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• Click "Print this page" on the left to print the whole section
• Download a handy PILL (Patient Information Leaflet), a two-page summary of the main questions and answers from here. This can then be printed.

There are many other Patient Information Leaflets (PILs) across the world for patients and carers. There are also official information leaflets (often called a Data Sheet, Package Insert, or Summary of Product Characteristics). They are not on our site, so we can't take any responsibility for them but you can click here for links to other sites and leaflets

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Lamotrigine is often used in the treatment of epilepsy, to help control fits or blackouts. It is sometimes used with other antiepileptic drugs but can be used on its own. There are many other anticonvulsant drugs. It may be necessary to try several drugs in different doses or combinations to find the best therapy for you i.e. least side effects and maximum effect.

Lamotrigine is also used to help in bipolar mood disorder, to help prevent bipolar depression coming back. It is often used when other mood stabilising drugs such as lithium and carbamazepine have not helped. Lamotrigine needs to be started slowly to reduce the possibility of side effects. It is not thought to help the symptoms of bipolar mania, nor for treating an episode of depression itself.

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The usual dose of lamotrigine depends on what you're having it for.

Epilepsy, for adults and children over 12:

The starting dose is 25mg a day for 14 days, then increasing by up to 50mg a day every 2 weeks to a usual dose of 100-200mg a day. 

If you are also already taking valproate or some other anticonvulsants, the dose will need to be lower. This is very important, because if your dose increases too quickly you have a bigger chance of getting the nasty skin reaction (see side effects below).

Bipolar depression, for adults:

The starting dose is 25mg a day for 14 days, then increasing by up to 50mg a day every 2 weeks to a usual dose of 50-200mg a day.  Sometimes doses of 200mg twice a day are needed.

If you are also already taking valproate or some other anticonvulsants, the dose will need to be lower. This is very important, because if your dose increases too quickly you have a bigger chance of getting the nasty skin reaction (see side effects below).

If you stop or start other drugs, the dose of lamotrigine may need to be changed. 

It is not recommended for bipolar depression in children but this is only because it has not been studied rather than because of any concerns about safety.

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This will rather depend on what you are taking it for. To help you choose, click on the links for the main options (self-help and help from others), the main medicines, and a handy chart comparing the main medicines:

• Bipolar depression - main options, main medicines and handy chart
• Epilepsy - main options and main medicines

There are other treatments for the conditions above. The main ones are included in the section on each of the conditions above.

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Epileptic seizures (fits or blackouts) happen when abnormal electrical discharges, like a short circuit causing a spark, occur in the brain. There is a chemical messenger (or "neurotransmitter") in the brain called glutamate, which "excites" the brain. Lamotrigine may help to decrease the action of the "excitatory" glutamate in the brain. This will help to calm the brain down (or get it less "excited") and reduce the chance of fits occurring. This may also be how it works as a mood stabiliser.

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Take lamotrigine as directed on the medicine label, usually at breakfast and at bedtime. If you are taking it for epilepsy, it is particularly important to take it regularly each day to make sure that you are getting the best control of your illness from your medicine. If you miss more than five days in a row, you should contact your doctor as you must start again slowly to make sure you don't get any serious side effects.

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The tablets should be swallowed with at least half a glass of water whilst you are sitting or standing, so that they reach the stomach and do not stick in your throat.
The dispersible lamotrigine tablets can be popped into some water in a glass, stirred with a spoon and the liquid swallowed when the tablet has disintegrated. They can also be chewed or swallowed whole with a little water.

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This may depend on what you are taking lamotrigine for. Click the link below for the answer for that condition:

• Bipolar mood disorder
• Bipolar depression, where it may take several weeks to start to work
• Epilepsy

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This will depend on what you are taking it for. It may also depend on how unwell you have been or how severe the symptoms have been, as people respond differently. Click on the link below for the answer for that condition:

• Bipolar mood disorder
• Bipolar depression
• Epilepsy

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Lamotrigine is not thought to be addictive or habit forming. For a drug to be addictive or produce dependence, then it must have a number of characteristics:

• should produce craving for the drug when the last dose "wears off"

• there should be a "reward" (e.g. a good feeling) from taking the drug

• should produce tolerance ie you need more drug to get the same effect

• should produce withdrawal symptoms specific to that drug.

