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Lamictal for bipolar disorder

Lamotrigine (Lamictal®) is an anticonvulsant that spreads out the episodes of depression and mania of bipolar disorder. It does not ease the actual symptoms of the depression or mania and therefore is usually taken in combination with other medications that do, such as lithium.

Although approved for bipolar I, Lamictal is sometimes prescribed off-label for treatment-resistant depression and bipolar depression, and bipolar II.

How is it taken?
Lamotrigine comes as a regular tablet and one that can be chewed or dissolved in liquid. Tablets come in 25-mg (white), 100-mg (peach), 150-mg (cream), and 200-mg (blue). For mood disorders, it is usually taken once a day. At the beginning of treatment, your doctor may direct you to take it every other day.

Follow directions carefully. If you forget a dose, take the missed dose as soon as you remember it. But if it is almost time for the next dose, skip the missed dose and continue your regular schedule. Do not take a double dose to make up for a missed one.

Do not stop taking lamotrigine without talking to your doctor who will probably decrease your dose gradually over two weeks or more at approximately 50% per week.

Caution
If you do stop taking lamotrigine for any reason, call your doctor immediately before you start taking it again. If you miss taking Lamictal for more than three to four days, you must start the treatment again with the same slow increase in dose as in the beginning or risk serious side effects.

Generic lamotrigine made by several manufacturers is now available in the USA.  There have been some reports that its efficiency is not identical to the brand-name. Talk to your doctor and your pharmacist.

There are other medications that have names similar to the brand name for lamotrigine. Be certain that you receive lamotrigine and not one of the similar medications each time you fill your prescription.

How fast does it work?
Many people taking Lamictal begin to feel improvement as the dosage is increased, often with some lifting of depression first, then stabilization of mood swings. It may take up to six weeks to reach the full therapeutic effect of this medication.

What are possible side effects?
prescribed with or without other mood stabilizers, it does it without adding to the weight gain typically found with the others.

Like many medications, side effects may appear when first starting Lamictil or when your dosage is increased, but may go away after a short time.

The risk of non-serious rash is increased when the recommended initial dose and/or the rate of dose escalation of Lamictal is exceeded. In clinical studies, about 1 in 1,000 adults had severe, potentially life-threatening rash. The risk of rash may be increased by

  1. taking Lamictal in combination with valproate (Depakene or Depakote),
  2. exceeding the recommended initial dose of Lamictal, or
  3. exceeding the recommended dose escalation for lamotrigine.

Therefore, it is important that the dosing recommendations be followed closely. If you stopped taking Lamictal because of rash, you should not go back on the drug, unless you and your doctor decide the potential benefits clearly outweigh the risks.

Lamictal is not likely to case weight gain.

Tell your doctor if any of these or other side effects are severe or do not go away:

  • diarrhea or constipation
  • difficulty thinking or concentrating
  • dizziness
  • drowsiness
  • dry mouth
  • irritability
  • loss of balance or coordination
  • mood changes
  • nervousness
  • unny nose or cough
  • sleeping problems
  • stomach, back, or joint pain
  • vision problems

Drug interactions
Lamictal (lamotrigine) is chemically unrelated to existing anticonvulsive drugs. It can be effectively combined with lithium, bupropion (Wellbutrin) or olanzapine (Zyprexa®).

Lamotrigine is often combined with Depakote {Valproic acid), but with adjustments to its usual doses. Depakote significantly increases lamotrigine levels, and therefore, lamotrigine begun at half the usual dosage provides the same therapeutic effect as the recommended dose for someone not taking Depakote. The combination without this adjustment increases the risk of serious side effects.

What do I need to tell my doctor?
Tell your doctor what prescription and nonprescription medications, vitamins, nutritional supplements, and herbal products you are takings. Dosage adjustments will be necessary in most patients who start or stop estrogen-containing oral contraceptives while taking lamotrigine. Discuss any allergies you have.

Tell your doctor if

  • you have or have ever had heart, kidney, or liver disease or a blood disorder.
  • you are pregnant, plan to become pregnant, or are breast-feeding. Babies exposed to Lamictal during the first three months of pregnancy may have a higher chance of birth defects. If you become pregnant while taking it, call your doctor.
  • you are having surgery, including dental surgery, tell the doctor or dentist that you are taking lamotrigine.

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