Lamictal (Lamotrigine) - Oral

What Is Lamictal?

Lamictal (lamotrigine) is an oral prescription anti-epilepsy drug (AED) and mood stabilizer used as a maintenance treatment for bipolar disorder and seizure disorders. It is also sometimes used off-label for several other neurological and psychiatric conditions. 

Lamictal stabilizes nerve activity in the brain by inhibiting voltage-sensitive sodium channels and modifying neurotransmitter activity.

Lamictal is available as a tablet, a chewable tablet, and an orally disintegrating tablet.

Drug Facts

Generic Name: Lamotrigine

Brand Name(s): Lamictal

Drug Availability: Prescription

Therapeutic Classification: Antiepileptic

Available Generically: Yes

Controlled Substance: No

Administration Route: Oral

Active Ingredient: Lamotrigine

Dosage Form(s): Tablets

What Is Lamictal Used For?

The Food and Drug Administration (FDA) has approved Lamictal as a maintenance treatment for bipolar disorder and a preventive for seizures in epilepsy. 

Epilepsy

Epilepsy is a condition characterized by a predisposition to recurring seizures

The FDA approved Lamictal to treat:

  • Adults and children ages 2 and older as an adjunctive (add-on) therapy to prevent certain seizure types
  • Adults and teenagers over age 16, as a monotherapy (single therapy) in some conditions

Adjunctive epilepsy therapy means the drug is used along with one or more AEDs. Monotherapy AED is used as the only AED in treatment.

Lamictal prevents the following seizure types: 

  • Partial-onset seizures, which are seizures that begin in one part of the brain 
  • Primary generalized tonic-clonic seizures, which are seizures that begin on both sides of the brain and cause rapidly repetitive jerking and stiffness
  • Generalized seizures in Lennox-Gastaut syndrome, a severe developmental disorder characterized by multiple seizure types and cognitive impairment
  • Preventing partial-onset seizures if switching from Tegretol (carbamazepine), Dilantin (phenytoin), phenobarbital, Mysoline (primidone), or valproate monotherapy

Bipolar Disorder 

Bipolar disorder is a chronic mood disorder characterized by recurrent episodes of depression and mania. 

Lamictal is used as a maintenance treatment for bipolar disorder in adults ages 18 and older. It can be effective for delaying or preventing mood episodes.

How to Take Lamictal

Lamictal dosing differs for each disorder, so you must use it as directed for your specific situation. Take Lamictal daily for the prevention of symptoms. Please do not use it as an emergency treatment or to quickly stop symptoms while they are happening. You can take all the different forms of Lamictal with or without food or drink.

Storage

Keep your medications tightly closed and out of the reach of children and pets, ideally locked in a cabinet or closet.

Store at room temperature (68 to 77 F (20 to 25 C)). Lamictal can be exposed for short periods to temperatures of 59 F to 86 F. Do not store your medication in the bathroom.

Avoid pouring unused and expired drugs down the drain or in the toilet. Ask your pharmacist or healthcare provider about the best ways to dispose of this medicine. Visit the FDA's website to know where and how to discard all unused and expired drugs. You can also find disposal boxes in your area. Ask your pharmacist or healthcare provider if you have any questions about the best ways to dispose of your medications.

If you travel with Lamictal, get familiar with your final destination's regulations. In general, make a copy of your Lamictal prescription. Keep the medication in its original container from the pharmacy with your name on the label. Ask your pharmacist or healthcare provider if you have any questions about traveling with your medicine.

Off-Label Uses

Healthcare professionals can prescribe Lamictal to treat several other conditions not specified by the FDA when medically appropriate. This is known as off-label use. 

Off-label uses of Lamictal include but are not limited to:

  • Migraine prevention 
  • Bipolar depression (acute treatment)
  • Depression that’s unrelated to bipolar disorder 
  • Schizophrenia that doesn’t improve with standard treatment 
  • Obsessive-compulsive disorder (OCD) that doesn’t improve with standard treatment 
  • Post-traumatic stress disorder (PTSD)
  • Depersonalization disorder
  • Emotional symptoms of borderline personality disorder

When prescribed off-label, the dosing and schedule of Lamictal can be different from the instructions for its approved indications.

How Long Does Lamictal Take to Work?

It might take a few weeks to notice changes in symptoms from taking Lamictal. The time it takes Lamictal to work may be different for everyone. Check with your healthcare provider or pharmacist with any questions.

What Are the Side Effects of Lamictal?

This is not a complete list of side effects, and others may occur. A healthcare provider can advise you on side effects. If you experience other effects, contact your pharmacist or healthcare provider. You may report side effects to the Food and Drug Administration (FDA) at fda.gov/medwatch or 800-FDA-1088.

