Common use
Lamictal (lamotrigine) is an anti-seizure medication and mood stabilizer used to treat epilepsy and to help prevent recurrence of mood episodes in bipolar I disorder. In epilepsy, it may be prescribed as monotherapy or as add-on therapy for partial-onset seizures, primary generalized tonic-clonic seizures, and seizures associated with Lennox-Gastaut syndrome. In bipolar I disorder, Lamictal is indicated for maintenance treatment to delay the time to occurrence of mood episodes—particularly depressive episodes—after acute stabilization. It is not used to treat acute mania, acute bipolar depression, or status epilepticus.
Lamictal is available as immediate-release tablets, chewable/dispersible tablets, orally disintegrating tablets, and extended-release tablets (Lamictal XR). Choice of formulation depends on clinical goals, dosing frequency, and patient preference. Because of a boxed warning for serious skin rashes, including Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), Lamictal must be started at a low dose and increased slowly. When titrated carefully under medical supervision, Lamictal is well-tolerated for many patients and can be an effective long-term option for seizure control and bipolar maintenance.
Dosage and direction
Dosing of Lamictal is individualized and depends on age, clinical indication, formulation, and especially on concomitant medications that alter lamotrigine metabolism. The guiding principle is “start low, go slow” to minimize rash risk. For many adults not taking interacting medicines, clinicians often begin with a low daily dose for two weeks, then increase every 1–2 weeks until a target maintenance dose is reached. Extended-release tablets are generally taken once daily; immediate-release is typically once or twice daily. Pediatric dosing is based on weight and requires specialist oversight.
Concomitant valproate (divalproex/valproic acid) inhibits lamotrigine metabolism and can more than double lamotrigine levels; therefore, starting and maintenance doses of Lamictal are usually reduced when used with valproate. By contrast, enzyme-inducing antiepileptic drugs (for example, carbamazepine, phenytoin, phenobarbital, and primidone) and some other inducers (like rifampin) can lower lamotrigine levels, so the prescriber may use higher titration steps. Estrogen-containing oral contraceptives can also increase lamotrigine clearance, potentially reducing efficacy and necessitating dose adjustments when starting, stopping, or cycling these contraceptives.
Never change your Lamictal dose or schedule without guidance from your clinician. If therapy is interrupted for several days or more, do not simply restart at the prior dose; re-titration from a lower dose may be required to reduce rash risk. Swallow tablets whole unless using chewable/dispersible or orally disintegrating forms as directed. Consistency matters—take Lamictal at the same time each day, with or without food, to help maintain steady blood levels and clinical response.
Precautions
Serious rash warning: Lamictal carries a boxed warning for potentially life-threatening skin rashes (SJS/TEN), most often occurring within the first 2–8 weeks of therapy and more likely with rapid dose escalation, higher starting doses, or coadministration with valproate. Stop Lamictal and seek urgent medical care if you develop a widespread rash, blistering, mucous membrane involvement, fever, or facial swelling. A non-serious, self-limited rash can also occur, so prompt evaluation is essential to distinguish benign from dangerous reactions.
Other important precautions include hypersensitivity reactions (such as drug reaction with eosinophilia and systemic symptoms, DRESS) that may involve liver, blood, or other organs; hemophagocytic lymphohistiocytosis (HLH), a rare but severe immune activation syndrome; aseptic meningitis; blood dyscrasias; and emergence or worsening of suicidal thoughts and behaviors as seen with antiepileptic drugs. Use caution in patients with significant hepatic or renal impairment (dose adjustments may be needed) and in those with known cardiac conduction abnormalities or structural heart disease, as lamotrigine has sodium-channel–blocking properties. Dizziness, blurred vision, ataxia, and somnolence can impair driving or operating machinery; avoid alcohol and other CNS depressants that exacerbate these effects. During pregnancy, lamotrigine clearance can rise, sometimes necessitating monitoring and dose adjustments; after delivery, levels often rebound and dosing may need to be reduced.
Contraindications
Lamictal is contraindicated in patients with a known hypersensitivity to lamotrigine or any tablet component. There are no other absolute contraindications listed in most labeling, but clinicians exercise heightened caution in patients with prior severe cutaneous adverse reactions to other antiepileptics, significant hepatic impairment, or underlying cardiac disease. Extended-release formulations have age-related restrictions; pediatric use requires weight-based dosing and specialist oversight. Always provide a complete medical and medication history to your provider to identify potential risks before starting therapy.
