with Other Drugs
How to Take Lamictal
Lamictal has the most complicated dosing instructions and schedules2 to increase the dosage (titration) of any crazy med. They take up 9 pages of the PI sheet. You need to look at the expanded dosing and titration page, as there’s no way to easily explain it without oversimplifying it. So here it is, which works for both epilepsy and bipolar disorder:
- Find a med that works.
- Once your symptoms are under control, decide if the side effects suck so much you want to be on a different med.
- If they do, switch to Lamictal by taking the two meds at the same time, lowering the dosage of the med you don’t like while increasing the dosage of Lamictal per the instructions in the appropriate Lamictal starter pack.
That’s essentially it. If you really want Lamictal to work, do it the way it’s approved to and follow GSK’s instructions. This is one of the few times I recommend a target dosage. The average target dosage for adults with bipolar disorder is 200 mg a day, taken as 100 mg twice daily.
If you had your symptoms under control at a fairly low dosage of another med, then you can probably get away with a similarly low dosage of Lamictal. Work it out with your doctor.
How to Stop Taking Lamictal (Discontinue, Withdrawal)
Glaxo-Smith Kline (GSK) has a “discontinuation strategy” of sorts:
If a decision is made to discontinue therapy, a step-wise reduction of dose over at least 2 weeks (approximately 50% per week) is recommended unless safety concerns require a more rapid withdrawal. --the PI sheet
Our rule of thumb: decrease the dosage at the same rate you increased it. Otherwise as slowly as you can. 25–50mg a day every week until you’re down to 100mg a day, then 25mg a day per week. If you have to stop due to a really serious side effect, such as SJS (Stevens-Johnson Syndrome, a.k.a. The Rash), then you and your doctor (or whoever is in the emergency room) will have to figure out a faster schedule. Although if you’re in the ER with with SJS it’ll probably be extremely simple: you stop taking it immediately and take Benadryl (diphenhydramine) - or something similar - for the rash and one or more of clonazepam, some other benzodiazepine, and more of any other antiepileptic drug(s) you’re already taking.
Learn More about Taking and Discontinuing Lamictal
Lamictal’s Pros and Cons
The best medication on the market to deal with bipolar depression without the risks of mania or lowering the seizure threshold associated with antidepressants. Weight neutral. One of the safest meds to use during pregnancy. The side effects suck less than the other meds with FDA approval for maintenance treatment of bipolar disorder.
That “without the risk of mania” is only after you’re taking enough. You might get a little too happy the first couple of weeks. Easily affected by drug-drug interactions, in spite of being metabolized in such a way that only a few meds should affect it. Can mess with your skin in all sorts of ways that could cause you to panic and stop taking it when you don’t have to.
Interesting Stuff your Doctor Probably didn’t Tell You about Lamictal
Women have noticeably more side effects than men. Lamictal prescriptions have been filled with Lamisil. Why GSK gave them such similar names is beyond me.
Best Known for
- The Rash. Everyone is scared shitless of The Lamictal Rash.
- Totally kicking the assess of Symbyax, Seroquel, and whatever other atypical antipsychotics with FDA approval to treat bipolar depression. Despite not having FDA approval to treat bipolar depression.
- A multiday hangover if you drink half a lite beer.
In-Depth Pros & Cons
Lamictal’s Potential Side Effects (Adverse Reactions)
Typical Side Effects
, itchy skin
, memory and cognitive problems
, and headaches that are sometimes really bad
. Did I mention rashes and assorted other skin problems
? The rash thing is overblown, as serious
rashes aren’t all that common. Other
skin problems, and mildly annoying, short-term rashes happen all the time. The headache is usually temporary, and if you do get it, the odds are it will be when you change the dosage. The lethargy and stupids usually diminish and may even go away, especially if you take folic acid
. Folic acid may even help with some of the skin problems. The insomnia is one of those side effects you’ll know is temporary as soon as is stops and doesn’t come back for a few months.
Uncommon Side Effects
A specific type of insomnia where you’re really sleepy but just can’t fall asleep
. Muscle aches
, everything from just a twinge in your neck or back to full-body aches that make you wonder if you were possessed by some spirit that made you participate in a triathalon the day before and have no memory of it. Similar to what you get with Topamax
. Dry mouth
. OCD-like symptoms
. Don’t be surprised if you get anxious
or have other hypomanic effects
if taking it for bipolar disorder.
As with the regular type of insomnia mentioned above, the muscle aches are one of those side effects you’ll know is temporary when it stops and doesn’t return. The dead-tired-but-still-can’t-sleep insomnia is like the headache - it might go away and only return when you change dosage, or it might go away for good (more or less) after some indeterminate amount of time, or it might just come and go on its own schedule3 for as long as you’re taking it.
Freaky Rare Side Effects
Hiccups that won’t stop
Learn More about Lamictal’s Side Effects.