These characteristics come from the World Health Organisation. Lamotrigine has none of these and so is not addictive.

Click here to read a bit more about this, where you can find our thoughts on this knotty problem.

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Start again as soon as you remember unless it is almost time for your next dose, then go on as before. Do not try to catch up by taking two or more doses at once as you may get more side-effects. You should tell your doctor about this next time you meet. If you are taking lamotrigine for epilepsy and are ill and vomit your tablets, you should take that dose again. Missing a dose can cause your fits to return. The amount in your bloodstream may drop below the level needed to control your fits. Missing the occasional dose (e.g. once a week) isn't usually a big problem (unless you are taking it for seizures).

If you have problems remembering your doses (as very many people do) ask you pharmacist, doctor or nurse about this. There are some special packs, boxes and devices that can be used to help you remember. You can try leaving the pack somewhere you will see it each morning e.g. in the bathroom, kitchen, by your bed, in a car etc.

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You should never stop taking this medication suddenly or without advice from your doctor as this might mean an increase in fits or blackouts. If your doctor decides that you no longer require this drug it will be withdrawn gradually (like any treatment for epilepsy) to make sure that your fits do not return. This will usually be by a slight reduction in your dose every few weeks. You should therefore not experience any problems.

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The table below will show you some of the main side effects you might get from lamotrigine.

Do not be worried by this list of side effects. Some people get no side effects at all and others may get some effects that are not listed in this table. Side effects tend to be worse with higher doses. Starting with a lower dose sometimes helps. If you think you might have a side effect to your medicine, you should discuss this with your doctor, nurse of pharmacist. You should also see the manufacturer's information leaflet.

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Lamotrigine may make you feel sleepy or drowsy and so you must take care if you are allowed to drive or when operating any type of machinery. This effect should wear off or at least reduce after you have been taking it for a while.

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It is not thought that lamotrigine causes any changes in weight. If, however, you do start to have problems with your weight tell your doctor next time you meet as he or she can arrange for you to see a dietician for advice. You are less likely to gain weight with medicines like lamotrigine if you have some include physical activity as well as dieting ^{(Gaspari and Guerreiro 2010)}

Click here for a few tips on how to help you feel less hungry and lose weight.

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Drugs can affect desire (libido), arousal (erection) and orgasmic ability. Lamotrigine is not thought to significantly affect these, although rarely improvement in desire or libido has been reported.

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You should have no problem with any foods or drinks, other than alcohol (see separate question).

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Whether or not it is safe to drink alcohol with any medicine will depend on:

• How much you have to drink e.g. the amount and over how long
• What you then try to do (e.g. sleep or drive)
• If you have any other conditions e.g. epilepsy, asthma or a chest infection (as alcohol can make it harder to breathe)
• If you are taking any other medicines

Alcohol reaches all parts of the brain and can affect many things e.g. thinking, reactions and breathing. Alcohol can also boost the effect of GABA (the brain's main calming chemical messenger).

It is not thought that drinking alcohol in moderation with lamotrigine will make you more sleepy. However, if this happens, you must take extra care if you need to drive or operate machinery. You should seek advice on this.   

It is not safe to drive after drinking alcohol, with or without lamotrigine. Some countries allow driving after a small amount of alcohol but others have a zero tolerance. The UK has the highest limit in Europe, France lower, Scandanavia even lower and zero in some Eastern European countries. It is not possible to say what blood level you might have from a drink so it is safest not to drink if you know you may have to drive. It is taken as a very serious offence in most countries. You should see National Guidelines, laws and regulations in the country in which you are driving.

