Lamotrigine

You and your doctor should talk about how long you need to take lamotrigine before you begin treatment with this medication.

If you take lamotrigine for bipolar disorder, you will probably take it for at least six months. Any shorter and your old symptoms can come back. If it works for you, you may take it for much longer than that.

You will get the best effects from your medicine if you take it every day at the dose prescribed by your doctor.

You may have to take lamotrigine once or twice a day.
It doesn’t matter what time you take it each day, but choose a time that you can always remember. This could be at mealtimes, or when you brush your teeth.

You can take it before or after food.

If you are taking the tablets that you swallow whole, wash them down with a glass of water. Do not try and chew them – they will taste unpleasant.

If you are taking the orodispersible tablets, get a glass of cold water and mix the tablet(s) in at least enough water to cover them. You can stir the drink to help them break up. It will look a little cloudy. Drink it all, and then add more water to the glass and drink that to make sure you get all the medicine in the tablet.

You can swallow the dispersible tablets whole with water if you prefer.

You can also chew the dispersible tablets, but it may help to rinse them down with some cold water.

If you are taking the liquid, it is important to shake the bottle for at least ten seconds before you measure out the dose. This makes sure the medicine is mixed evenly and you get the correct dose. The medicine will be provided with a syringe and a cup. Follow the directions in the patient information leaflet with the pack. Ask your pharmacist for advice if you are unsure how to measure the correct dose.

If you miss a dose during the day, take it as soon as possible. If you forget to take it by the time of the next dose, just start again with the next dose. Do not try and catch up by taking a double dose.

If you have forgotten to take multiple doses of lamotrigine, contact your pharmacist for urgent advice. Depending on how many doses you have missed, you may need to restart your medicine with a low dose and gradually increase the dose again. Your pharmacist can advise you to contact your doctor if this is the case.

If you are unable to contact your pharmacist or doctor, contact NHS 111 for urgent advice.

If you forget to take your tablets for a few days, you may start getting your old symptoms of low mood back.

If you are taking lamotrigine as a mood stabiliser for bipolar disorder, it can be stopped suddenly, but where possible it is recommended that it is done gradually over at least one to two weeks. Discuss this with your doctor and agree a plan to gradually reduce and stop your medicine together.

Information about lamotrigine does not report any withdrawal symptoms if stopping this medicine suddenly, but there have been reports of some people experiencing the following symptoms:

• loss of focus
• lethargy
• depression, hypomania, aggression and hostility, anhedonia and dysphoria
• tingling sensations
• headaches
• reoccurring frightening and vivid nightmares
• tachycardia

Sometimes seizures or fits can occur even if you are not taking this for epilepsy. This is because after taking lamotrigine for some time, your body will have become used to having this medicine. Suddenly stopping the use of lamotrigine may therefore cause a seizure. But don't worry – this doesn't mean you are suddenly epileptic.

If you are thinking of stopping treatment with lamotrigine, talk to your doctor before doing this. If you have stopped taking lamotrigine, you need to speak to your doctor so that you can safely start it again and build back up to your dose. It is best to be honest – they will help you get back on track.

If you have taken more than the dose prescribed by your doctor, contact NHS 111 immediately to ask for advice, or ask a family member or friend to do this for you. This is important even if you don’t feel any different.

NHS 111 can give you advice and direct you to the best place to get more help if you need it.

If you have taken too much medication on purpose, or if after taking this you quickly feel unwell, call 999 or get someone to take you to A&E straight away. This includes any of the following signs:

• quick, uncontrollable body movements
• clumsiness and lack of co-ordination, causing problems with your balance
• heart rhythm changes
• loss of consciousness, convulsions/seizures (fits) or coma

If you need to go to A&E, do not travel alone or drive yourself there. Get your parent, family member or friend to go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you and tell doctors how much you have taken.

Depression (and other mental illnesses) can sometimes cause you to have thoughts about hurting yourself or taking your own life. While uncommon, this could also be a side effect of your medicine. This can happen to anyone but is more likely to happen if you are under 25 years old.