TMI at times
What You Really Need to be Careful About
Stevens-Johnson Syndrome. AKA The Rash.
Lamictal’s Black Box and Other Warnings, Pregnancy Category, etc.
lamotrigine’s Half-Life & How Long Until It Clears Your System
Plasma half-life: Half-life: 25–32 hours, depending on all sorts of factors. And that’s the median average. Clearance: 6–8 days.
lamotrigine’s Pharmacokinetics Information Overload
Half-life is the average time it takes for you to process half of the drug’s active ingredient. If a drug has a half-life of around 24 hours and you take a dose of 100mg, you’ll have roughly the equivalent a 50mg dose after one day, a 25mg dose after two days, and so on. The rule of thumb is: multiply the half-life by five and you get how long it is for the dose you took to be cleared from your bloodstream, so there’s nothing swimming around to attach itself to your brain and start doing stuff4. That’s called “plasma clearance.” Complete clearance is a complex equation based on a lot of factors which may or may not: be published in the PI sheet, include personal data like your weight, or even completely figured out by corporate and independent researchers. It usually winds up being 2–5 days after plasma clearance no matter what5, but can take weeks. Sometimes a drug will clear from your brain and other organs before it clears from your blood. If we’ve found the complete clearance, or how to calculate it if it requires things like your weight and what your piss looks like, you’ll find that on lamotrigine’s pharmacokinetics page.
As if I didn’t go on long enough already.
Ratings, Reviews, Comments, PI Sheet, and More
Antiepileptic drugs / anticonvulsants (AEDs / ACs) are generally a pain in the ass to take, and Lamictal is the biggest diva of them all. But it works, and works well, for two difficult-to-treat conditions: bipolar 2 featuring severe, near-constant depression that is usually misdiagnosed as a variant of unipolar depression, and Lennox-Gastaut syndrome.
Crazy meds are an exercise in patience. You need to wait for side effects to go away. You need to wait for the meds to start working. In The Prescriber’s Guide (Essential Psychopharmacology Series) Stahl has “Wait. Wait. Wait.” as the first three things to try in order to deal with side effects that he must of had a keyboard macro for it. Lamictal, being Lamictal, has to be the most extreme when it comes to that by requiring you to have your symptoms under control by another medication before starting. At least if you want to have the best chance for Lamictal to work. The idea is for Lamictal to replace whatever you’re taking.
You may have to drastically alter your lifestyle and that of your entire family (e.g. no more perfume or scented cleaning products) to keep taking it without being covered in a scary-looking, but otherwise benign rash, but that sucks so much less than treatment-resistant bipolar 2 or watching your kid with Lennox-Gastaut hit the floor for the twentieth time today. See the extended comments and detailed side effects pages for more information on Lamictal’s interaction with fragrances.
In spite of the climate of fear that permeates everything having to do with it because of The Rash, and loud complaints about killer headaches and full-body muscle aches, Lamictal actually has one of the lowest side effect profiles around. It’s not as low as Keppra’s but it is almost as low as Neurontin’s, with the added advantage of actually doing something for bipolar disorder and forms of epilepsy that are usually way too severe for Neurontin to handle. It may be the pickiest of all AEDs, but has been an absolute lifesaver for thousands of people.
Give your overall impression of Lamictal on a scale of 0 to 5. Detailed ratings and reviews are available on the Lamictal Ratings & Reviews Page.
Get all critical about Lamictal
Rating 4.1 out of 5 from 483 criticisms.
Vote Distribution: 41 – 11 – 10 – 21 – 126 – 274
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If you’re still feeling judgmental as well as just mental6, please boost or destroy my self-confidence by honestly (and anonymously) rating this article on a scale of 0 to 5. The more value-judgments the better, even if you can criticize my work only once.
Get all judgmental about the Lamictal (lamotrigine) Overview
Rates 4.4 out of 5 from value judgments.
Vote Distribution: 6 – 4 – 4 – 16 – 93 – 192
It’s always a good idea to check for drug-drug interactions yourself. Just because most people in the crazy meds business know about really important interactions (e.g. MAOIs and a lot of stuff, warfarin and everything on the planet) doesn’t mean the person who prescribed your meds told you about them, or the pharmacist has all the meds you take at their fingertips like they’re supposed to. Or they have the time to do their jobs properly when not dealing with complete idiots or playing Angry Farmers on the Faecesbooks.
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- Lamictal’s Full US Prescribing Information
- Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.
