Brand Name: Lamictal (lamotrigine)

Maker: GlaxoSmithKline

Drug Website: lamictal.com

Approved Indications

1. Maintenance treatment of bipolar I disorder (2003)

2. Approved uses in epilepsy (1994) and other seizure disorder: partial seizures, the generalized seizures of Lennox-Gastaut syndrome, and primary generalized tonic-clonic seizures in adult and pediatric patients (≥2 years of age); and for conversion to monotherapy in adults with partial seizures who are receiving treatment with carbamazepine, phenytoin, phenobarbital, primidone, or valproate as the single AED.

Off-Label Uses

Sometimes used for unipolar depression with some use in PTSD and borderline personality disorder.

The Good

As anti-convulsants go, Lamictal is fairly low key. No hair loss, or weight gain as with Depakote, for example. The drug has become popular amongst docs and patients for its ability to treat bipolar depression, which is not well-treated by conventional anti-depressants. (Please see the STEP-BD study for more on the problems with anti-depressants and bipolar depression.) Lamictal is not thought to be an anti-manic drug along the lines of Lithium. Common dosage is 200 mgs. a day. Two years ago, I declared Lamictal the rock star of psych meds.

The Bad

Lamictal takes as long as two months to get to a therapeutic dose in most patients and requires a long ramp-up period on a specific schedule. Follow your doctor's instructions. This is the longest ramp-up period of any psych med. This is why it is not indicated for acute episodes of bipolar disorder.

"Common side effects with LAMICTAL include dizziness, headache, blurred or double vision, lack of coordination, sleepiness, nausea, vomiting, insomnia, and rash. LAMICTAL may cause other side effects not listed here. If you develop any side effects or symptoms you are concerned about or need more information, call your doctor." Source: lamitcal.com

If you stop taking this drug for five days or more, then you will need to start all over and taper back to a therapeutic dose over two months or so.

The Ugly

In a word, the rash. Serious rashes and Stevens-Johnson syndrome have been reported and required hospitalization. Will this happen to you? Probably not, but you should be on-guard for any rashes which develop. As usual, contact your doctor if you have questions.

"Although most patients who develop rash while receiving LAMICTAL have mild to moderate symptoms, some individuals may develop a serious skin reaction that requires hospitalization. Rarely, deaths have been reported. These serious skin reactions are most likely to happen within the first 8 weeks of treatment with LAMICTAL. Serious skin reactions occur more often in children than in adults.

"Rashes may be more likely to occur if you: (1) take LAMICTAL in combination with valproate [Depakene®* (valproic acid) or Depakote®* (divalproex sodium)], (2) take a higher starting dose of LAMICTAL than your doctor prescribed, or (3) increase your dose of LAMICTAL faster than prescribed." Source: lamitcal.com

In addition, Will Hall of the Freedom Center has written about a friend of his who was almost killed by Lamictal. As with any psych med, Lamictal users have a wide-range of experiences.

Withdrawal Problems

Coming off Lamictal does have its problems and a patient should taper off the drug slowly. Even with a slow taper, there are reports of patients losing concentration and short-term memory as they come off the drug. It's not clear how long it takes these effects to clear on average, but my own experience was that it took me six weeks.

In addition, as doses get smaller, patients have reported episodes of extreme irritability.

I've written about Lamictal withdrawal problems separately and loads of readers have commented as well with their experiences coming off the drug. Feel free to share any experiences of yours on those threads or by email.

Black Box (FDA) Warnings

Black box warning about life threatening skin reactions, including Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. See prescribing information.

Package Insert/Prescribing Information (goes to .pdf)

Comments or user stories should be directed to the author by email.

Entry created Nov. 12, 2007

Copyright by Philip Dawdy, 2007