Lamotrigine

Medication name

Lamotrigine ("la-MO-tri-jean")
Brand name

Lamictal ("la-MIC-tal")
Medication type

Mood stabiliser

Tablets: 25mg, 50mg, 100mg and 200mg strengths

Chewable/dispersible* tablets: 2mg, 5mg, 25mg and 100mg strengths

Oral suspension: Lamotrigine 10mg/ml (sugar free)

*These tablets dissolve in water or other liquid.

If you are 18 or over, the doctor can prescribe lamotrigine for you as a licensed medicine to prevent and treat episodes of low mood and depression in bipolar disorder.

If you are under 18, a specialist doctor may still consider this as a treatment option.

Lamotrigine is also commonly used as a treatment for epilepsy as it can help to reduce seizures.

Find out more about bipolar disorder

About lamotrigine

Lamotrigine is a type of medicine called a ‘mood stabiliser’ because it can reduce feelings of excitability and over-activity and reduce mood swings. It tends to work better on the low mood and depression part of bipolar disorder.

Lamotrigine can help to calm down the brain. There are gateways in the brain called ‘sodium channels’, which can be open or closed. When they are open, there is more electrical activity in the brain. Lamotrigine locks on to closed sodium channels and keeps them closed. Reduced electrical activity leads to reduced release of chemical transmitters that excite the brain, like glutamate and aspartate.

It is still not fully understood how lamotrigine works to treat bipolar disorder, but the reduction in glutamate activity in the brain is thought to play an important part in this.

Lamotrigine and everyday life

It can take time to build up to the dose that is right for you, so it may take one to two months before you start to feel positive benefits. This can continue to improve over the next few months.

You will need to start with a low dose and gradually increase it every few days or weeks until you and your doctor find the dose that is right for you. It may take up to six weeks to do this, by which time you should be a on a stable, long-term dose and have seen some helpful results from the medication.

It is important not to hurry the dosing timetable as doing so can increase your chances of getting side effects, which may include a serious skin reaction.

A common side effect of lamotrigine is a dry mouth. Over a long time, this can increase your risk of developing tooth decay or gum disease. Make sure you brush your teeth well and have regular dental check-ups. Speak to your dentist, doctor or pharmacist about things you can do to help.

You may want to let your family and friends know you are taking lamotrigine so they can support you and help you look out for side effects.

For guidance on this, check out our page on getting support with your medication.

Lamotrigine may make you feel very drowsy or sleepy when you start taking it. It may also make it difficult for you to get to sleep.

If these symptoms carry on for a long time, or if this is difficult for you, talk to your doctor or pharmacist about other medicines you could take.

Alcohol

It may be possible to drink some alcohol in moderation while taking lamotrigine but having the two together might make you very sleepy and unsteady on your feet.

During the first few weeks of treatment, it might be best to stop drinking alcohol until you see how the medicine affects you.

Drinking alcohol every day, or in large amounts, can make your symptoms worse and may mean you won’t get the maximum benefit from your medication.

Street drugs

We do not know how street drugs affect lamotrigine, but all these drugs affect the way the brain works so they may not mix well and it’s best to be cautious. There is no regulation of street drugs or ‘legal highs’, so even if there are no known issues with the medication you take, the supply you receive might be mixed with other substances that could be dangerous.

Lamotrigine can produce a false positive test for phencyclidine (PCP) on a urine drug screen. Talk to your doctor about this if it is a problem for you.

Get more advice on drugs and alcohol.

Lamotrigine does not mix well with some other medicines, including some vitamins and herbal remedies. They may affect the way in which they work and increase the risk of side effects.

Tell your doctor if you are taking any other medications including over-the-counter medicines for common illnesses and things you put on your skin.

Special information about contraceptive pills containing oestrogen:

When lamotrigine is taken with any type of the pill (oral contraceptive) containing oestrogen, it lowers the level of lamotrigine that you have in your body.
If you have a pill-free week, the levels of lamotrigine will then rise, which may give you side effects.
If you take the pill without a break, it will make your lamotrigine levels stable. You will not be harmed by not having the break.
Talk to your doctor or pharmacist before you start taking lamotrigine if you also take the pill.
The morning-after pill does not affect the level of lamotrigine in your body as it does not contain oestrogen.

Look at the leaflet inside your medicine box for more information about other medicines that can interact with lamotrigine. With some medicines your doctor may need to adjust the dose of your medicines if you take them together. Ask a doctor or pharmacist for more information if you have any questions.

