Treating Bipolar Disorder With Lamictal

Prescribing Information and Treatment Considerations

Lamictal and Lamotrigine Tablets
Lamictal and Lamotrigine Tablets. Wikimedia Commons

Lamictal (lamotrigine) is an anticonvulsant epilepsy drug approved for use as a mood stabilizer in people with bipolar disorder. 

Lamictal was the second medication, after lithium, to be approved by the U.S. Food and Drug Administration (FDA) to treat or prevent manic and depressive episodes of bipolar I disorder. It works by moderating (attenuating) extreme variations in brain activity and seems particularly useful in persons with extreme depression.

It is still not yet fully understood how Lamictal works or its exact mechanism of action in treating bipolar disorder.

Lamictal Indications and Usage

Lamotrigine is approved for use in persons 18 years of age or older. It is a chewable tablet available in  25 mg (white), 100 mg (peach), 150 mg (cream), and 200 mg (blue) formulations.

Lamictal tablets may be swallowed whole, chewed, or dispersed in water or diluted fruit juice. If the tablets are chewed, sip a small amount of water to aid in swallowing. If dissolving in a tablespoon of water, wait for a least one minute until completely dissolve before swallowing the dose.

Once started, it may take up to two weeks to begin to feel the effects of Lamictal therapy. Do not stop or alter dosages without first speaking with your doctor.

Driving or handling heavy equipment is also not advised until you are fully aware of how Lamictal affects you.

Common Side Effects 

There are a number of side effects associated with Lamictal use.

Some are transient and will normalize within days or weeks. Others may be more persistent and, in some, be intolerable.

The most common side include:

  • rash
  • weight loss
  • loss of appetite
  • dizziness or loss of balance
  • drowsiness
  • insomnia
  • nausea 
  • vomiting
  • diarrhea
  • constipation
  • dry mouth
  • fever
  • eye movement you can't control
  • difficulty speaking
  • missed or painful menstrual periods
  • double vision
  • concentration problems

Drug Warnings and Contraindications 

Lamictal is contraindicated in persons who experience a hypersensitivity reaction or have had a reaction in the past to any of its ingredients.

If a reaction does occur, treatment must be tapered off gradually over a period of at least two weeks to avoid the risk of withdrawal seizures. All told, about 10 percent of people on Lamictal will experience rash, usually in the first two to eight weeks of treatment.

Advise your doctor immediately if you experience a rash or any other symptom of hypersensitivity reaction including swollen lymph nodes (lymphadenopathy) and fever.

If left untreated, hypersensitivity can cause multi-organ failure and even death.

Other Considerations

Lamictal dosages will need to be adjusted for women who start or stop taking oral contraceptives containing estrogen. Do not start or stop taking birth control pills without first talking with your doctor.

It is also important to advise your physician if there are any changes in menstrual patterns (such as breakthrough bleeding) after starting Lamictal. Breastfeeding while taking Lamictal is not recommended.

Dose adjustments may also need to be made if you are on anti-tuberculosis therapies containing rifampin.

Source:

U.S. Food and Drug Administration (FDA). "Lamictal (lamotrigine) Prescribing Information." Silver Spring, Maryland; updated July 1, 2005.

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