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Lamictal

Generic name: Lamotrigine
Brand names: Lamictal CD, Lamictal

Why is Lamictal prescribed?

Lamictal is prescribed to control partial seizures in people with epilepsy. It is also used to control a serious form of epilepsy known as Lennox-Gastaut syndrome. Lamictal is used in combination with other antiepileptic medications or as a replacement for a medication such as Tegretol, Dilantin, phenobarbital, or Mysoline.

In addition, Lamictal is used to help prevent the manic and/or depressive phases of bipolar disorder.

Most important fact about Lamictal

You may develop a rash during the first 2 to 8 weeks of Lamictal therapy, particularly if you are also taking Depakene or Depakote. If this happens, notify your doctor immediately. The rash could become severe and even dangerous, particularly in children. Signs of a more serious reaction include hives, fever, swollen lymph glands, painful sores in the mouth or around the eyes, or swelling of the lips or tongue. A slight possibility of this problem remains for up to 6 months.

How should you take Lamictal?

Take Lamictal exactly as prescribed by your doctor. Taking more than the prescribed amount can increase your risk of developing a serious rash. Do not stop taking Lamictal without first discussing it with your doctor. An abrupt halt could increase your seizures. Your doctor can schedule a gradual reduction in dosage.

Lamictal Chewable Dispersible (CD) tablets may be swallowed whole, chewed, or dissloved in liquid. When chewing the tablets, drink a small amount of water or diluted fruit juice to aid in swallowing. When dissolving the tablets, add them to a small amount of water or diluted fruit juice (about 1 teaspoonful), and wait 1 minute until the tablets are completely dissolved. Swirl the solution and drink immediately. Do not try to cut the dose by drinking only part of the solution.

--If you miss a dose...

Take it as soon as you remember. If it is almost time for your next dose, skip the one you missed and go back to your regular schedule. Do not take 2 doses at once.

--Storage instructions...

Store in a tightly closed container at room temperature. Keep dry and protect from light.

What side effects may occur?

Side effects cannot be anticipated. If any develop or change in intensity, tell your doctor as soon as possible. Only your doctor can determine if it is safe for you to continue taking Lamictal.

• More common side effects may include:
  Abdominal pain, back pain, blurred vision, constipation, dizziness, double vision, dry mouth, fatigue, headache, increased cough, insomnia, nausea, rash, runny nose, sleepiness, sore throat, uncoordinated movements, vomiting

• Additional side effects in children may include:
  Bronchitis, convulsions, ear problems, eczema, facial swelling, hemorrhage, infection, indigestion, light sensitivity, lymph node problems, nervousness, penis disorder, sinus infection, swelling, tooth problems, urinary tract infection, vertigo, vision problems

Why should Lamictal not be prescribed?

If you are sensitive to or have ever had an allergic reaction to Lamictal, you should not take Lamictal. Make sure your doctor is aware of any drug reactions you have experienced.

Special warnings about Lamictal

Lamictal may cause some people to become drowsy, dizzy, or less alert. Do not drive or operate dangerous machinery or participate in any activity that requires full mental alertness until you are certain the drug does not have this kind of effect on you. Remember to be alert for development of any type of rash, especially during the first 2 to 8 weeks of treatment (see "Most important fact about Lamictal").

Be sure to tell your doctor about any medical problems you have before starting therapy with Lamictal. If you have kidney or liver disease, or heart problems, Lamictal should be used with caution.

Lamictal may cause vision problems. If any develop, notify your doctor immediately. Also be quick to call your doctor if you develop a fever or have any other signs of an allergic reaction. Notify your doctor, too, if your seizures get worse.

If you"re taking Lamictal for bipolar disorder, be aware that the drug should not be used to stop an episode of mania or depression once it has started.

There are no clinical studies to prove the safety and effectiveness of Lamictal for treating bipolar disorder in children less than 18 years old.

