Help CenterΕverything you need to know about LAMOTRIGINE
It’s a funky word, isn’t it? This drug has been around for thirty years and has become a well-known treatment for many mental troubles. Let’s find out more.
What’s it used for?
We don’t think of it as an “antidepressant”. We use it in patients 18 and older to deal with mood changes. For example, in the case of bipolar disorder.
However, it also has antidepressant uses. When we use Lamotrigine to deal with, for example, depression, a non-bipolar disorder, and when we use it in younger patients, this is “off-label”. This is very common and legal except if it violates ethical guidelines. The use of Lamotrigine in these ways is well backed-up by treatment experience and a history of clinical practice.
For example, there are many reports of the use of Lamotrigine in:
- Borderline personality disorders
- Obsessive-compulsive disorder
- Increasing the antidepressant effects of other medications
- Other forms of mood dysregulation
It seems very helpful for broader mood dysregulation (mood swings), particularly for depressive mood swings. Whilst it is not a typical antidepressant, it is beneficial with recurrent depression.
How does this thing work?
We must say the exact mechanism of action is not entirely understood. We know that Lamotrigine reduces the intensity of irregular electrical activity in the brain. This means longer delays between mood changes: and manic or depressive states in people, which allows for better awareness of mood swings and emotional dysregulation.
What dose?
We start with a low dose. We increase this every fortnight week for several weeks. When the dose becomes effective, there is no need to keep doing this.
How does Lamotrigine mix with other drugs?
The amount you receive of Lamotrigine may depend on your other medications. This is because some medications slow your metabolism of Lamotrigine. This means we need to increase the dose at a slower rate in order to truly assess the effects. In contrast, some drugs “speed up” your metabolism of Lamotrigine. An example would be estrogen-containing oral contraceptives. This means we increase the dose at a faster rate. Your experienced doctor will steer you through these matters.
What do I do if I forget to take a dose?
Take the missed dose as soon as you remember. And yet, if you remember close to the time of your next dose, “skip” the missed dose and go on with the rest of the schedule. Never take a double dose of Lamotrigine.
What about side effects…
Experts say Lamotrigine is a well-tolerated drug. This means you “don’t tend to feel dull, flat or groggy on it”. Many feel this way when they take other mood stabilizers, and they are happy to avoid these effects by taking Lamotrigine. Using the drug as your doctor prescribes and taking it gradually at the start will generally mean you will tolerate it well.
There are still a few side effects that a few users experience:
The rash
Patients taking Lamotrigine should stop taking the drug at the first sign of a rash, no matter how big, and immediately contact their doctor or psychiatrist.
The appearance of a rash occurring between five days and eight weeks of taking Lamotrigine may have serious consequences.
Many fever or flu-like symptoms may be present before or simultaneously with the rash.
If the rash happens in the first five days of Lamotrigine, it is probably not drug-related. The patient should stop taking the drug and contact their psychiatrist or general doctor. It may reveal a compassionate allergy to the drug presented so early.
And if the rash happens between five days and eight weeks after taking the drug, do the same thing: stop taking it and contact your psychiatrist or general doctor as soon as possible. There is a need for blood tests to fully understand the situation. There are two types of rashes and different ways to tell each:
Rash - not as serious:
- The rash has fine red spots that do not come together
- These may be itchy, though they are not tender to the touch
- The rash will peak within days, settling in ten to 14 days
- No fever or flu-like symptoms come with this rash
The more serious rash
- This may be life-threatening.
- Reaches the membranes of the eyes, lips, mouth, nostrils, genital or anal areas
- Fever, flu-like symptoms, or no appetite come with this rash
- Merging hives. The dots may be round and red
- Purple areas - these may be small - that, when touched by a finger, are tender and do not go white as normal rashes do
- There may be shedding of the skin
Taking the drug after a rash
We need to stop taking Lamotrigine at the first sign of a rash. This is a necessary safety precaution given the dire consequences of a rash that has become serious. This might mean a valuable treatment for bipolar has been unnecessarily foregone if the rash was never severe.
Because Lamotrigine is so effective as a mood stabilizer, we may recommend the drug in these cases. This decision will follow the doctor’s view of the risks and benefits and an assessment of the rash.
Starting the drug again may begin after a delay of six months. The starting dose will be lower and increased faster than before. The drug will be stopped if the rash worsens or other symptoms appear. To this end, the patient will be closely monitored.
Arrhythmia
ECG tests before taking Lamotrigine are helpful at first because there may be adverse effects on the heart. There have been reports of this drug causing arrhythmia or an irregular heart rate. This is more common in people who have had heart problems before, such as:
- Structural heart problems
- Heart failure
- The second or third-degree of heart block
- Heart attacks
Blood tests
We recommend a standard blood test before taking Lamotrigine as there have been some infrequent reports of a reduction in white cell count. We recommend you recheck the complete blood picture regularly.
How to find out more…
The material in this fact sheet was based on the information provided by Black Dog Institute in Sydney.
Boris Lorberg, Nagy A. Youssef and Subin Bhagwagar (2009). Lamotrigine-associated rash: to re-challenge or not to re-challenge? International Journal of Neuropsychopharmacology;12:257-265.
FDA Safety Warning on the Cardiac Effects of Lamotrigine: An Advisory from the AD Hoc ILAE/AES Task Force - 26 Jan 2021
Agranulocytosis Associated with Lamotrigine - published online: 1 Oct 2000 https://doi.org/10.1176/appi.ajp.157.10.1704