Lamictal is the brand name for the prescription medication lamotrigine. It is primarily used to treat epilepsy and to delay mood episodes in people with bipolar disorder. Lamictal works by calming overactive electrical signals in the brain, which helps prevent seizures and stabilize mood. It is not a painkiller and does not work like a typical sedative or sleeping pill.
What Is The Drug Lamictal Used For?
Lamictal has two main approved uses in the United States. The first is the treatment of certain types of epilepsy in adults and children. The second is the maintenance treatment of bipolar I disorder to delay the time between mood episodes.
In epilepsy, Lamictal is used alone or with other medications to control partial seizures, primary generalized tonic-clonic seizures, and seizures associated with Lennox-Gastaut syndrome. It is a standard option for many people with newly diagnosed epilepsy.
In bipolar disorder, Lamictal is specifically approved for maintenance therapy. That means it helps prevent future depressive and manic episodes. It is not considered a fast-acting treatment for an active acute manic episode or an active depression.
How Does Lamictal Work in the Brain?
Nerve cells in the brain communicate by sending electrical signals. In epilepsy, these signals can fire too rapidly and in an uncoordinated way, which causes a seizure. Lamictal works by blocking sodium channels on nerve cells.
When a nerve cell fires, sodium flows into the cell. Lamictal slows this flow, which makes the nerve cell less excitable. The result is that abnormal electrical bursts are dampened before they can spread and cause a seizure.
Why Lamictal stabilizes mood in bipolar disorder is less fully understood. Researchers believe the same mechanism of calming excessive nerve firing plays a role. It may also affect the release of glutamate, a chemical messenger involved in learning and memory. The mood-stabilizing effect builds gradually over weeks.
What Are the Most Common Side Effects?
Like all medications, Lamictal can cause side effects. The most common ones include dizziness, headache, blurred vision, double vision, nausea, vomiting, and sleepiness. Many of these are more noticeable when the dose is being increased and often improve over time.
Some people experience coordination problems, a shaky or unsteady walk, or tremor. These can affect daily activities, so it is important to tell your doctor if they interfere with your life.
Serious but less common side effects include aseptic meningitis, which is inflammation of the membranes around the brain. Symptoms include fever, stiff neck, headache, nausea, and sensitivity to light. This requires immediate medical attention.
What Is the Serious Rash Risk?
The most serious risk with Lamictal is a severe skin rash. In rare cases, this rash can progress to a life-threatening condition such as Stevens-Johnson syndrome or toxic epidermal necrolysis. These conditions cause blistering and peeling of the skin and can be fatal.
The risk is highest in the first eight weeks of treatment. The risk is also higher if the starting dose is too high or if the dose is increased too quickly. This is why doctors always start Lamictal at a low dose and raise it slowly over several weeks or months.
Children under 16 appear to have a higher risk of serious rash than adults. Anyone who develops a new rash while taking Lamictal should contact their doctor right away. Not every rash is dangerous, but a medical evaluation is necessary to tell the difference.
How Is Lamictal Dosed and Titrated?
Lamictal dosing is highly individualized. The starting dose and the rate of increase depend on your age, your condition, and whether you take other medications that interact with Lamictal.
For adults with epilepsy not taking interacting drugs, the typical starting dose is 25 mg once daily for two weeks. The dose is then gradually increased over several weeks to a maintenance dose, which is often between 100 mg and 400 mg per day.
For bipolar disorder, the target maintenance dose is usually 200 mg per day, but the dose is built up very slowly. Reaching the full dose can take six weeks or more. This slow schedule is essential for reducing the risk of serious rash.
Certain other medications change how the body processes Lamictal. Valproate, a common epilepsy and bipolar drug, roughly doubles Lamictal levels in the blood. When these drugs are taken together, the Lamictal dose must be reduced. Conversely, drugs like rifampin and some seizure medications can lower Lamictal levels and require higher doses.
What Drug Interactions Matter?
Lamictal interacts with several common medications. Oral contraceptives are a notable example. Estrogen-containing birth control pills can reduce Lamictal levels by about 50 percent. This can make seizures more likely or cause mood symptoms to return.
When someone starts or stops birth control pills, the Lamictal dose may need adjustment. This is a common reason for breakthrough seizures in women taking both medications.
Other seizure medications also interact with Lamictal. Carbamazepine, phenytoin, and phenobarbital can speed up the breakdown of Lamictal, lowering its levels. Valproate does the opposite, as mentioned above.
Always give your doctor a complete list of every medication and supplement you take. This includes over-the-counter products and herbal remedies. Interactions can be complex, and dose adjustments are common.
What Should You Know Before Taking Lamictal?
Lamictal can be taken with or without food. It comes as a tablet, a chewable tablet, and an orally disintegrating tablet. Consistency matters. Taking it at the same time each day helps maintain steady levels in the blood.
Do not stop taking Lamictal suddenly. Abruptly stopping a seizure medication can trigger withdrawal seizures or a severe return of mood symptoms. If you need to stop, your doctor will guide you through a gradual dose reduction.
Some people feel drowsy or less coordinated when starting Lamictal. Until you know how the medication affects you, use caution with driving and operating machinery. Alcohol can worsen these effects.
Lamictal is not recommended during pregnancy unless the benefits clearly outweigh the risks. The medication has been associated with an increased risk of cleft lip and cleft palate in babies exposed during the first trimester. If you are pregnant, planning pregnancy, or breastfeeding, discuss the risks and benefits with your doctor before starting this medication.
Frequently Asked Questions
Is Lamictal a controlled substance?
No, Lamictal is not a controlled substance. It has no recognized potential for abuse or dependence, unlike benzodiazepines or opioids.
How long does Lamictal take to work?
For seizures, effects may begin within days to weeks as the dose is adjusted. For mood stabilization in bipolar disorder, it typically takes six to eight weeks at a therapeutic dose to see full benefit.
Can Lamictal cause weight gain?
Weight gain is not a typical side effect of Lamictal. In clinical studies, weight changes were uncommon, and the medication is often preferred over other mood stabilizers for this reason.
Can you drink alcohol while taking Lamictal?
Alcohol is not directly forbidden with Lamictal, but it can increase drowsiness and dizziness. Heavy drinking may also lower the seizure threshold and reduce the effectiveness of the medication.