If you have any thoughts like this, it is important you get urgent help. Contact your doctor immediately for advice and support. This could be your GP or specialist mental health team. If you are able, share how you are feeling with family member or friend as well so they can support you to get help.

If you discussed with your doctor what to do if you get these thoughts and created a safety plan, read this to remind you who to contact for support and what you can do to help you cope.

Lamotrigine can cause serious side effects, including allergic reactions.
Get urgent medical advice from your doctor straight away if you get or think you could be having an allergic reaction or potentially life-threatening skin reaction. This is more likely to happen in the first few months of taking lamotrigine (especially if the starting dose is too high or the dose is increased too quickly). Symptoms of these reactions include:

• skin rashes or redness with blisters and peeling skin around the mouth, nose, eyes and groin/sex organs (genitals)
• peeling of large areas of skin (up to 30% of your body surface)
• ulcers in the mouth, throat, nose or around your groin/sex organs (genitals)
• red or swollen eyes
• a high temperature (fever), flu-like symptoms or drowsiness
• swelling around your face
• swollen glands in your neck, armpit or groin
• unexpected bleeding or bruising or your fingers turning blue
• a sore throat
• more infections (such as colds) than usual

Get your parent, family member or friend to take you or go with you to support you and keep you safe on the way. If someone is not able to drive you there, call for an ambulance. Take your medication with you.

Contact your doctor immediately but don't stop taking lamotrigine, if you get any of the following symptoms:

• feeling or hearing things that are not real or believing things that are not true
• problems with your eyesight (blurred vision or double vision)
• uncontrolled movements and muscle spasms of your eyes, head and body, or any jerking, shaking or stiffness of your muscles
• back or joint pain (which may be accompanied by a fever)
• catching more colds or having more infections than usual
• yellowing of the skin or whites of the eyes (your liver may not be working properly)

If you are unable to contact your doctor, call NHS 111 for urgent advice.

Side effects are more common when you first start taking lamotrigine. Many go away as you continue your medicine. If they don’t get better, or if you are worried by them and they are causing you distress, speak to your doctor or pharmacist about them.

Very common side effects of taking lamotrigine (affecting more than one in ten people) include:

• headaches
• skin rashes

Common side effects of taking lamotrigine (affecting up to one in ten people) include:

• feeling aggressive, agitated or irritable
• feeling sleepy, tired or drowsy
• insomnia (having difficulty sleeping)
• feeling dizzy
• shaking or tremors
• diarrhoea (loose poo)
• dry mouth
• nausea (feeling sick) or vomiting (being sick)
• having pain in your back or joints, or elsewhere

There are other side effects that you can get when taking this medicine. We have only included the most common ones here.

This list of side effects can look scary. You may not experience any of them, but it’s important to be aware of them so you know what to do if they do happen.

Unless your side effects are very severe or distressing, try to continue taking your medication until you can talk to your doctor. Your doctor can make changes to your medication to help if needed.

Uncommon but important side effects to be aware of include thoughts of harming yourself, thinking about taking your own life or trying to take your own life. This may be a symptom of your illness, including depression, but may be a side effect of medication. If you experience these thoughts, contact your doctor to seek immediate support to keep you safe.

Your doctor will make sure you are monitored carefully for these side effects, and you should decide with your doctor what to do if you experience these feelings while taking sertraline. It’s a good idea to write these plans down and keep them somewhere safe.

If you are taking lamotrigine and have not talked about this with your doctor, go back to them and talk it through. You might also want to talk to your parents, family member or friend about it too.

Before starting lamotrigine your doctor will check that your blood, liver and kidneys are healthy and functioning normally. This will require a blood test.

There is no specific routine monitoring recommended during treatment with lamotrigine, but your doctor may recommend a blood test if they have any concerns about side effects you are reporting, or to check the levels of lamotrigine in your body. For example, these can change if you are pregnant, and having this information means your doctor can make sure your dose is correct.