Lamotrigine (Lamictal)

Quick Reference

Generic Name: Lamotrigine
Brand Names: Lamictal, Lamictal XR, Lamictal ODT
Drug Class: Sodium channel blocker
Primary Uses: Focal seizures, generalized seizures, absence seizures, Lennox-Gastaut syndrome

What is Lamotrigine?

Lamotrigine is an anti-seizure medication used for many seizure types. It tends to have fewer cognitive side effects than older medications and may improve mood in some people. Careful dose escalation is important to reduce the risk of serious skin reactions.

How It Works

Lamotrigine blocks sodium channels in the brain, stabilizing overexcited nerve cell membranes. It also reduces the release of glutamate, a chemical that can trigger seizures. This dual action makes it effective for both focal and generalized seizures.

Who Might Take This Medication?

Lamotrigine is FDA-approved for:

  • Focal (partial) seizures in adults and children 2 years and older
  • Primary generalized tonic-clonic seizures in adults and children 2 years and older
  • Generalized seizures of Lennox-Gastaut syndrome in adults and children 2 years and older

It is also commonly used off-label for:

  • Absence seizures
  • Myoclonic seizures (may worsen some types)
  • Mood stabilization in bipolar disorder

Common Side Effects

Most people tolerate lamotrigine well after the initial titration period.

Common side effects:

  • Dizziness, headache, double or blurred vision
  • Sleepiness, nausea, coordination problems, tremor, insomnia

Less common but important:

  • Serious rash
  • Mood changes (usually improvement, occasionally worsening)
When to Call Your Doctor Immediately

Contact your healthcare provider or go to the emergency room if you notice:

  • Any new rash, especially in the first 8 weeks
  • Fever with rash, swollen lymph nodes, sores in mouth or around eyes
  • Peeling skin or blisters
  • Difficulty swallowing or breathing
  • Severe dizziness or unsteadiness

Serious Side Effects: Rash

Serious skin reactions are rare but important.

  • Benign rash: Mild, usually resolves on its own or with temporary dose adjustment
  • Serious rash: Stevens-Johnson Syndrome (SJS) or Toxic Epidermal Necrolysis (TEN), typically occurs in first 2-8 weeks and can be life-threatening

Minimizing Rash Risk

  • Start at a low dose and increase slowly
  • Do not increase faster than prescribed
  • Avoid if you had a rash from lamotrigine before
  • If you skip several doses, call your doctor before restarting
  • Watch for rash during the first 8 weeks

What to Watch For

Seek medical attention for:

  • Any new rash
  • Rash with fever or swollen glands
  • Rash that spreads, blisters, or appears with sores in mouth, throat, nose, or eyes

Drug Interactions

Medications that may decrease lamotrigine levels:

  • Birth control pills (estrogen-containing)
  • Carbamazepine, phenytoin, phenobarbital, primidone
  • Rifampin

Medications that may increase lamotrigine levels:

  • Valproic acid (levels may double)

Lamotrigine does not reduce birth control effectiveness, but estrogen-containing pills reduce lamotrigine levels by about 50%.

Birth Control Considerations

If you start or stop hormonal birth control while taking lamotrigine:

  • Levels may change significantly
  • Dose adjustments may be needed
  • Inform your doctor before starting or stopping birth control
  • Watch for breakthrough seizures or increased side effects

Monitoring

Your doctor may order:

  • Blood levels (helpful but not always required)
  • Liver and kidney function tests occasionally
  • Close monitoring during first 8 weeks for rash and side effects

Stopping This Medication

Warning

Never stop lamotrigine suddenly. This can cause withdrawal seizures.

Taper gradually with your doctor. If you stop for several days, you may need to restart at a low dose to reduce rash risk.

Frequently Asked Questions

How long does it take to work?
6-8 weeks or longer to reach a therapeutic dose due to slow titration.

What if I miss a dose?
Take it as soon as remembered. If close to the next dose, skip and continue regular schedule. After multiple missed doses, call your doctor before restarting.

I got a mild rash - what should I do?
Call your doctor immediately; all rashes need evaluation. Do not increase dose.

Can I drink alcohol?
Moderation is recommended; alcohol may increase drowsiness and lower seizure threshold.

Will it affect my weight?
Lamotrigine is generally weight-neutral.

Does it affect mood?
Often positively; mood worsening is uncommon.

I’m starting birth control pills - what do I need to know?
Pills reduce lamotrigine levels by about 50%. Dose adjustments may be needed. Work closely with your doctor.

Difference between Lamictal and Lamictal XR?
XR is extended-release once daily; regular Lamictal is usually twice daily. Do not interchange mg-for-mg.

Note

All of the possible uses, cautions, side effects, or interactions of this drug are not covered in this handout. If you want more information about this medication, ask your child’s doctor, pharmacist, or nurse. This information handout does not pertain to pregnancy or breastfeeding—talk to your doctor if this is a concern.

This information is for educational purposes only and does not replace medical advice. Always consult your healthcare provider about medications and treatment decisions.