How to Take Lamictal If You Have Bipolar Disorder

Starting Treatment Correctly to Avoid Severe Rash

Lamictal 200 mb tablets
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Lamictal (lamotrigine) is used as a mood stabilizer for people with bipolar disorder and as an anticonvulsant for people with epilepsy. When used to treat bipolar disorder, the drug helps reduce the cycling of moods characterized by bouts of depression alternating with bouts of mania.

Starting treatment with Lamictal can be confusing since there are not only different formulations but different dosing instructions based on what other drugs you may be taking.

While your doctor is always the best person to answer treatment-related questions, it does help to have a basic understanding of how Lamictal is prescribed and taken.

Indications for Use

When used for bipolar disorder, Lamictal is prescribed as a maintenance drug to control mood swings after acute symptoms have been treated and are in remission. It is prescribed specifically to treat bipolar I disorder (the more severe form of the disease) and only used in people 18 and over.

Formulations

Lamictal is offered in a tablet form and available in a number of different formulations and strengths:

  • Lamictal tablets, available in 25-, 100-, 150-, and 200-milligram (mg) strengths
  • Lamictal ODT (orally disintegrating tablet), available in 25-, 50-, 100-, and 200-mg strengths
  • Lamictal CD (chewable dispersible) tablets, available in 2-, 5-, and 25-mg strengths
  • Lamictal XR (extended release) tablets, available in 25-, 50-, 100-, 200-, 250-, and 300-mg strengths

    Lamictal XR is only used for the treatment of epilepsy, not bipolar disorder. Similarly, Lamictal CD is meant for children with epilepsy who can take the drug from the age of two

    Lamictal tablets can be taken with or without water or food.

    Common Side Effects

    Lamictal can cause side effects, many of which are transient and will resolve once your body adapts to the medication.

    The most common side effects (affecting at least five percent of users) are:

    • Dizziness (affecting 38 percent of users)
    • Headaches (29 percent)
    • Double vision (28 percent)
    • Unsteadiness (22 percent)
    • Nausea (19 percent)
    • Blurred vision (16 percent)
    • Drowsiness (14 percent)
    • Nasal drip and sneezing (14 percent)
    • Rash (10 percent)
    • Sore throat (10 percent)
    • Vomiting (9 percent)
    • Cough (8 percent)
    • Flu-like symptoms (7 percent)
    • Menstrual cramps (7 percent)
    • Diarrhea (6 percent)
    • Fever (6 percent)
    • Insomnia (6 percent)
    • Loss of coordination (6 percent)
    • Abdominal pain (5 percent)
    • Indigestion (5 percent)

    Black Box Warning

    In around one of every 1,000 people taking Lamictal, a potentially life-threatening hypersensitivity drug rash may develop. It most commonly occurs in adults who are taking the drug on its own for the first time. The rash can be extremely serious and lead to conditions known as Stevens-Johnson syndrome (SJS) or toxic epidermal necrosis (TEN), both of which require emergency medical treatment, 

    Most hypersensitivity reactions occur two to eight weeks after starting treatment, although some cases have been known to develop six months later. As such, the appearance of any rash should be taken seriously and seen s a matter of urgency.

    In addition to stopping Lamictal, pain medications, topical steroids, and other drugs may​ be needed to treat the hypersensitivity rash. Severe cases required hospitalizations.

    Once a hypersensitivity reaction has occurred, no matter how mild, Lamictal treatment should never be restarted.

    Starting Treatment

    To avoid the risk of a hypersensitivity reaction, Lamictal is usually started at a lower dose and gradually increased over a period of six to seven weeks.

    To this end, starter kits are available for both Lamictal and Lamictal ODT which provide instructions on how and when to increase dosages. The instructions vary based on whether you are taking Lamictal alone or with other drugs.

    The starter kit is recommended whether you are starting Lamictal for the first time or restarting therapy.

    The two drugs commonly prescribed with Lamictal to treat bipolar disorder are sodium valproate (marketed under the brand names Depakote, Depakene, and others) and Tegretol (carbamazepine).

    Guideline for Starting Lamictal

     If taking Lamictal with sodium valproateIf taking Lamictal alone (monotherapy)If taking Lamictal with Tegretol
    Weeks 1 and 225 mg every other day25 mg daily50 mg daily
    Weeks 3 and 425 mg daily50 mg daily100 mg daily (in divided doses)
    Week 550 mg daily100 mg daily200 mg daily (in divided doses)
    Week 6100 mg daily200 mg daily300 mg daily (in divided doses)
    Week 7100 mg daily200 mg dailyUp to 400 mg daily (in divided doses)

     

    Drug Interactions

    Oral contraceptives containing estrogen may affect the concentration of Lamictal in your blood and require a dose adjustment. Always advise your doctor if you are taking (or have stopped taking) an estrogen-containing oral contraceptive.

    Because of Lamictal's effects on the central nervous system, you will need to be careful about drinking alcohol or taking medications such as muscle relaxants, antihistamines, cold medications, or sedatives as Lamictal may amplify their psychoactive side effects. The bottom line is to always advise your doctor about any prescription or non-prescription drugs (including recreational drugs) you may be taking without exception.

    Lamictal in Pregnancy

    A dose adjustment may be needed during pregnancy as blood serum concentrations of Lamictal can often decrease by as much as 30 percent.

    In terms of safety, Lamictal is classified as a class C drug, meaning that animals studies have demonstrated a risk of birth defects but studies in humans are lacking. As such, you need to work your doctor to weigh the benefits and consequences of taking Lamictal while pregnancy or breastfeeding.

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