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Lamotrigine has a few interactions with other medicines:

• The effects of lamotrigine can sometimes be increased by sertraline or valproate ('Epilim', 'Convulex', 'Depakote')
• The effect of lamotrigine can be decreased by carbamazepine (Tegretol), lopinavir/ritanovir (Kaletra®), phenytoin or oral contraceptives ("the pill"). The Pill can reduce lamotrigine levels in the blood by over a half (50%, or by even more) so be careful if you start The Pill, during any pill-free weeks and if you stop The Pill (when blood levels will go up and you might get more side effects)
• Lamotrigine can sometimes decrease the effect of oral contraceptives

This does not necessarily mean that this will happen in everyone or that some of these medicines can not be used together. It is just that you may need to follow your doctor's instructions very carefully. There are many other possible drug interactions (e.g. you can try an external on-line drug interactions checker, although this is nothing to do with our site).

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Cigarette smoke contains over 3000 different chemicals. Some of these chemicals can make some of the enzymes in the liver work faster (called "enzyme induction" of e.g. CYP1A2 or P4501A2). This means that any medicine those enzymes break down will be broken down quicker. So, you'll end up with less of that medicine if you smoke. And also you will have more of it in the body if you stop smoking.

Lamotrigine is one of those medicines. The amount of lamotrigine in the body can drop by up to a fifth (20%) if you smoke, giving less effect or meaning you might need a higher dose to get the same effect. It also means that if you stop smoking, the levels will rise so you might get more side effects.

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By including this section, we're not saying it's right to take illicit or illegal drugs, because it isn't. We're just trying to answer the questions as best we can under the circumstances. With illicit drugs, the full answer is usually that we don't really know. So, we can only go on a few studies, a few reports and what we know about the drugs themselves.

Cannabis (illegal in most countries):

Smoking cannabis increases the amount of dopamine in the pleasure centres of the brain, which is where the reward or buzz comes from. However, psychosis also comes from having too much dopamine in another area of the brain. You have to remember that cannabis can increase dopamine in all areas of the brain and so can make psychosis worse. Please be careful, everything in moderation and if dope makes you worse, keep off the grass. It really won't help you in the long-term. Don't forget that if you're a toker, you're also a smoker, so see the question above. However, there are no extra problems with smoking cannabis, other than the smoking itself (see above).

Cocaine (illegal in most countries)

Cocaine is of course highly addictive and has many adverse or side effects on the body and brain. It can make most mental health symptoms worse in the long-term. However, there are no reports of extra problems with lamotrigine and cocaine, although this doesn't mean it's safe.

Ecstasy (illegal in most countries)

Ecstasy has many effects on the brain, the main ones producing the high seem to be by boosting serotonin, noradrenaline and dopamine in the brain. While it can cause a high, the effect wears off fairly quickly. It seems that the toxic effects on the brain are cumulative i.e. the more tablets you have over your lifetime, the more chance you have of having damage to the brain e.g. long-term depression and poor memory. However, there are no reports of extra problems with lamotrigine and ecstasy, but again this doesn't mean it's safe.

Opiates

The opiates include many chemicals, some of which are used in medical care (e.g. codeine for diarrhoea and stopping coughs, diamorphine and morphine for pain). However, there are no extra problems reported from taking opiates (e.g. heroin, methadone, codeine) with lamotrigine, although you might feel more drowsy.

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Yes. Lamotrigine may reduce the effect of oral contraceptives ("The Pill"). Also, "The Pill" can also reduce the effective of lamotrigine. The latest advice is:

• If you are on "The Pill" and are starting lamotrigine, then the normal dose increases can be used

• If you are on lamotrigine and then start taking "the Pill", your dose of lamotrigine will probably need to be increased. In fact, it may need to be doubled.

• If you are taking lamotrigine and then stop taking "The Pill", your dose of lamotrigine may need to be reduced. This should be done during the first week after you stop.

You should take advice from your GP about this.

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Several female functions such as menstrual cycle (e.g. your periods) are controlled by a hormone called prolactin. Prolactin in the body rises during and after pregnancy and this triggers the body to make breast milk. The amount of prolactin in the body is kept in control by one part of the brain uses dopamine as its chemical messenger. Some medicines (especially antipsychotics) block the effect of dopamine in the brain.