Common Side Effects

Often, the side effects of Lamictal are tolerable.

Common side effects of Lamictal when it's used to treat epilepsy include but aren't limited to:

  • Dizziness 
  • Headaches 
  • Blurred vision or double vision 
  • Balance problems 
  • Nausea 
  • Extreme tiredness 
  • Sore throat or congestion 
  • Rash 

Common side effects of Lamictal when it's used to treat bipolar disorder include but aren't limited to:

  • Nausea 
  • Trouble sleeping 
  • Extreme tiredness 
  • Back pain
  • Rash 
  • Nasal congestion 
  • Abdominal pain
  • Xerostomia (dry mouth)

Specific side effects can be treated or managed. Talk to your healthcare provider about any side effects, but do not change your medication dosing without your provider's advice.

Severe Side Effects

The severe side effects of Lamictal can be dangerous and life-threatening. Contact your healthcare provider immediately if you develop any signs of a severe reaction. Call 911 if your symptoms feel life-threatening.

Severe effects of Lamictal include:

  • Life-threatening rash 
  • Drug reaction with eosinophilia and systemic symptoms (DRESS), a potentially fatal type of organ failure that can start with a rash, fever, and swollen lymph nodes 
  • Blood disorders that can cause bleeding or blood clots
  • Suicidal thoughts or behavior 
  • Noninfectious meningitis (inflammation around the brain and spinal cord), which can cause headaches, photophobia (discomfort when looking at light), neck stiffness, and fevers 

These problems can worsen rapidly. Get medical attention promptly if you start to experience any of these symptoms.

Long-Term Side Effects

Generally, the side effects of Lamictal should cease within days of stopping the medication. However, if a serious reaction causes organ damage, lasting effects can occur.

Report Side Effects

Lamictal may cause other side effects. Call your healthcare provider if you have any unusual problems while taking this medication.

If you experience a serious side effect, you or your provider may send a report to the FDA's MedWatch Adverse Event Reporting Program online or by phone (800-332-1088).

Dosage: How Much Lamictal Should I Take?

Drug Content Provided and Reviewed by IBM Micromedex®

The dose of this medicine will be different for different patients. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of this medicine. If your dose is different, do not change it unless your doctor tells you to do so.

The amount of medicine that you take depends on the strength of the medicine. Also, the number of doses you take each day, the time allowed between doses, and the length of time you take the medicine depend on the medical problem for which you are using the medicine.

