Highlighting uses, dosage, how to take and discontinue

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L is for Lamictal

Lamictal’s Side Effects, Warnings, etc. >>

Brand & Generic Names; Drug Classes

US brand name: Lamictal
Generic name: lamotrigine

Drug Class(es)

Primary drug class: AntiepilepticDrugs/Anticonvulsants
Additional drug class(es): MoodStabilizers (approved) Antidepressants (off-label) Migraine/NeuropathicPain (off-label)

Approved & Off-Label Uses (Indications)

Lamictal’s US FDA Approved Treatment(s)

Bipolar 1 - maintenance treatment. Epilepsy - by itself or with other meds as maintenance, for adults & children. Unlike most other meds Lamictal is not approved as initial therapy (a med you take to get your symptoms under control), but to switch to after something else gets your symptoms under control because Lamictal tends to suck less.

Uses Approved Overseas but not in the US

Off-Label Uses of Lamictal

Initial therapy for bipolar disorder. Bipolar 2 (best treatment, hands down - or maybe not). Treatment-resistant depression / misdiagnosed bipolar 2. SUNCT syndrome headaches.


When & If Lamictal Will Work

Lamictal’s Usual Onset of Action (when it starts working)

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 …

Epilepsy

Usually whenever you reach a dosage of 200–400mg a day.

Bipolar

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

Epilepsy

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.

Bipolar 2

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.

Bipolar 1

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.

Taking and Discontinuing

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. So here it is, which works for both epilepsy and bipolar disorder:

  1. Find a med that works.
  2. Once your symptoms are under control, decide if the side effects suck so much you want to be on a different med.
  3. 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 (discontinuation / withdrawal)

Manufacturer’s Recommendations

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 Full US Lamictal PI sheet

Crazymeds’ Suggestions

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.

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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.


Last modified on Mon, 01 Jun, 2015 at 15:38:30 by JerodPoorePage Author Date created January 18, 2011, at 15:16:23
“Lamictal (lamotrigine): Uses and Using” by Jerod Poore is copyright © 2011 Jerod Poore Published online 2011/01/18

Lamictal, and all other drug names on this page and used throughout the site, are the trademarks of someone else.

will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.



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