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Lamictal 200mg Tablet
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Indications & Clinical Uses
- Lamictal 200 mg tablets contain lamotrigine, an antiepileptic that calms overactive nerve signalling by blocking voltage-sensitive sodium channels and reducing the release of glutamate.
- In epilepsy it is approved as add-on treatment from 2 years of age for partial-onset seizures, for primary generalised tonic-clonic seizures and for the seizures of Lennox-Gastaut syndrome, and as single-drug treatment from 16 years of age in the United States after conversion from another antiepileptic.
- In adults it is also approved for the maintenance treatment of bipolar I disorder; the UK licence is specifically for preventing depressive episodes.
- The 200 mg tablet is a maintenance strength and never a starting dose: no one begins Lamictal at 200 mg.
- Lamictal XR, the extended-release tablet, is a separate product with its own dosing and is not interchangeable with these immediate-release tablets.
Side Effects
- Very common effects are headache and skin rash.
- Common effects include sleepiness, dizziness, tremor, nausea, vomiting, diarrhoea, double vision, difficulty sleeping, irritability and tiredness.
- LAMICTAL CARRIES A BOXED WARNING FOR SERIOUS SKIN RASHES: life-threatening rashes, including Stevens-Johnson syndrome and toxic epidermal necrolysis, have occurred and have required hospitalisation and permanent withdrawal of the drug.
- The risk is around 1 in 500 adults treated for epilepsy and is higher in children, and it is increased by starting at too high a dose, by increasing the dose faster than the label allows, and by taking valproate at the same time.
- Nearly all serious rashes appear within the first eight weeks.
- Stop Lamictal and get medical help immediately for any rash, especially with fever, swollen glands, blisters, mouth or eye ulcers or peeling skin.
- Other serious reactions needing urgent attention are haemophagocytic lymphohistiocytosis and multiorgan hypersensitivity or DRESS, both causing fever and swollen glands; aseptic meningitis; low blood counts; heart rhythm changes; and new or worsening depression or suicidal thoughts.
Precautions & Warnings
- The single most important rule with Lamictal is to start low and increase slowly, exactly as prescribed, because rushing the dose increases the risk of a life-threatening rash.
- If you also take valproate, every starting dose and every increase is halved, typically 25 mg on alternate days for the first two weeks; if you take an enzyme-inducing medicine such as carbamazepine or phenytoin without valproate, higher steps are used, typically 50 mg daily at first; with neither, the usual start is 25 mg daily.
- Doses are stepped up about every two weeks.
- The colour-coded Lamictal Starter Kits (blue, green and orange) supply the first five weeks at different dose steps according to your other medicines and ARE NOT INTERCHANGEABLE - using the wrong kit can cause a dangerous overdose.
- Never restart at your old dose after a break of five days or more; the titration must begin again.
- Taper over at least two weeks when stopping.
Avoid Interactions
- Valproate is the most important interaction: it more than doubles lamotrigine blood levels, so the starting dose and every step of the increase must be halved, and the combination raises the risk of serious rash.
- Enzyme-inducing medicines pull levels down instead: carbamazepine, phenytoin, phenobarbital, primidone, rifampicin and the HIV combination lopinavir with ritonavir or atazanavir with ritonavir can cut lamotrigine concentrations by roughly half, so higher doses are used.
- Oestrogen-containing contraceptives, including the combined pill, can halve lamotrigine levels, and levels rise again in the pill-free week, so seizure control can swing; pregnancy has the same effect.
- Tell your prescriber before starting or stopping any contraceptive.
- Alcohol adds to drowsiness and dizziness.
- Report every medicine, herbal remedy and supplement you take.
References
- LAMICTAL (lamotrigine) tablets, chewable dispersible tablets, ODT and kits - US Prescribing Information, DailyMed
- Lamictal Tablets - SmPC, electronic Medicines Compendium (UK)
- LAMICTAL - prescribing information, Drugs.com professional monograph
- emc search results for Lamictal (GlaxoSmithKline UK)
- DailyMed search results for LAMICTAL (including LAMICTAL XR)
Frequently Asked Questions
Lamictal (lamotrigine) treats epilepsy and bipolar I disorder. It is used as add-on therapy from 2 years of age for partial-onset seizures, generalised tonic-clonic seizures and Lennox-Gastaut syndrome, and in adults to prevent mood episodes in bipolar I disorder. The 200 mg tablet is a maintenance dose, never a starting dose.
Lamictal carries a boxed warning for life-threatening rashes, including Stevens-Johnson syndrome and toxic epidermal necrolysis. Starting too high or increasing lamotrigine too fast raises that risk sharply, as does taking valproate. Doses therefore start very low and rise roughly every two weeks. Stop and get help immediately for any rash.
Swallow Lamictal tablets whole with water, once or twice daily as prescribed, with or without food. Lamotrigine doses are built up gradually over several weeks. If you also take valproate, every starting dose and increase is halved. Never restart your old dose after missing five days or more.
No. The blue, green and orange Lamictal Starter Kits contain different dose steps for the first five weeks, chosen according to whether you also take valproate or an enzyme-inducing medicine. Using the wrong kit can give far too much lamotrigine and raise the risk of a serious rash. Lamictal XR is a separate product.
Headache and skin rash are very common with Lamictal. Common lamotrigine side effects include sleepiness, dizziness, tremor, nausea, vomiting, double vision, poor sleep and irritability. Seek urgent help for any rash, fever with swollen glands, unusual bruising, stiff neck with headache, or new suicidal thoughts.
Yes. Oestrogen-containing contraceptives can halve lamotrigine blood levels, and levels rise again during the pill-free week, so seizure control can swing. Pregnancy has a similar effect. Tell your prescriber before starting or stopping any hormonal contraceptive, as your Lamictal dose may need changing.
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