Lamotrigine tablets have lactose in them which may not suit people who have a problem drinking milk or eating certain sugars. Talk to your doctor or pharmacist about this if you think it could be a problem for you.

The liquid contains para hydroxybenzoates which may cause allergic reactions.

Always let your pharmacist know if you have any food allergies or intolerances, and always check with them if you’re concerned about any of the ingredients in your medication.

If you need to avoid animal products, please note that non-active ingredients used in the production of medicines may sometimes be of animal origin. Ask your pharmacist if you have any questions about the ingredients.

Further information about practical considerations for medicines if you need to avoid animal products can be found on the Vegan Society website.

Do not drive a car or ride a bike just after you start taking lamotrigine.

Taking lamotrigine may make you feel dizzy and may affect your eyesight (possibly causing blurred or double vision) when you start taking it or sometimes after an increase in dose.

This could affect you if you drive a car, ride a bike, or do anything else that needs a lot of focus. It might be best to stop doing these things for the first few days, until you know how it affects you.

Most people drive as normal while taking lamotrigine. It you are worried about this or have any concerns you would like to discuss, speak to your doctor or pharmacist.

It is illegal to drive after taking medication if your ability to drive safely is impaired.

You must tell The DVLA (Driver and Vehicle Licensing Agency) if you have bipolar disorder, schizophrenia, schizoaffective disorder or other mental health conditions that could affect your driving.

You can be fined if you do not tell The DVLA about a medical condition that affects your driving and may be prosecuted if you are involved in an accident as a result.

Pregnancy

Studies of over 7,500 women taking lamotrigine showed no increase in problems during the early stages of pregnancy.

If you do become pregnant while you are on lamotrigine, you should carry on taking your medication and speak to your doctor about this as soon as possible. They can discuss the benefits and risks of continuing lamotrigine and help you make a decision that is best for you and your baby. They may refer you to a specialist perinatal mental health team to support you with this decision. You can find out more information about taking lamotrigine during pregnancy at Bumps (Best Use of Medicines in Pregnancy).

Untreated mental illness, like bipolar disorder, can also be harmful to you and your developing baby, so decisions about stopping or avoiding medication when you are pregnant need to be discussed carefully with your doctor. If you and your doctor agree that it is best for you to continue taking lamotrigine while pregnant, you should tell your midwife. If you are planning to get pregnant. It is recommended that you take folic avid while you are trying for a baby and during pregnancy,

From month four onwards in your pregnancy you might need a higher dose of lamotrigine to keep the level of the medication in your body constant. After giving birth, your lamotrigine dose will go back to what it was before.

If you are taking lamotrigine for epilepsy, any dose increases may be made based on the results of your blood level tests. Your doctor will help you make sure that you have the right levels you need.

Post-natal

Some new born babies whose mothers take lamotrigine during pregnancy can get withdrawal symptoms at birth and soon after, like breathing problems and restlessness.

Tell your midwife you are taking lamotrigine, so that they can help if the baby has any symptoms after birth.

Breastfeeding

Lamotrigine can be passed to the baby in breastmilk. The amount can vary dependent on how much the mother has taken.

If your baby was born early, then breastfeeding while you are taking lamotrigine may not be recommended. Talk to your midwife and doctor about feeing options.

If you breastfeed while taking lamotrigine, seek urgent medical advice if your baby becomes restless, very sleepy or develops feeding problems.

Talk to your doctor or midwife about the benefits and risks of breastfeeding whilst taking this medication to help you make the decision that is best for you and your baby.

There is no evidence to suggest that lamotrigine will affect your fertility.

Talk to your doctor about your lamotrigine if you are trying to get pregnant or planning a family.

Lamotrigine is not a banned substance in sport.

Most people play sports as normal while taking lamotrigine, but if lamotrigine affects your concentration, eyesight or co-ordination, then you may want to wait to see if those effects go away before playing spots that need a lot of focus. If you have any concerns, discuss this with your doctor.

Lamotrigine may affect your concentration, give you blurred eyesight, and make you feel dizzy and tired.

Ideally it is best not to take lamotrigine for the first time just before your exams,

It’s not possible to predict how the medication will make you feel, and if you do get any side effects, these are more likely to occur when you first start taking lamotrigine.