- Stahl, Stephen M. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) Third edition Cambridge University Press 2008. ISBN:978–0521673761
- Julien, Robert M. Ph.D, Claire D. Advokat, and Joseph Comaty Primer of Drug Action: A comprehensive guide to the actions, uses, and side effects of psychoactive drugs 12th edition Worth Publishers 2011. ISBN:978–1429233439
- Stahl, Stephen M. The Prescriber’s Guide (Essential Psychopharmacology Series) Third edition Cambridge University Press 2009. ISBN:978–0521743990
- Virani, Adil S., K. Bezchlibnyk-Butler, and J. Jeffries Clinical Handbook of Psychotropic Drugs 18th edition Hogrefe & Huber Publishers 2009. ISBN:978–0889373693
- Silberstein, Stephen D., Michael J. Marmura Essential Neuropharmacology: The Prescriber’s Guide Cambridge University Press 2010. ISBN:978–0521136723
- Stein, Dan, Bernard Lerer, Stephen Stahl Evidence-based Psychopharmacology Cambridge University Press 2005. ISBN:978–0521531887
- Clinical Neurology for Psychiatrists David Myland Kaufman MD © 2001 W.B. Saunders Company. An imprint of Elsevier
- Antiepileptic Drugs René H. Levy, Richard H. Mattson, Brian S. Meldrum, Emilio Perucca © 2003
- Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 ISBN:978-0323040587 An imprint of Elsevier.
- PDR: Physicians’ Desk Reference 2010 64th edition
- Marson, Anthony G., Asya M. Al-Kharusi, Muna Alwaidh, Richard Appleton, Gus A. Baker, David W. Chadwick, Celia Cramp et al. “The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial.” The Lancet 369, no. 9566 (2007): 1000-1015.
- Marson, Anthony G., Asya M. Al-Kharusi, Muna Alwaidh, Richard Appleton, Gus A. Baker, David W. Chadwick, Celia Cramp et al. “The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy: an unblinded randomised controlled trial.” The Lancet 369, no. 9566 (2007): 1016-1026.
- Arif, Hiba, Richard Buchsbaum, Joanna Pierro, Michael Whalen, Jessica Sims, Stanley R. Resor, Carl W. Bazil, and Lawrence J. Hirsch. “Comparative effectiveness of 10 antiepileptic drugs in older adults with epilepsy.” Archives of neurology 67, no. 4 (2010): 408-415.
- Fuller, Matthew A. “Medical Management of Bipolar Disorder: A Pharmacologic Perspective.” ANNALS OF CLINICAL PSYCHIATRY (2011): 23-48.
- “Lamictal (lamotrigine) and Lamisil (terbinafine hydrochloride) ‘Dear Healthcare Professional Letter.’” U.S. Food and Drug Administration website. 2000 Last Updated: 08/03/2009. Last Accessed: 17 July 2014.
- Hikma Pharmaceuticals Central Nervous System Portfolio Last Accessed 04 July 2014
- ChemSpider’s lamotrigine page Last Accessed 04 July 2014
- New Zealand Medicines and Medical Devices Safety Authority Medicine Data Sheet for Lamictal Dispersible/Chewable Tablets Last Accessed 04 July 2014
- electronic Medicines Compendium Summary of Product Characteristics for Lamictal Tablets SPC Last updated 08 April 2014. Last Accessed 04 July 2014
Lamictal Article Index | Brand and Generic Availability ›
1 How many of us voluntarily see a doctor for the first time - or the first time after several years - during a euphoric mania? The only reason I did was because that was when I could deal with the agoraphobia and new people. I must be one of very few of the bipolar who consistently see new doctors while manic to some degree.
2 That's right, schedules, as in more than one. While many crazy meds have different titration schedules based on what condition you have, and can be influenced by any other medications you may be taking, it is such a freaking diva about drug-drug interactions that GSK has three different starter packs. But that still doesn't cover things like if you're planning to switch from your existing meds to Lamictal alone, or will you be staying on them.
3 There are probably all sorts of factors involved, such as life stressors or a random-seeming interaction with caffeine like Topamax has. Then again, it's Lamictal, and if there is any drug on the planet that is more random I'm glad I'm not taking it.
4 Based on Julien's calculations from A Primer of Drug Action, the half-life multiplied by five is the generally accepted estimate of how long it takes a single dose of any given drug to be eliminated from the blood stream/plasma of someone with a normal metabolism. That's also the rough estimate for steady stage if they can't get, or won't provide a number for that.
5 For crazy meds. I have no idea what the average complete clearance is for other types of medications. For all I know there are drugs that utterly vanish from your system in under five passes, and others that won't let go of your squishy bits for years after you stop taking them.
6 Thank you! I'll be here all weak. Be sure to tip your content provider. And don't try the veal, it's cruelicious!
7 These include: Canada's Product Monographs (PM), New Zealand's Medicine Data Sheets (MDS), the EU's European Public Assessment Reports (EPAR), and the Summary of Product Characteristics (SPC) used in Britain, Ireland, and many other places.
If you have any questions not answered here, please see the Crazymeds Lamictal discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.us)
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1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.
2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.
3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion of anonymity. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.
* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.
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