Luckily lamotrigine doesn't seem to have any effect on dopamine in this part of the brain and so should not have any effect on your periods. If your periods are irregular or late, or you start leaking milk, then you should see your doctor about this to find the cause.

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In the UK, Levonelle one step® is available and is usually known as 'the morning after pill'. It is taken to reduce the chances of becoming pregnant after unprotected sex or failure of a contraceptive method. In fact "Emergency Contraception" is the better term because it can be taken up to 72 hours (3 days) afterwards. It can be bought over-the-counter without a prescription from pharmacies. EllaOne® tablets (which may work up to 5 days afterwards) and a coil (Intra-uterine device) can also be used but must be prescribed by a Doctor.

If you are taking lamotrigine, the usual dose should work if you follow the instructions carefully.

N.B. We accept that for religious, cultural or ethical reasons some people do not approve of, or agree with, the use of the "Morning After" pill. However, we have answered the question because it is one of the most often asked of NHS Direct in UK, and they suggested we include it.

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It is important to consider that there will be a risk to you and your child from taking a medicine during pregnancy but also a possible risk from stopping the medicine e.g. getting ill again. Unfortunately, no decision is risk-free. It will be for you to decide which is the least risk. All we can do here is to help you understand some of the issues, so you can make an informed decision. For your information, major malformations occur "spontaneously" in about 2-4% of all pregnancies, even if no drugs are taken. The main problem with medicines is termed "teratogenicity" i.e. a medicine causing a malformation in the unborn child. A medicine causing teratogenicity is called a "teratogen". Since a baby has completed it's main development between days 17 and 60 of the pregnancy (the so-called "first trimester") these first 2-16 weeks are the main concern. After that, there may be other problems e.g. some medicines may cause slower growth. The infant may also be affected after birth e.g. withdrawal effects are possible with some drugs.

If possible, the best option is to plan in advance. If you think you could become pregnant, discuss this with your doctor and it may be possible to switch to medicines thought to carry least risk, and take other risk-reducing steps e.g. adjusting doses, taking vitamin supplements etc. If you have just discovered you are pregnant, don't panic, but seek advice from your GP within the next few days if possible. He or she may also want to refer you on to someone with more specialist knowledge of your medicine.

Very few medicines have been shown to be completely safe in pregnancy and so no manufacturer or advisor can ever say any medicine is safe. They will usually advise not to take a medicine during pregnancy, unless the benefit is much greater than the risk. In the UK, there is the NTIS (National Teratology Information Service) who offer individual risk assessments. However, their advice should always be used to help you and your doctor decide what is the risk to you and your baby. There is a risk from taking the medicine and a risk should you stop a medicine e.g. you might become ill again and need to go back on the medication again. The advice offered here is just that i.e. advice, but may give you some idea about the possible risks and what (at the time of writing) is known through the medical press.

It may be helpful to know that in the USA, the FDA (Food and Drug Administration) classifies medicines in pregnancy in five groups:
A = Studies show no risk, so harm to the unborn child appears only a remote possibility
B = Animal and human studies indicate a lack of risk but are not fully conclusive
C = Animal studies indicate a risk but there is no safety data in humans
D = a definite risk exists but the benefit may outweigh the risk in some people
X = the risk outweighs any possible benefit

Lamotrigine is classified as "C" but there is now good evidence that lamotrigine is not a risk in pregnancy or afterwards.

Firstly an 18 year register has shown that in 1558 women who took lamotrigine in the first trimester (the first 3 months) there were 35 (2.2%) children born with malformations. This is the same as happens in the general population, and there was no pattern of the type or dose (Cunnington 2011). This is actually really good evidence.

Secondly, 35 children whose mothers took lamotrigine in pregnancy were followed up for 9 months to 5 years, and there was no effect on the child's development compared to children whose mothers did not take lamotrigine (Cummings 2011). Again this is really good evidence.