  • For oral dosage forms (chewable dispersible tablets, disintegrating tablets, tablets for suspension, or tablets):
    • For treatment of bipolar disorder:
      • Adults not taking valproic acid (Depakote®) and not taking carbamazepine (Tegretol®), phenobarbital (Luminal®), phenytoin (Dilantin®), or primidone (Mysoline®)—At first, 25 milligrams (mg) of lamotrigine once a day for 2 weeks, then 50 mg once a day for 2 weeks. After this, your doctor may gradually increase your dose as needed. However, the dose is usually not more than 200 mg a day.
      • Adults taking valproic acid (Depakote®)—At first, 25 mg of lamotrigine once every other day for 2 weeks, then 25 mg once a day for 2 weeks. After this, your doctor may gradually increase your dose as needed. However, the dose is usually not more than 100 mg a day.
      • Adults not taking valproic acid (Depakote®) but taking carbamazepine (Tegretol®), phenobarbital (Luminal®), phenytoin (Dilantin®), or primidone (Mysoline®)—At first, 50 mg of lamotrigine once a day for 2 weeks, then a total of 100 mg divided into 2 smaller doses each day for 2 weeks. After this, your doctor may gradually increase your dose as needed. However, the dose is usually not more than 400 mg a day.
      • Adults who are discontinuing valproic acid (Depakote®) or discontinuing carbamazepine (Tegretol®), phenobarbital (Luminal®), phenytoin (Dilantin®), or primidone (Mysoline®)—Dose will be determined by your doctor.
      • Children—Use and dose must be determined by your doctor.
    • For treatment of epilepsy:
      • Adults not taking valproic acid (Depakote®) but taking carbamazepine (Tegretol®), phenobarbital (Luminal®), phenytoin (Dilantin®), or primidone (Mysoline®)—At first, 50 milligrams (mg) of lamotrigine once a day for 2 weeks, then a total of 100 mg divided into 2 smaller doses each day for 2 weeks. After this, your doctor may gradually increase your dose as needed. However, the dose is usually not more than 500 mg a day.
      • Adults not taking valproic acid (Depakote®), carbamazepine (Tegretol®), phenobarbital (Luminal®), phenytoin (Dilantin®), or primidone (Mysoline®)—At first, 25 mg of lamotrigine once a day for 2 weeks, then 50 mg once a day for 2 weeks. After this, your doctor may gradually increase your dose as needed. However, the dose is usually not more than 375 mg a day.
      • Adults taking valproic acid (Depakote®)—At first, 25 mg of lamotrigine once every other day for 2 weeks, then 25 mg once a day for 2 weeks. After this, your doctor may gradually increase your dose as needed. However, the dose is usually not more than 400 mg a day.
      • Adults who are discontinuing valproic acid (Depakote®) or discontinuing carbamazepine (Tegretol®), phenobarbital (Luminal®), phenytoin (Dilantin®), or primidone (Mysoline®)—Dose will be determined by your doctor.
      • Children 2 to 12 years of age:
        • Children not taking valproic acid (Depakote®) but taking carbamazepine (Tegretol®), phenobarbital (Luminal®), phenytoin (Dilantin®), or primidone (Mysoline®)— At first, 0.6 milligrams per kilogram (mg/kg) of body weight of lamotrigine divided into 2 smaller doses each day for 2 weeks, then 1.2 mg/kg of body weight divided into 2 smaller doses each day for 2 weeks. After this, your doctor may gradually increase your dose as needed. However, the dose is usually not more than 400 mg a day.
        • Children not taking valproic acid (Depakote®), carbamazepine (Tegretol®), phenobarbital (Luminal®), phenytoin (Dilantin®), or primidone (Mysoline®)— At first, 0.3 mg/kg of body weight of lamotrigine given in one dose or two smaller doses each day for 2 weeks, then 0.6 mg/kg of body weight divided into 2 smaller doses each day for 2 weeks. After this, your doctor may gradually increase your dose as needed. However, the dose is usually not more than 300 mg a day.
        • Children taking valproic acid (Depakote®)— At first, 0.15 mg/kg of body weight of lamotrigine given in one dose or two smaller doses each day for 2 weeks, then 0.3 mg/kg of body weight given in one dose or two smaller doses each day for 2 weeks. After this, your doctor may gradually increase your dose as needed. However, the dose is usually not more than 200 mg a day.
      • Children younger than 2 years of age—Use and dose must be determined by your doctor.
  • For oral dosage form (extended-release tablets):
    • For seizures:
      • Adults and children older than 13 years of age not taking valproic acid (Depakote®) but taking carbamazepine (Tegretol®), phenobarbital (Luminal®), phenytoin (Dilantin®), or primidone (Mysoline®)—At first, 50 milligrams (mg) of lamotrigine once a day for 2 weeks, then 100 mg once a day for 2 weeks. After this, your doctor may gradually increase your dose as needed. However, the dose is usually not more than 600 mg a day.
      • Adults and children older than 13 years of age not taking valproic acid (Depakote®), carbamazepine (Tegretol®), phenobarbital (Luminal®), phenytoin (Dilantin®), or primidone (Mysoline®)—At first, 25 mg of lamotrigine once a day for 2 weeks, then 50 mg once a day for 2 weeks. After this, your doctor may gradually increase your dose as needed. However, the dose is usually not more than 400 mg a day.
      • Adults and children older than 13 years of age taking valproic acid (Depakote®)—At first, 25 mg of lamotrigine once every other day for 2 weeks, then 25 mg once a day for 2 weeks. After this, your doctor may gradually increase your dose as needed. However, the dose is usually not more than 250 mg a day.
      • Children younger than 13 years of age—Use and dose must be determined by your doctor.

Modifications

The following modifications (changes) should be kept in mind when using Lamictal:

Severe allergic reaction: Avoid using Lamictal if you have a known allergy to it or its ingredients. Ask your pharmacist or healthcare provider for a complete list of the ingredients if you're unsure.

Pregnancy may affect Lamcital's therapeutic effect, so dosage adjustments may be necessary for pregnant people. Discuss with your healthcare provider if you plan to become pregnant or are pregnant, and weigh the benefits and risks of taking Lamictal during your pregnancy.

Breastfeeding: Lamictal passes into breast milk. People who are breastfeeding should talk to their healthcare provider about the best way to feed their babies while taking Lamictal. If you are breastfeeding while on Lamictal, monitor your baby for side effects such as: 

  • Trouble breathing
  • Episodes of temporarily stopped breathing
  • Sleepiness
  • Poor sucking

Talk with your healthcare provider if you plan to breastfeed, to weigh the benefits and risks of taking Lamictal while nursing and the different ways available to feed your baby.

