Brand & Generic Names; Drug Classes
|US brand name: Lamictal|
|Generic name: lamotrigine|
|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 LamictalInitial 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 …
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
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.
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:
- 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 (discontinuation / 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 Full US Lamictal 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.