Possible food and drug interactions when taking Lamictal

If Lamictal is taken with certain other drugs, the effects of either could be increased, decreased, or altered. It is especially important to check with your doctor before combining Lamictal with the following:

Carbamazepine (Tegretol)
Drugs that inhibit folate metabolism, such as methotrexate and Septra
Oral contraceptives
Phenobarbital
Phenytoin (Dilantin)
Primidone (Mysoline)
Valproic acid (Depakene, Depakote)

Special information if you are pregnant or breastfeeding

The effects of Lamictal during pregnancy have not been adequately studied. If you are pregnant or plan to become pregnant, tell your doctor immediately. Lamictal should be used during pregnancy only if clearly needed. Lamictal appears in breast milk. Because the effects of Lamictal on an infant exposed to Lamictal are unknown, breastfeeding is not recommended.

Recommended dosage

ADULTS

For Seizures

Lamictal combined with Tegretol, Dilantin, Phenobarbital, or Mysoline

One 50-milligram dose per day for 2 weeks, then two 50-milligram doses per day, for 2 weeks. After that, your doctor will have you take a total of 300 milligrams to 500 milligrams a day, divided into 2 doses.

Lamictal combined with Depakene or Depakote, whether taken alone or with any of the above medications

One 25-milligram dose every other day for 2 weeks, then 25 milligrams once a day for 2 weeks. After that, the doctor will prescribe a total of 100 milligrams to 400 milligrams a day, taken in 1 or 2 doses.

Lamictal as a replacement for Tegretol, Dilantin, Phenobarbital, Mysoline, or Valproate

While you continue to take Tegretol, Dilantin, phenobarbital, or Mysoline, your doctor will add Lamictal, starting at a dose of 50 milligrams per day, then gradually increasing the daily dose. Once you"ve reached a dosage of 500 milligrams per day divided into 2 doses, the doctor will then begin gradually reducing the dosage of the other drug until, after 4 weeks, it has been completely eliminated. If you"re switching from valproate, your doctor will have you follow a slightly different regimen.

For Bipolar Disorder

Lamictal NOT combined with Depakene, Depakote, Tegretol, Dilantin, Phenobarbital, or Mysoline

One 25-milligram dose of Lamictal per day for weeks 1 and 2, then 50 milligrams per day for weeks 3 and 4, then 100 milligrams a day for week 5. After that, your doctor will have you take a total of 200 milligrams a day.

Lamictal combined with Depakene or Depakote

One 25-milligram dose of Lamictal every other day for weeks 1 and 2, then 25 milligrams once a day for weeks 3 and 4, then 50 milligrams a day for week 5. After that, your doctor will have you take a total of 100 milligrams a day.

Lamictal combined with Tegretol, Dilantin, Phenobarbital, or Mysoline

One 50-milligram dose of Lamictal per day for weeks 1 and 2, then 50 milligrams twice a day for weeks 3 and 4, then 100 milligrams twice a day for week 5. After that, your doctor will have you take a total of 300 to 400 milligrams a day, divided into 2 doses.

If you are currently taking Lamictal and the doctor tells you to stop taking any of the medications listed above--or you start or stop taking oral contraceptives or psychiatric drugs--the doctor may need to adjust your Lamictal dose accordingly.

Because there is little data on the use of Lamictal in people with liver or kidney impairment, the drug should be used with caution. The doctor may have you take less than the usual dose and raise it based on your body"s response.

CHILDREN 2 YEARS OF AGE AND OLDER

For Seizures

Lamictal can be added to other epilepsy drugs prescribed for children under 16 who have partial seizures or a serious form of epilepsy known as Lennox-Gastaut syndrome. Doses for children under 12 are based on the child"s weight. Children 12 and older receive the adult dose. Doses are increased gradually from a low starting level to limit the risk of severe rash. Lamictal is not used as a replacement drug for children under 16.

For Bipolar Disorder

Due to the lack of clinical studies, Lamictal is not recommended for treating bipolar disorder in children under 18 years old.

Overdosage

A massive overdose of Lamictal can be fatal. If you suspect an overdose, seek medical treatment immediately.

• Symptoms of Lamictal overdose may include:
  Coma, decreased level of consciousness, delayed heartbeat, increased seizures, lack of coordination, rolling eyeballs