Adults 65 years and older should start at the low end of the dosing range to be safe. Also, dosing may be modified when taking other medications that interact with Lamictal.

Other modifications: People taking estrogen-containing oral contraceptives may also require dosing adjustments while taking Lamictal.

Kidney problems: No dose adjustments for Lamictal are needed for people with kidney impairment. However, a healthcare provider may need to monitor your dosing carefully if you have chronic kidney failure.

Missed Dose

If you accidentally forgot your Lamictal dose, take it as soon as you remember. If it's already close to your next scheduled dose, skip the missed dose and take the following dose at your next scheduled dosing time. Don't try to double up to make up for the missed dose.

Find ways to help yourself remember to keep your appointments and take your medication routinely. If you miss too many doses, Lamictal might be less effective at treating your condition.

Overdose: What Happens If I Take Too Much Lamictal?

Taking too much Lamictal can cause side effects such as fatigue and dizziness. However, in some instances, Lamictal overdose can be dangerous. 

Severe effects of Lamictal overdose may include:

These effects may have to be treated symptomatically until the medication is eliminated from the body. In some situations, dialysis may be necessary to remove Lamictal from the body.

What Happens If I Overdose on Lamictal?

If you think you or someone else may have overdosed on Lamictal, call a healthcare provider or the Poison Control Center (800-222-1222).

If someone collapses or isn't breathing after taking Lamictal, call 911 immediately.

Precautions

Drug Content Provided and Reviewed by IBM Micromedex®

It is important that your doctor check your or your child's progress at regular visits, especially during the first few months of your treatment with lamotrigine. This will allow your doctor to change your dose, if necessary, and will help reduce any unwanted effects.

It is important to tell your doctor if you become pregnant while using this medicine. Your doctor may want you to join a pregnancy registry for patients taking a seizure medicine.

You should not start or stop using birth control pills or other female hormonal products while you are using this medicine until you have consulted your doctor.

Tell your doctor right away if you have unusual changes in your menstrual cycle such as breakthrough bleeding while taking lamotrigine and birth control pills or other female hormonal products.

This medicine may increase the effects of alcohol and other central nervous system (CNS) depressants (medicines that make you drowsy or less alert). Some examples of CNS depressants are antihistamines or medicine for allergies or colds, sedatives, tranquilizers, or sleeping medicine, prescription pain medicine or narcotics, medicine for seizures or barbiturates, muscle relaxants, or anesthetics, including some dental anesthetics. Check with your doctor before taking any of the above while you are using this medicine.

Lamotrigine may cause blurred vision, double vision, clumsiness, unsteadiness, dizziness, or drowsiness. Do not drive or do anything else that could be dangerous until you know how this medicine affects you. If these reactions are especially bothersome, check with your doctor.

Skin rash may be a sign of a serious unwanted effect. Check with your doctor immediately if you or your child develop a rash, fever, flu-like symptoms, or swollen glands, or if your seizures becomes worse.

This medicine may cause hemophagocytic lymphohistiocytosis, a rare and life-threatening disorder wherein the body makes too many activated immune cells (macrophages and lymphocytes). Talk to your doctor if you have any concerns.

Lamotrigine may cause serious allergic reactions affecting multiple body organs (eg, liver or kidney). Check with your doctor right away if you or your child have the following symptoms: fever, dark urine, headache, hives, muscle pain or stiffness, stomach pain, unusual tiredness, or yellow eyes or skin.

This medicine may cause some people to be agitated, irritable, or display other abnormal behaviors. It may also cause some people to have suicidal thoughts and tendencies or to become more depressed. If you, your child, or your caregiver notice any of these side effects, tell your doctor or your child's doctor right away.

Check with your doctor right away if you or your child start to have a stiff neck, confusion, drowsiness, fever, chills, headache, nausea, vomiting, rash, or sensitivity to light. These could be symptoms of a rare and serious condition called aseptic meningitis.

Check with your doctor right away if blurred vision, difficulty with reading, or any other change in vision occurs during or after treatment. Your doctor may want your eyes be checked by an ophthalmologist (eye doctor).

Do not stop taking lamotrigine without first checking with your doctor. Stopping this medicine suddenly may cause your seizures to return or to occur more often. Your doctor may want you to gradually reduce the amount you are taking before stopping completely.

Do not take other medicines unless they have been discussed with your doctor. This includes prescription or nonprescription (over-the-counter [OTC]) medicines and herbal or vitamin supplements.

What Are Reasons I Shouldn’t Take Lamictal?

If you're allergic to Lamictal or any of its ingredients, avoid using it. Ask your pharmacist or healthcare provider for a complete list of the ingredients if you're unsure.