Possible side effects
Common side effects may include headache, dizziness, drowsiness or insomnia, nausea, vomiting, abdominal pain, tremor, blurred or double vision, nystagmus, ataxia, and back or joint pain. Some people experience anxiety, irritability, or mood changes. Many of these effects improve with slower titration, dose adjustments, or time as the body adapts. If side effects are persistent or troublesome, contact your clinician to discuss options such as dose modification, switching formulations, or evaluating for drug interactions.
Serious adverse effects warrant immediate medical attention: rash with blistering or mucosal involvement (possible SJS/TEN), signs of hypersensitivity or DRESS (fever, lymphadenopathy, facial swelling, organ involvement), severe fatigue with easy bruising or infection (possible blood dyscrasia), confusion or stiff neck (possible aseptic meningitis), arrhythmia or syncope in those with cardiac risk, and new or worsening suicidal thoughts or behavior. Never stop Lamictal abruptly without medical guidance, as sudden cessation can trigger seizures or destabilize mood.
Drug interactions
Major pharmacokinetic interactions center on agents that affect glucuronidation. Valproate markedly increases lamotrigine levels, necessitating lower Lamictal doses and slower titration. Enzyme inducers such as carbamazepine, phenytoin, phenobarbital, primidone, and rifampin can decrease lamotrigine levels, often requiring higher maintenance doses. Estrogen-containing oral contraceptives may lower lamotrigine concentrations; dose adjustments and clinical monitoring are recommended when starting or stopping hormonal contraception. Lamotrigine may modestly reduce levonorgestrel exposure; advise patients to report breakthrough bleeding and consider backup contraception if indicated.
Additional considerations: atazanavir/ritonavir and lopinavir/ritonavir can reduce lamotrigine levels; sertraline and many SSRIs do not meaningfully alter lamotrigine kinetics but may contribute to additive CNS effects; alcohol and sedatives can intensify dizziness or somnolence. Use caution with other sodium channel–blocking agents and in patients receiving class I antiarrhythmics or with known conduction disease. Always provide an updated medication list, including over-the-counter drugs and supplements, so your clinician and pharmacist can screen for interactions and adjust your Lamictal plan appropriately.
Missed dose
If you miss a dose of Lamictal, take it as soon as you remember unless it is near the time for your next dose. If it is close to the next dose, skip the missed dose and resume your regular schedule. Do not double up to make up for a missed dose. If you miss several days in a row, contact your prescriber before restarting; you may need to re-titrate from a lower dose to reduce the risk of serious rash or other adverse effects.
Overdose
Overdose symptoms may include severe dizziness, ataxia, nystagmus, vomiting, seizures, altered mental status, coma, and, rarely, cardiac conduction abnormalities. If an overdose is suspected, seek emergency medical care and contact Poison Control at 1-800-222-1222 (U.S.). Treatment is supportive, focusing on airway protection, vital signs, seizure management, and monitoring. Do not attempt to self-treat an overdose. Keep medications in child-resistant containers and out of reach of children and pets to prevent accidental ingestion.
Storage
Store Lamictal at controlled room temperature (generally 20°C to 25°C/68°F to 77°F), protected from moisture and light. Keep tablets in the original blister or bottle until use, and avoid storing in bathrooms or other humid environments. Do not use tablets that are discolored, chipped, or expired. Dispose of unused medication responsibly—ask your pharmacist about drug take-back programs.
U.S. Sale and Prescription Policy
In the United States, Lamictal (lamotrigine) is a prescription-only medication. That means you cannot legally buy Lamictal without prescription, and any website or vendor offering it without a valid prescription should be avoided as unsafe and potentially illegal. Legitimate access requires evaluation by a licensed clinician who determines whether Lamictal is appropriate, prescribes it when indicated, and provides monitoring for safety and efficacy. This rule protects patients by ensuring interaction checks, dose titration, and follow-up for rare but serious side effects such as SJS/TEN.
Geisinger HealthSouth and other integrated, accredited health systems offer structured, compliant pathways to care—such as in-person visits or telemedicine assessments—through which a licensed clinician can evaluate your condition and, if appropriate, issue a prescription that can be filled at an accredited pharmacy or via secure mail-order services. These programs do not bypass the prescription requirement; rather, they make obtaining qualified medical evaluation and ongoing monitoring more convenient and coordinated. To start safely, schedule a consultation with a neurologist, psychiatrist, or primary care clinician, and use only state-licensed pharmacies for dispensing.
