Experiences with

Lamotrigine

Lamotrigine is a medicine used to treat epilepsy. It can also help prevent low mood (depression) in adults with bipolar disorder.

Seizures are bursts of electrical activity in the brain that temporarily affect how it works. Lamotrigine slows these electrical signals down to stop seizures.

Lamotrigine is available on prescription. It comes either as tablets you swallow, or tablets you chew or dissolve in water to make a drink.

Who can take lamotrigine

Most adults, and children aged 2 years and over, can take lamotrigine.

Who may not be able to take lamotrigine

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

• have ever had an allergic reaction to lamotrigine or any other medicine
• 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, trying to get pregnant or breastfeeding

Dosage

For epilepsy, the usual dose of lamotrigine is:

• adults and older children (aged 12 years and over) – 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

Changes to your dose

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

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

How to take it

You'll usually 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, take it first thing in the morning and in the evening.

If you're taking standard tablets, swallow them whole with a drink of water. Do not chew them.

If you're taking chewable or dispersible tablets, you can swallow them whole with a drink of water, or chew them or mix them with water or juice to make a drink.

How long to take it for

If you have epilepsy, it's likely that once your condition is under control you'll still need to take lamotrigine for many years.

If you have bipolar disorder, it's likely that you'll take lamotrigine for at least 6 months, but possibly much longer.

Do not stop taking lamotrigine without speaking to your doctor first.

If you take lamotrigine once a day and forget your dose, take the missed dose as soon as you remember, unless it's less than 12 hours until your next dose is due. In this case, leave out the missed dose and take your next dose at the usual time.

If you take it twice a day, take the missed dose as soon as you remember, unless it's less than 8 hours before the next dose is due. In this case, leave out the missed dose and take your next dose at the usual time.

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's 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.

If you take too much

Taking too much lamotrigine can lead to symptoms such as:

• rapid, uncontrollable eye movements
• feeling clumsy or losing your balance
• feeling a change in the rhythm of your heartbeat
• having a seizure (fit)
• passing out

• you take more than your prescribed dose of lamotrigine

Get help from 111 online or call 111. Call 111 if you need advice for a child under 5 years old

If you need to go to A&E, do not drive. Ask someone to drive you or call 999 and ask for an ambulance.

Bring the lamotrigine packet or leaflet inside it, any remaining medicine, and any other medicines you take.

Do not stop taking lamotrigine without talking to your doctor.

If you're 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're taking lamotrigine for bipolar disorder, it's 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.

Common side effects

These common side effects of lamotrigine may happen in more than 1 in 10 people. There are things you can do to help you cope:

If this advice does not help and you are bothered by any of these side effects, keep taking the medicine but tell your doctor or pharmacist.

Serious side effects

Skin rashes

It's common to get a skin rash with lamotrigine. Most skin rashes are not serious.

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's 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 have developed a rash before with a different epilepsy medicine
• people who are allergic to an antibiotic called trimethoprim
• people also taking a medicine called sodium valproate

To help reduce the chance of you getting a rash that could be confused with Stevens-Johnson syndrome, it's best to not try any new medicines or food during the first 3 months of treatment with lamotrigine.

• you get a severe rash with flushing, blisters or ulcers – these can be signs of Stevens-Johnson syndrome

Find your nearest A&E

Very few people taking lamotrigine have any serious problems as any serious reaction is quite rare.

Tell a doctor or call 111 straight away if you have a serious side effect, including:

• worsening fits or seizures (if you take lamotrigine for epilepsy)
• unexpected bruising or bleeding, a high temperature or sore throat – these could be signs of a blood disorder

• you have 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
• you have a stiff neck, headaches, feel or are being sick, a high temperature and extreme sensitivity to bright light – these could be signs of meningitis

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

There have been reports of osteoporosis and osteopenia in people taking lamotrigine for a long time. Both these conditions increase 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.

Other side effects

These are not all the side effects of lamotrigine. For a full list, see the leaflet inside your medicine packet.

Lamotrigine and pregnancy

Lamotrigine may be taken during pregnancy if it's needed to keep you well.

Do not stop taking lamotrigine if you become pregnant. Talk to your doctor, as they may want to review your medicine and may need to change your dose.

If you're trying to get pregnant or have become pregnant while taking lamotrigine, your doctor or midwife should recommended that you take a high dose of folic acid (5mg a day). Speak to them about getting it on prescription.

Ideally, it's best to take high dose folic acid for 3 months before you start trying to get pregnant and for the first 12 weeks of pregnancy. Do not worry if you have not taken it before you get pregnant, but start taking it as soon as possible once you know that you are pregnant. It helps your baby to grow normally.

Your baby may need extra monitoring for a few days after they're born. This is because they can sometimes have withdrawal symptoms from lamotrigine.

Lamotrigine and breastfeeding

If your doctor or health visitor says your baby is healthy, you can take lamotrigine while you're breastfeeding.

If you were taking lamotrigine during pregnancy, your dose may need to be reduced once you have given birth.

It's 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.

Lamotrigine can pass into breast milk in different amounts. These amounts are usually small but sometimes it may pass into breast milk in larger amounts.

There have been some reports of side effects in breastfed babies, including drowsiness, poor feeding, skin rashes, muscles being more floppy than usual and, very rarely, breathing problems or effects on the blood. However, many babies do not get any side effects.

If you notice your baby has any of these side effects, or is not feeding as well as usual, or you have any other concerns about them, talk to your pharmacist, health visitor, midwife or doctor as soon as possible.

Lamotrigine and fertility

There's no evidence to suggest that taking lamotrigine causes fertility problems in either men or women.

Speak to a pharmacist or your doctor if you're trying to get pregnant. They may want to review your treatment.

Cautions with other medicines

Some medicines and lamotrigine can affect 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're taking:

• other medicines used to treat epilepsy, such as carbamazepine, felbamate, gabapentin, levetiracetam, oxcarbazepine, phenobarbital, phenytoin, pregabalin, primidone, topiramate, sodium valproate, valproic acid 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)

Lamotrigine and contraception

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. They may recommend that you use a particular type of hormonal contraceptive, or another method of contraception, such as condoms, a cap or coil.

You can take the progestogen-only contraceptive pill, but lamotrigine might increase the amount of progesterone in your blood and cause you to have more side effects.

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.

Ask your pharmacist for advice.

There's not enough information to say that other complementary medicines and herbal remedies are safe to take with lamotrigine. They're not tested in the same way as pharmacy and prescription medicines. They're generally not tested for the effect they have on other medicines.

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