You should still of course seek personal advice from your GP, who may then if necessary seek further specialist advice. If you are taking this medicine for epilepsy, then you will need to also consider the risk of seizures as well.

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Almost every medicine passes into breast-milk. The main questions are how much and if this is likely to have an effect on your baby. But also remember that being ill (e.g. depressed, manic, psychotic) may have more harmful and lasting effects on you and your child (such as bonding and behaviour e.g. Field, 2010) than a small amount of an effective medicine. If you have been taking a medicine while you are pregnant, you should usually be able to carry on as the amount in breast-milk is much less than the baby would have got while you were pregnant. It is usually thought to be fairly safe if the baby gets less than 10% of the mum's dose. But there may be times when although a medicine gets into breast milk the benefit may be worth the risk, so you should seek personal advice on this.

If you stop any medicine suddenly, some people can get discontinuation or withdrawal symptoms (see question above). If you have been taking a medicine during pregnancy, the same can sometimes happen to the baby when born. If the drug gets into breast milk, this can reduce the effect of suddenly not having the medicine (as well as coping with being in the big wide world too).

If you want to breast-feed there are some things you can do to reduce any risk:

• Nearly all medicines can be taken once a day. So, taking your daily dose just before the baby's longest sleep (often this will be at night) will reduce the amount the baby gets from the milk.
• Any side effects in the baby will be higher if the mum is taking a higher dose. So, try to take the lowest dose possible to still get an effect.
• Try not to take any medicines you don't really need. This includes any medicines you might buy over-the-counter
• Make sure your nurse, health visitor or doctor checks your baby for any side effects e.g. being extra sleepy, having colic, feeding problems, being floppy or poor weight gain. If there are any problems you might need to switch medicines or drop your dose a bit
• Hind milk (the second half of the feed) is likely to contain slightly more of any medicine than the first half
• Avoid new medicines if possible as there is less information about them and breast-feeding.

You must be extra careful of any medicines if your baby was pre-mature, or has kidney, liver, heart or brain problems.

We know that lamotrigine gets into breast milk and the amount can vary a lot from mum to mum. The big problem is that while adult livers can break down lamotrigine fairly quickly, babies livers aren't up to it for several months so lamotrigine can build up in the baby, giving some side effects. It is best not to breast feed while taking lamotrigine so you should seek personal advice if you want to. One large study showed that breast feeding while someone is taking lamotrigine has no harmful effects on the child's development over the next 3 years.

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Two studies have shown that lamotrigine has no effect on co-ordination and eye movements. It doesn't seem to cause much sedation. However, dizziness and double-vision can occur and this would make driving a bit harder so be careful before driving or operating machinery.

If you are taking any medicines (including epilepsy or bipolar disorder), the rules about driving will depend on the country you’re driving in. Click on the links below for advice:

• Medicines and driving in the UK (England, Scotland, Northern Ireland and Wales)

• Medicines and driving in the Republic of Ireland

General advice on driving safely

If you want to drive, you should take sensible steps to reduce any risk. These could include:

• Avoid driving when you are tired or ill
• Do not drive after having any alcohol as this can make any drowsiness worse (a third of all fatal road traffic incidents involve alcohol-dependent drivers)
• Avoid driving at night, dusk or in bad weather
• Avoid motorways, dual carriageways and the rush hour
• Give yourself plenty of time. Don’t rush
• Be extra careful if you have not slept well the previous night

As some medicines can affect your driving, be extra careful:

• If starting a new medicine
• After a change in dose (especially an increase)
• If you are on a high dose or seem very sensitive to side effects
• If you are taking any medicines for other symptoms e.g. antihistamines for hay fever or allergies
• If your medicine causes you blurred vision, drowsiness, poor co-ordination, poor attention

If you are driving less than 2000 miles a year, once you consider insurance, tax, MoT, repairs, maintenance, parking and petrol, you may actually find it is cheaper to get taxis and busses, and walk the short journeys.

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You should not need any blood or other tests to check on your lamotrigine.

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