Lamotrigine

Lamotrigine can be taken by adults, and by children aged 2 years and over.

Lamotrigine is not suitable for some people. To make sure lamotrigine is safe for you, tell your doctor if you:

• have ever had an allergic reaction to lamotrigine or other medicines in the past
• have liver or kidney problems
• have bipolar disorder and have ever had thoughts of harming or killing yourself
• have ever had meningitis or a rash caused by lamotrigine
• are pregnant or trying to get pregnant
• have an intolerance to or cannot digest lactose (lactose intolerance) – some brands of lamotrigine contain lactose

 

Pregnancy and breastfeeding

Lamotrigine and pregnancy

There is no firm evidence that lamotrigine is harmful to an unborn baby. But for safety, your doctor will only advise you to take it in pregnancy if the benefits of the medicine outweigh the risks.

It is important for you and your baby to stay well during pregnancy. If you become pregnant while taking lamotrigine, tell your doctor or nurse straight away. Do not stop taking it without talking to your doctor first.

If you have epilepsy, it is very important that it is treated during pregnancy as seizures can harm you and your unborn baby. If you are pregnant, or trying to get pregnant, and taking lamotrigine, you are recommended to take a higher dose of folic acid, a vitamin that helps your baby grow normally.

Your doctor might prescribe a high dose of 5mg a day while you are trying to get pregnant and during the first 12 weeks of pregnancy.

 

Lamotrigine and breastfeeding

If your doctor or health visitor says your baby is healthy, lamotrigine can be taken while you are breastfeeding.

It is important to keep taking lamotrigine to keep you well. Do not stop taking it without talking to your doctor. Breastfeeding will also benefit both you and your baby.

If you notice your baby is not feeding as well as usual, seems unusually sleepy, or you have any other concerns about them, talk to your pharmacist or doctor as soon as possible.

Lamotrigine is a prescription medicine. It is important to take it as advised by your doctor.

Dosage

• For epilepsy, the usual dose for:
• adults and older children (aged 12 years and over) is 100mg to 700mg a day, taken as 1 or 2 doses

• younger children (aged 2 to 11 years) – the dose will vary depending on their weight

• For bipolar disorder, the usual dose for adults is between 200mg and 400mg a day, taken as either 1 or 2 doses

 

How to take it

It is usual to take lamotrigine once or twice a day. You can take it with or without food. If you take it twice a day, try to space your doses evenly through the day. For example, first thing in the morning and in the evening.

• Non-chewable or non-dispersible tablets – swallow whole with a glass of water. Do not chew them.

• Chewable or dispersible tablets – can be swallowed whole with a glass of water, chewed or mixed with water or juice to make a drink.

 

Will my dose go up or down?

When you start taking lamotrigine, it Is important to increase the dose slowly as this will help reduce or stop some side effects happening.

Once you find a dose that suits you, it will usually stay the same.

 

How long will I take it for?

If you have epilepsy, it is likely that once your condition is under control, you will still need to take lamotrigine for many years. If you have bipolar disorder, it is likely that you will take lamotrigine for at least 6 months, but possibly much longer.

 

What if I forget to take it?

If you take lamotrigine and you forget a dose:

• once a day – take the missed dose as soon as you remember. If it is less than 12 hours until your next dose is due, leave out the missed dose and take your next dose as normal.

• twice a day – take the missed dose as soon as you remember. If it is less than 8 hours before the next dose is due, it is better to leave out the missed dose and take your next dose as normal.

Do not take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.

If you have epilepsy, it is important to take this medicine regularly. Missing doses may trigger a seizure.

If you forget to take your tablets for more than 5 days in a row, speak to your doctor, as you’ll need to start on a low dose again and gradually increase to your usual dose.

If you forget doses often, it may help to set an alarm to remind you. You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.

 

What if I take too much?

Taking too much lamotrigine can cause serious side effects:

• rapid uncontrollable eye movement
• clumsy or loss balance
• change in rhythm of heartbeat
• have a fit or seizure
• pass out

Like all medicines, Lamotrigine can cause side effects, although not everyone gets them.

 

Skin rashes

It is common to get a skin rash with lamotrigine. Most skin rashes are not serious. But if you develop a skin rash or redness, tell a doctor straight away, as this can develop into a life-threatening skin condition called Stevens-Johnson syndrome.

Stevens-Johnson syndrome is a rare side effect of lamotrigine. It causes flu-like symptoms, followed by a red or purple rash that spreads and forms blisters. The affected skin eventually dies and peels off.

It is more likely to happen in the first 8 weeks of starting lamotrigine, or when the dose is increased too quickly.It can also happen if lamotrigine is stopped suddenly for a few days and then restarted at the same dose as before, without reducing the dose and then increasing it slowly again.