You should talk to your doctor about any future exams if you are starting lamotrigine. You might decide together to delay starting it until you have done them.

If they are more than a month away, however, you might find that it is better to start lamotrigine to improve your sleep, motivation and ability to study.

Most people take exams as normal while taking lamotrigine, but if you have concerns, discuss this with your doctor.

Information and safety considerations

Your doctor will consider any other medical conditions or symptoms you have before recommending a medicine for you.

Your medicine will come with a ‘patient information leaflet’. It’s important that you read this information. Speak to your pharmacist if:

you’re not given a leaflet
you don’t understand the information
you need it in a different format or language
you’re concerned about something you’ve read

The information leaflet also includes a list of warnings and precautions to consider before you take the medicine. If you think that any of these apply to you and are concerned that your doctor is not already aware of them, check with your doctor or pharmacist before you start to take your medication (or as soon as possible if you are already taking it).

Uses, warnings, safety and side effects

Taking lamotrigine

You and your doctor should talk about how long you need to take lamotrigine before you begin treatment with this medication.

If you take lamotrigine for bipolar disorder, you will probably take it for at least six months. Any shorter and your old symptoms can come back. If it works for you, you may take it for much longer than that.

You will get the best effects from your medicine if you take it every day at the dose prescribed by your doctor.

You may have to take lamotrigine once or twice a day.
It doesn’t matter what time you take it each day, but choose a time that you can always remember. This could be at mealtimes, or when you brush your teeth.

You can take it before or after food.

If you are taking the tablets that you swallow whole, wash them down with a glass of water. Do not try and chew them – they will taste unpleasant.

If you are taking the orodispersible tablets, get a glass of cold water and mix the tablet(s) in at least enough water to cover them. You can stir the drink to help them break up. It will look a little cloudy. Drink it all, and then add more water to the glass and drink that to make sure you get all the medicine in the tablet.

You can swallow the dispersible tablets whole with water if you prefer.

You can also chew the dispersible tablets, but it may help to rinse them down with some cold water.

If you are taking the liquid, it is important to shake the bottle for at least ten seconds before you measure out the dose. This makes sure the medicine is mixed evenly and you get the correct dose. The medicine will be provided with a syringe and a cup. Follow the directions in the patient information leaflet with the pack. Ask you pharmacist for advice if you are unsure how to measure the correct dose.

If you miss a dose during the day, take it as soon as possible. If you forget to take it by the time of the next dose, just start again with the next dose. Do not try and catch up by taking a double dose.

If you have forgotten to take multiple doses of lamotrigine, contact your pharmacist for urgent advice. Depending on how many doses you have missed, you may need to restart your medicine with a low dose and gradually increase the dose again. Your pharmacist can advise you to contact your doctor if this is the case.

If you are unable to contact your pharmacist or doctor, contact NHS 111 for urgent advice.

If you forget to take your tablets for a few days, you may start getting your old symptoms of low mood back.

If you are taking lamotrigine as a mood stabiliser for bipolar disorder, it can be stopped suddenly, but where possible it is recommended that it is done gradually over at least one to two weeks. Discuss this with your doctor and agree a plan to gradually reduce and stop your medicine together.

Information about lamotrigine does not report any withdrawal symptoms if stopping this medicine suddenly, but there have been reports of some people experiencing the following symptoms:

loss of focus
lethargy
depression, hypomania, aggression and hostility, anhedonia and dysphoria
tingling sensations
headaches
reoccurring frightening and vivid nightmares
tachycardia

Sometimes seizures or fits can occur even if you are not taking this for epilepsy. This is because after taking lamotrigine for some time, your body will have become used to having this medicine. Suddenly stopping the use of lamotrigine may therefore cause a seizure. But don't worry – this doesn't mean you are suddenly epileptic.

If you are thinking of stopping treatment with lamotrigine, talk to your doctor before doing this. If you have stopped taking lamotrigine, you need to speak to your doctor so that you can safely start it again and build back up to your dose. It is best to be honest – they will help you get back on track.

Warnings and safety

If you have taken more than the dose prescribed by your doctor, contact NHS 111 immediately to ask for advice, or ask a family member or friend to do this for you. This is important even if you don’t feel any different.

NHS 111 can give you advice and direct you to the best place to get more help if you need it.

