Medication Guide
Lamotrigine (Lamictal) Side Effects and Uses
A plain-language guide to Lamotrigine, a mood stabilizer / anticonvulsant. Learn how it helps, what it treats, how to take it and which side effects to know about.
Quick answer. Lamotrigine (Lamictal) is a mood stabilizer / anticonvulsant. Common lamotrigine side effects include headache, dizziness, nausea and trouble sleeping or vivid dreams. The rare but serious ones, and when to get help, are listed under lamotrigine side effects below. Never stop or change your dose on your own.
How Lamotrigine Can Help You
Lamotrigine calms extra electrical firing in the brain. It does this by acting on sodium channels. It also lowers the release of glutamate, a chemical that excites nerve cells. In bipolar disorder, its key strength is preventing low episodes. That makes it a main choice for long-term care, mostly when depression is the bigger problem.
The dose must be raised slowly for safety. So benefits come bit by bit. Most people reach a helpful dose over about six weeks. Mood keeps steadying after that. Change often feels quiet, not dramatic. There are fewer slides into depression, and thinking stays clear.
Unlike many mental health drugs, lamotrigine causes little weight gain or sleepiness. It is one of the easiest mood stabilizers to take.
Uses for Lamotrigine
- Bipolar I maintenance, to delay mood episodes
- Bipolar II disorder (off-label, widely used)
- Bipolar depression (off-label)
- Epilepsy and seizures
- Add-on for hard-to-treat depression (off-label)
How to Take Lamotrigine
Lamotrigine must be started at a low dose and raised slowly over several weeks. This slow climb lowers the risk of a serious rash. Your prescriber sets the schedule. Some drugs, such as valproate, change the schedule. So share every drug you take. Do not speed it up on your own.
If you stop lamotrigine for more than a few days, do not restart at your old dose. Call your prescriber. You may need to start the slow climb again. Tell your prescriber if you start or stop birth control with estrogen. It changes lamotrigine levels.
Report any rash right away, mostly in the first two to eight weeks. If you miss a single dose, take it when you remember, unless the next dose is near. Never double up. Never stop all at once. That can bring back mood episodes or seizures.
Lamotrigine Side Effects
Common Side Effects
- Headache
- Dizziness
- Nausea
- Trouble sleeping or vivid dreams
- Sleepiness
- Mild rash, which must still be reported
- Blurred or double vision
- Tremor
Serious: Get Medical Help Promptly
- Serious rash, such as Stevens-Johnson syndrome (boxed warning)
- Drug reaction with fever, swollen glands and organ harm (DRESS)
- HLH, a rare severe immune reaction with fever and rash
- Aseptic meningitis (headache, stiff neck, fever)
- New or worse suicidal thoughts (warning for all seizure drugs)
- Heart rhythm problems in people with some heart conditions
How Lamotrigine Works
Lamotrigine blocks some sodium channels on nerve cells. This steadies cells that fire too easily. It also lowers the release of glutamate. Together, these effects are thought to calm the brain. They help keep mood steady.
Lamotrigine is better at preventing lows than at treating highs. So it is sometimes paired with another medicine that covers mania. Your prescriber decides whether you need both.
The Lamotrigine Rash and How to Stay Safe
Lamotrigine has a boxed warning about serious skin rashes, such as Stevens-Johnson syndrome. These are rare. But they can be life-threatening. The risk is higher if the dose goes up too fast. It is also higher with valproate, or in children. Most rashes are mild. But only a clinician can tell the difference.
Call your prescriber about any new rash. Get care right away for rash with fever, blisters, mouth sores or swollen glands. Follow the starting schedule exactly. Keep your supply filled so you do not run out by accident.
Before You Start Lamotrigine
Share every medicine you take. Valproate raises lamotrigine levels. Carbamazepine and some other drugs lower them. Estrogen birth control lowers levels too. Tell your prescriber about heart disease and kidney or liver problems. Also share any past rash with a seizure drug.
Like all seizure drugs, lamotrigine has a warning about new or worse suicidal thoughts. If you are thinking about harming yourself, call or text 988, or call 911. You can learn about bipolar disorder care by telehealth from anywhere in California.
Is Lamotrigine Right for You?
Only a full evaluation with a prescriber can tell you if Lamotrigine fits your symptoms, history and goals. Harpal Singh, PMHNP-BC offers psychiatric evaluations and ongoing medication management by telehealth anywhere in California.
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Articles About Lamotrigine
Related Medication Guides
Other guides in the same group, written the same simple way. Being in one group does not mean you can swap one medicine for another.
- Carbamazepine (Tegretol), mood stabilizer / anticonvulsant
- Divalproex sodium (Depakote), mood stabilizer / anticonvulsant
- Lithium (Lithobid), mood stabilizer
- Oxcarbazepine (Trileptal), anticonvulsant / mood stabilizer (off-label)
FAQ
Questions About Lamotrigine
How worried should I be about the rash?
The dangerous rash is rare, and the slow starting schedule exists to prevent it. Mild rashes are more common, but any rash should be reported so your prescriber can check it. Get care right away for rash with fever, blisters or mouth sores.
Why does lamotrigine take so long to start working?
The dose is raised in small steps over about six weeks for rash safety. So you spend the first weeks below a helpful dose. Once you reach it, mood benefits build over the following weeks.
Is lamotrigine good for bipolar depression?
Its strongest evidence is in preventing depressed episodes. It is less helpful for mania, so some people take it with another medicine that covers highs. For bipolar disorder with frequent lows, it is often a first choice.
Will lamotrigine cause weight gain or sleepiness?
Lamotrigine is close to weight-neutral and causes much less sleepiness than most mood stabilizers. Most people feel mentally clear on it. If you feel foggy or notice changes, tell your prescriber.
What if I stop taking it for a week?
After several days off lamotrigine, your body loses the tolerance built during the slow start. Restarting at your full dose raises the risk of a serious rash. Call your prescriber, who will likely restart you low and build back up.
Does birth control affect lamotrigine?
Yes. Birth control with estrogen can lower lamotrigine levels. Tell your prescriber before you start or stop it, since the plan may need to change.
Can I take lamotrigine with valproate?
Yes, but valproate raises lamotrigine levels. When the two are combined, lamotrigine is started more slowly and kept lower. Keep every prescriber aware of both medicines.
Can I drink alcohol while taking lamotrigine?
It is best to avoid alcohol or keep it to a strict limit. Alcohol can add to dizziness and can make mood symptoms worse. Talk with your prescriber about what is safe for you.