Stevens-Johnson syndrome is more common in:

• children
• people who developed a rash with a different epilepsy medicine in the past
• people who are allergic to an antibiotic called trimethoprim
• people also taking a medicine called sodium valproate

To help prevent the chance of you getting a rash that could be confused with Stevens-Johnson syndrome, it is best to not start any new medicines, foods or products during the first 3 months of treatment with lamotrigine.

It is also best to not start lamotrigine within 2 weeks of a viral infection, vaccination or rash caused by something else.

 

Other common side effects

These common side effects may happen in more than 1 in 100 people. They are usually mild and go away by themselves. Keep taking the medicine, but talk to your doctor if these side effects bother you or do not go away:

• headaches
• feeling drowsy, sleepy or dizzy
• aggression, or feeling irritable or agitated
• shaking or tremors
• difficulty sleeping
• diarrhoea
• feeling or being sick (nausea or vomiting)

 

Other serious side effects

Very few people taking lamotrigine have serious problems. Tell a doctor straight away if you have a serious side effect, including:

• thoughts of harming or killing yourself – a small number of people taking lamotrigine for bipolar disorder have had suicidal thoughts, and this can happen after only a few weeks of treatment
• worsening seizures (if you take lamotrigine for epilepsy)
• unexpected bruising or bleeding, a high temperature or sore throat – these could be warning signs of a blood disorder
• a stiff neck, headaches, feeling or being sick, a high temperature and extreme sensitivity to bright light – these could be signs of meningitis

 

Serious allergic reaction

In rare cases, it is possible to have a serious allergic reaction (anaphylaxis) to lamotrigine.

• you get a skin rash that may include itchy, red, swollen, blistered or peeling skin
• you are wheezing
• you get tightness in the chest or throat
• you have trouble breathing or talking
• your mouth, face, lips, tongue or throat start swelling

 

How to cope with side effects of lamotrigine

What to do about:

• headaches – make sure you rest and drink plenty of fluids. Do not drink too much alcohol. Ask your pharmacist to recommend a painkiller. Talk to your doctor if your headaches last longer than a week or are severe.

• feeling drowsy, sleepy or dizzy – as your body gets used to lamotrigine, these side effects should wear off. Do not drive, ride a bike or operate machinery until you feel more alert. If they do not go within a week or two, your doctor may reduce your dose or increase it more slowly. If that does not work, speak to your doctor. You may need to switch to a different medicine.
• aggression, or feeling irritable or agitated – talk to your doctor.

• shaking or tremors – talk to your doctor if this is bothering you. These symptoms can be a sign that the dose is too high for you. It may help to change your dose or take your medicine at a different time of day.

• difficulty sleeping – talk to your doctor.

• diarrhoea – drink lots of fluids, such as water or squash, to avoid dehydration. Signs of dehydration include peeing less than usual or having dark, strong-smelling pee. Do not take any other medicines to treat diarrhoea without speaking to a pharmacist or doctor. Speak to a doctor if symptoms get worse or last longer than a week.

• feeling or being sick – stick to simple meals and do not eat rich or spicy food. It might help to take your lamotrigine after a meal or snack. If you are being sick, take small, frequent sips of water or squash to avoid dehydration. Speak to a doctor if symptoms get worse or last longer than a week.

 

Cautions with other medicines

Some medicines and lamotrigine interfere with each other and increase the chances of side effects. Your doctor may need to change your dose of lamotrigine.

Check with your pharmacist or doctor if you are taking:

• other medicines used to treat epilepsy, such as carbamazepine, felbamate, gabapentin, levetiracetam, oxcarbazepine, phenobarbital, phenytoin, pregabalin, primidone, topiramate, valproate or zonisamide
• aripiprazole, lithium, olanzapine or risperidone (used for mental health problems)
• bupropion, a “stop smoking” medicine
• rifampicin, an antibiotic usually given to treat tuberculosis (TB)
• medicines used to treat HIV
• hormonal contraceptives or hormone replacement therapy (HRT)

 

Mixing lamotrigine with herbal remedies and supplements

There might be a problem taking some herbal remedies and supplements alongside lamotrigine, especially ones that can cause rashes, sleepiness or shaking and tremors.

How does Lamotrigine work?

For epilepsy – brain cells normally “talk” to each other using electrical signals and chemicals. Seizures can happen when the brain cells are not working properly or working faster than normal. Lamotrigine slows down these electrical signals to stop seizures.

For bipolar disorder – we do not really know how lamotrigine prevents low mood in people. It might work in a similar way to epilepsy. Sometimes it is called a mood stabiliser, as it reduces mood swings.

 

How long does it take to work?

It usually takes around 6 weeks for lamotrigine to work properly. This is because the dose needs to be increased slowly to prevent side effects. You may still have seizures or feel low during this time.

 

Is it safe to take Lamotrigine for a long time?

Many people can take lamotrigine safely for several months or years.

But there are some side effects that might happen over a long time. Long-term treatment with lamotrigine can cause osteoporosis and osteopenia, increasing your risk of breaking a bone. Your doctor can arrange for tests to check your bone strength. Regular exercise and a good diet can also help keep your bones strong.