If you have taken too much medication on purpose, or if after taking this you quickly feel unwell, call 999 or get someone to take you to A&E straight away. This includes any of the following signs:

quick, uncontrollable body movements
clumsiness and lack of co-ordination, causing problems with your balance
heart rhythm changes
loss of consciousness, convulsions/seizures (fits) or coma

If you need to go to A&E, do not travel alone or drive yourself there. Get your parent, family member or friend to go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you and tell doctors how much you have taken.

Suicidal thoughts

Depression (and other mental illnesses) can sometimes cause you to have thoughts about hurting yourself or taking your own life. While uncommon, this could also be a side effect of your medicine. This can happen to anyone but is more likely to happen if you are under 25 years old.

If you have any thoughts like this, it is important you get urgent help. Contact your doctor immediately for advice and support. This could be your GP or specialist mental health team. If you are able, share how you are feeling with family member or friend as well so they can support you to get help.

If you discussed with your doctor what to do if you get these thoughts and created a safety plan, read this to remind you who to contact for support and what you can do to help you cope.

Read our guide to suicidal feelings

Serious side effects

Lamotrigine can cause serious side effects, including allergic reactions.
Get urgent medical advice from your doctor straight away if you get or think you could be having an allergic reaction or potentially life-threatening skin reaction. This is more likely to happen in the first few months of taking lamotrigine (especially if the starting dose is too high or the dose is increased too quickly). Symptoms of these reactions include:

skin rashes or redness with blisters and peeling skin around the mouth, nose, eyes and groin/sex organs (genitals)
peeling of large areas of skin (up to 30% of your body surface)
ulcers in the mouth, throat, nose or around your groin/sex organs (genitals)
red or swollen eyes
a high temperature (fever), flu-like symptoms or drowsiness
swelling around your face
swollen glands in your neck, armpit or groin
unexpected bleeding or bruising or your fingers turning blue
a sore throat
more infections (such as colds) than usual

Get your parent, family member or friend to take you or go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you.

Contact your doctor immediately but don't stop taking lamotrigine, if you get any of the following symptoms:

feeling or hearing things that are not real or believing things that are not true
problems with your eyesight (blurred vision or double vision)
uncontrolled movements and muscle spasms of your eyes, head and body, or any jerking, shaking or stiffness of your muscles
back or joint pain (which may be accompanied by a fever)
catching more colds or having more infections than usual
yellowing of the skin or whites of the eyes (your liver may not be working properly)

If you are unable to contact your doctor, call NHS 111 for urgent advice.

Side effects and your health

Side effects are more common when you first start taking sertraline. Many go away as you continue your medicine. If they don’t get better, or if you are worried by them and they are causing you distress, speak to your doctor or pharmacist about them.

Very common side effects of taking lamotrigine (affecting more than one in ten people) include:

headaches
skin rashes

Common side effects of taking lamotrigine (affecting up to one in ten people) include:

feeling aggressive, agitated or irritable
feeling sleepy, tired or drowsy
insomnia (having difficulty sleeping)
feeling dizzy
shaking or tremors
diarrhoea (loose poo)
dry mouth
nausea (feeling sick) or vomiting (being sick)
having pain in your back or joints, or elsewhere

There are other side effects that you can get when taking this medicine. We have only included the most common ones here.

This list of side effects can look scary. You may not experience any of them, but it’s important to be aware of them so you know what to do if they do happen.

Unless your side effects are very severe or distressing, try to continue taking your medication until you can talk to your doctor. Your doctor can make changes to your medication to help if needed.

Uncommon but important side effects to be aware of include thoughts of harming yourself, thinking about taking your own life or trying to take your own life. This may be a symptom of your illness, including depression, but may be a side effect of medication. If you experience these thoughts, contact your doctor to seek immediate support to keep you safe.

Your doctor will make sure you are monitored carefully for these side effects, and you should decide with your doctor what to do if you experience these feelings while taking sertraline. It’s a good idea to write these plans down and keep them somewhere safe.

If you are taking lamotrigine and have not talked about this with your doctor, go back to them and talk it through. You might also want to talk to your parents, family member or friend about it too.

Before starting lamotrigine your doctor will check that your blood, liver and kidneys are healthy and functioning normally. This will require a blood test.

There is no specific routine monitoring recommended during treatment with lamotrigine, but your doctor may recommend a blood test if they have any concerns about side effects you are reporting, or to check the levels of lamotrigine in your body. For example, these can change if you are pregnant, and having this information means your doctor can make sure your dose is correct.