Lamictal might carry risks if you are pregnant or breastfeeding. Talk to your healthcare provider about whether you should continue taking Lamictal if you become pregnant or intend to become pregnant.

What Other Medications Interact With Lamictal?

Several medications interact with Lamictal, but the interactions are not all serious. Some of these medications are commonly prescribed with Lamictal. When Lamictal is used along with drugs that cause interactions, the dosing and instructions for each medication are usually adjusted to optimize therapeutic effects and reduce the risk of side effects. 

Medications that decrease the concentration of Lamictal in the body include but aren't limited to:

  • Tegretol (carbamazepine)
  • Dilantin (phenytoin)
  • Luminal (phenobarbital)
  • Mysoline (primidone)
  • Rifadin and Rimactane (rifampin)
  • Estrogen-containing oral contraceptives 
  • Kaletra (lopinavir/ritonavir) and Ritovaz (atazanavir/ritonavir), which are used to treat HIV

Depakote (sodium valproate) increases the concentration of Lamictal in the body.

Talk with your pharmacist or healthcare provider for more detailed information about medication interactions with Lamictal.

Also talk with your healthcare provider about any other medicines you take or plan to take, including over-the-counter, nonprescription products, vitamins, herbs, or plant-based medicines.

What Medications Are Similar?

Some AEDs are similar, but not identical, to Lamictal.

Tegretol and Depakote are AEDs that can also treat bipolar disorder.

Keppra (levetiracetam), Topamax (topiramate), and Neurontin (gabapentin) are also commonly used AEDs. Lithium (brand name, Lithobid) is commonly prescribed to treat bipolar disorder.

Frequently Asked Questions

  • What is Lamictal used for?

    Lamictal is approved to prevent seizures in epilepsy and as a maintenance treatment for bipolar disorder. Lamictal can also treat many conditions off-label, including schizophrenia, post-traumatic stress disorder, and obsessive-compulsive disorder.

  • How does Lamictal work?

    Lamictal reduces nerve excitability in the brain by inhibiting sodium channels and neurotransmitter activity.

  • What drugs should not be taken with Lamictal?

    Lamictal has many drug interactions, especially with other AEDs, and doses may need to be adjusted to account for the interactions.

  • How long does it take for Lamictal to work?

    It can take several weeks of taking Lamictal before you experience adequate symptom control. However, Lamictal can begin to affect the body within hours.

How Can I Stay Healthy While Taking Lamictal?

When taking Lamictal, there are several things you need to do to stay healthy. 

This medication might cause risks if you are pregnant or breastfeeding. Talk to your healthcare provider about the risks and benefits of continuing Lamictal if you become pregnant or are thinking about becoming pregnant. 

Take your medication as prescribed. Do not make dosing changes on your own. Inform your healthcare team if you start new medicines, supplements, or herbs or are newly diagnosed with medical conditions while taking Lamictal. 

Talk to your provider about any side effects you develop while taking Lamictal. Develop an action plan to follow if you begin to experience severe side effects. 

Make sure you are maintaining optimal management of the condition for which you are taking Lamictal: 

  • Avoid seizure triggers if you have epilepsy. These include alcohol, illicit drugs, sleep deprivation, flashing lights, and severe stress. 
  • Seek counseling and behavioral therapy and social support for any psychiatric condition you have.
  • Tell your healthcare provider if you start to develop or worsen your symptoms.

Medical Disclaimer

Verywell Health's drug information is meant for educational purposes only and is not intended as a replacement for medical advice, diagnosis, or treatment from a healthcare provider. Consult your healthcare provider before taking any new medication(s). IBM Watson Micromedex provides some of the drug content, as indicated on the page.

4 Sources
Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Read our editorial process to learn more about how we fact-check and keep our content accurate, reliable, and trustworthy.
  1. Naguy A, Al-Enezi N. Lamotrigine uses in psychiatric practice. Am J Ther. 2019 Jan/Feb;26(1):e96-e102. doi:10.1097/MJT.0000000000000535

  2. Food and Drug Administration. Lamictal label.

  3. Alyahya B, Friesen M, Nauche B, Laliberté M. Acute lamotrigine overdose: a systematic review of published adult and pediatric cases. Clin Toxicol (Phila). 2018 Feb;56(2):81-89. doi:10.1080/15563650.2017.1370096

  4. Parker G. Risks associated with lamotrigine prescription: a review and personal observations. Australas Psychiatry. 2018 Dec;26(6):640-642. doi:10.1177/1039856218760733

By Heidi Moawad, MD
Heidi Moawad is a neurologist and expert in the field of brain health and neurological disorders. Dr. Moawad regularly writes and edits health and career content for medical books and publications.