 

How can I come off Lamotrigine?

If you are taking lamotrigine for epilepsy, stopping it suddenly can cause seizures. Coming off lamotrigine should be done very slowly and might take a few months.

If you are taking lamotrigine for bipolar disorder, it is usually safe to stop taking it without having to reduce your dose first. If you get a serious side effect, such as a severe skin rash, your doctor may tell you to stop taking lamotrigine straight away, even if you have epilepsy.

 

What happens if I want to switch to a different medicine?

If you are switching medicines, it is very important to do it exactly as your doctor tells you to. If you want to switch, you will usually start taking the new one at a low dose and slowly build up the dose while you are still taking lamotrigine.

Once you are taking the correct dose of the new medicine, you should be able to slowly reduce your dose of lamotrigine. It can take several weeks or months until you have stopped taking lamotrigine completely.

 

Does lamotrigine cause weight loss?

Lamotrigine does not usually affect weight at all.

 

Will the side effects wear off?

Most side effects of lamotrigine wear off, but it can take several weeks or months.

When you start taking lamotrigine, it is important to increase the dose slowly as this will help reduce or stop some side effects happening. Lamotrigine can also cause some unpredictable side effects no matter what dose you take, and these can happen at any time.

 

Are there similar medicines?

There are lots of medicines that can be used for epilepsy and bipolar disorder, but they work in different ways. They might have different side effects, or be taken more or less often.

If you have epilepsy, the choice will depend on the type of seizures that you have. Your doctor will discuss the best medicine for you. If you have low mood with bipolar disorder, other medicines your doctor might use include lithium or quetiapine.

 

Do I need to take the same brand of lamotrigine?

If your epilepsy has been hard to control in the past and the brand of lamotrigine you are now taking is working well for you, your doctor may recommend you stay on the same one.

If you take lamotrigine for bipolar disorder, most people do not have to stay on the same brand. Talk to your doctor if you have been asked to switch to a different brand of lamotrigine and you’re worried about it.

 

Can I take sodium valproate with lamotrigine?

Yes, you can take sodium valproate with lamotrigine.

But sodium valproate can increase the amount of lamotrigine in your blood, so your doctor may prescribe a lower dose of lamotrigine.

 

How does it compare with other medicines for epilepsy?

There are many different medicines for treating epilepsy. It is not possible to say that one works better than the other.

It varies from person to person, and depends on the type of seizures and how often you have them.

Other epilepsy medicines include:

• brivaracetam
• carbamazepine
• clobazam 
• ethosuximide
• gabapentin
• levetiracetam
• phenytoin
• pregabalin

 

How does it compare with other medicines for bipolar disorder?

If you have bipolar disorder, there are several types of medicine to prevent low mood.

It is not possible to say that one works better than another, and varies from person to person.

Lithium is commonly used for treating low mood in bipolar disorder, as well as a medicine called quetiapine (an antipsychotic medicine). You can take lamotrigine on its own, or sometimes together with lithium or quetiapine, depending on what your doctor recommends.

 

Can I take lamotrigine before surgery?

Tell your surgeon that you take lamotrigine. Take your medicine as normal on the day of your surgery, unless your doctor or surgeon advises you not to.

 

Will it affect my contraception?

The combined pill, patch and vaginal ring can lower the amount of lamotrigine in your blood, so you might want to use a different type of contraception instead.

If you decide to take the combined pill, you may need to change your dose of lamotrigine, but this depends on what other epilepsy medicines you’re taking.

Lamotrigine might stop the combined pill working. Look out for bleeding or spotting between your periods (breakthrough bleeding), which might be a sign the pill is not working. Talk to your doctor if this happens.

 

Will it affect my fertility?

There is no firm evidence that lamotrigine affects female fertility.

For some men with epilepsy, epilepsy medicines can reduce their levels of testosterone. It does not affect everyone, but it could make you less fertile.

 

Can I drink alcohol with it?

Yes, you can drink alcohol with lamotrigine. But it may make you feel sleepy or tired, and alcohol and hangovers can bring on seizures in some people with epilepsy.

During the first few days of taking lamotrigine, it is best to stop drinking alcohol until you see how the medicine affects you. If you do drink, try not to have more than the recommended guidelines of up to 14 units of alcohol a week.

 

Is there any food or drink I need to avoid?

No. You can eat and drink normally while taking lamotrigine.

 

Can I drive or ride a bike with it?

You may feel sleepy, tired or dizzy when you first start taking lamotrigine or the dose is increased.

If this happens to you, do not drive, ride a bike or operate machinery until you feel more alert. It can also affect your vision. Do not drive or ride a bike if your vision is affected.

If you have epilepsy, you’re not allowed to drive until you have had no seizures for 1 year or you only have seizures while you’re asleep. You’re not allowed to drive for 6 months after changing your epilepsy medicine.