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Lamotrigine

Sounds like 'lam-OH-try-jeen'

Key points about lamotrigine

Lamotrigine is used to treat some types of epilepsy and prevent depressive episodes in bipolar disorder.
Lamotrigine is also known as Lamictal®, Logem® and Arrow-Lamotrigine®.
Find out how to take it safely and possible side effects.

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Lamotrigine is used to treat epilepsy (by preventing seizures) and to control depressive episodes in bipolar disorder. Lamotrigine blocks certain kinds of nerve activity and in this way reduces seizures and helps with mood disorders.

In Aotearoa New Zealand, lamotrigine is available in different strength tablets (2 mg, 5 mg, 25 mg, 50 mg, 100 mg).

Lamotrigine is available as the brands Lamictal®, Logem® and Arrow-Lamotrigine®. These brands are all slightly different, so it’s important that you stay on the same brand if possible. If your tablets look different from usual, check with your pharmacist.

The dose of lamotrigine is different for different people.
Your doctor will start you on a low dose, and increase your dose slowly over a few weeks to avoid side effects.
Lamotrigine is usually taken 1 or 2 times a day but sometimes when you start lamotrigine it's taken every other day.
Always take your lamotrigine exactly as your healthcare provider has told you. The pharmacy label on your medicine will tell you how much to take, how often to take it, and any special instructions.

From October 2023 the packaging of the 25 mg, 50 mg and 100 mg tablets of the Lamictal brand of lamotrigine has changed.

This has been done for safety reasons to protect children from getting into them. The tablets themselves are exactly the same, there has been no change to what's in them, who makes them or how they are made.

Read more about the change(external link) and the best way to open the new packaging.

Swallow your lamotrigine tablets with a glass of water, milk or juice.
If you have swallowing problems, you can chew the tablets or put the tablet in a small amount of water or fruit juice and mix well so it dissolves. This may take a few minutes. Then swallow all of the solution straight away.
Take lamotrigine at the same times each day, to help you to remember to take it.
You can take lamotrigine with or without food.
If you forget to take your dose, take it as soon as you remember; don't take double the dose.
- If you're taking lamotrigine once every other day, take your missed dose as soon as you remember, as long as it's 12 hours or more before the next dose is due.
- If you're taking lamotrigine once a day, take your missed dose as soon as you remember, if it's 12 hours or more before the next dose is due.
- If you're taking lamotrigine twice a day, take it as soon as you remember but if it's more than 4 hours since the dose was due, just take the next dose at the usual time. Don't take double the dose.

Here are some things to know when you’re taking lamotrigine. Other things may be important as well, so ask your healthcare provider what you should know about.

Lamotrigine may cause dizziness or drowsiness: This is more likely when you first start taking lamotrigine or when your dose is increased.
- Driving: Don’t drive or operate machinery until you know how this medicine affects you.
- Children shouldn’t ride a bike, climb trees or do anything else that could be dangerous if they’re still feeling drowsy or sleepy.
Alcohol: limit alcohol, it can make any dizziness and drowsiness worse.

Other medicines: Lamotrigine interacts with some medicines, herbal supplements and rongoā Māori, so check with your doctor or pharmacist before starting lamotrigine and before starting any new products. This is especially important if you're taking:
- medicines that make you sleepy
- other anti-seizure medicines
- the oral contraceptive pill (‘The pill’)
- hormone replacement therapy (HRT), or
- menopausal hormone therapy (MHT).
Keep taking lamotrigine every day. It may take a few weeks before you notice the full benefits of lamotrigine.
Don't stop taking lamotrigine suddenly, it could make your condition worse; talk to your healthcare provider before stopping so they can help you with this. See tips to help you remember to take your medicines regularly(external link).
Keep taking the same brand of lamotrigine. If you have to change from your usual brand this must be managed carefully with your doctor.
Children taking lamotrigine should be reviewed by their doctor regularly as the dose may change as they grow.
Contraception: If you could become pregnant you should use 2 forms of effective contraception (eg, condoms and another kind) for the whole time you're taking lamotrigine and for 2 weeks after stopping it. Talk to your healthcare provider about this as some contraceptives may not work as well while you’re taking lamotrigine, and for 4 weeks after you’ve stopped taking it. Read more about epilepsy and contraception.(external link)
Breastfeeding: Talk to your doctor if you're breastfeeding or want to breastfeed your baby.

If you're planning a pregnancy

It’s important to contact your doctor 6 to 12 months before you want to become pregnant. Read more about epilepsy and pregnancy(external link).
If you're taking lamotrigine and you become pregnant: Contact your doctor immediately but don’t stop taking lamotrigine until you’ve discussed it with them. There are risks to yourself and your unborn child from uncontrolled epilepsy or bipolar disorder, and you may need your dose or your medicines changed while you're pregnant.
For more information, read:

Like all medicines, lamotrigine can cause side effects, although not everyone gets them. Often side effects improve as your body gets used to the new medicine.

Skin rash

Skin rash is a common side effect of lamotrigine and is most likely to happen in the first 8 weeks of treatment; let your doctor know if this happens. It can affect your body, face or mouth. Some people may also feel unwell and have a fever with the rash.
You're more likely to get a rash if you're also taking sodium valproate, or another anti-seizure medicine, and if you have other allergies. It's less likely to happen if lamotrigine is started at a low dose and increased slowly.
The rash is usually mild and goes away on its own but for some people it can become a severe skin reaction. Serious skin reactions have been reported in:
- 1 in 500 adults taking lamotrigine for epilepsy
- 1 in 100 to 300 children taking lamotrigine for epilepsy
- 1 in 1000 people taking lamotrigine for bipolar disorder.
The risk of a severe skin reaction is higher if you have an autoimmune disorder, eg, rheumatoid arthritis or lupus.
If you get a rash, let your doctor know as soon as possible so they can help you to manage it and let you know what to do if it gets worse.

Other possible side effects

Side effects	What should I do?
Feeling sleepy, drowsy or tired Feeling dizzy Problems with your eyesight such as blurred vision or double vision	Be careful when driving or using tools until you know how this medicine affects you. Limit or avoid alcohol. Tell your doctor if these bother you.
Headache Back or joint aches and pains Tremor	These are common. Tell your doctor if these bother you.
Feeling sick (nausea) Stomach upset Dry mouth	These are common. Try taking lamotrigine with food. Tell your doctor if these bother you.
Easy bruising, feeling tired, looking pale, getting sick often	This is rare. Tell your doctor as you may need a blood test.
Skin rash, skin peeling or blisters Ulcers in the mouth, throat, nose or genital area Sudden fever	This is most likely to happen in the first 8 weeks of treatment. Tell your doctor immediately or ring Healthline 0800 611 116.
Changes in mood, personality or behaviour Suicidal thoughts, anxiety or depression	These are not common. Tell your doctor immediately or ring Healthline 0800 611 116.