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lamotrigine
Lamictal · Lamictal XR/ODT/CD
Mood stabilizer⚠ Unverified beta content
At a glance
- Class
- Anticonvulsant mood stabilizer (sodium-channel / glutamate modulator)
- Black box
- ⚠ Serious skin rashes including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN)…
- Key monitoring
- Skin (rash)
- Titration adherence / missed doses
- Usual adult dose
- Bipolar maintenance target: 200 mg/day (no interacting drugs)
- Call provider / escalate if
- ANY new rash (especially in first 8 weeks), blisters, peeling skin, mouth/eye sores • Fever, swollen lymph nodes, facial swelling • Stiff neck, severe headache (aseptic meningitis)
Built-in explanation — generated offline from this app’s structured data (no AI, no network). Still unverified beta content.
What it is
- lamotrigine (Lamictal, Lamictal XR/ODT/CD) — anticonvulsant mood stabilizer (sodium-channel / glutamate modulator).
- Used for: Bipolar I disorder – maintenance; Epilepsy.
Usual adult dosing
- Bipolar maintenance target: 200 mg/day (no interacting drugs) (Must titrate slowly: 25 mg/day wks 1–2, 50 mg/day wks 3–4, 100 mg/day wk 5, 200 mg/day wk 6.)
- With valproate: 100 mg/day target (Halve titration: 25 mg every other day wks 1–2, 25 mg/day wks 3–4, 50 mg/day wk 5, 100 mg/day wk 6.)
- With enzyme inducers (carbamazepine, phenytoin, rifampin): Up to 400 mg/day target
Boxed warning
- Serious skin rashes including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and rash-related death. Risk is increased by coadministration with valproate, exceeding the recommended initial dose, or exceeding the recommended dose escalation. Discontinue at the first sign of rash unless clearly not drug-related.
Monitor
- Skin (rash) [Every contact, especially first 8 weeks and after dose changes]
- Titration adherence / missed doses
Nursing priorities
- Document all current meds, especially valproate, carbamazepine, estrogen contraceptives.
- Baseline skin check; teach patient to self-inspect.
- Verify the correct titration schedule (with/without valproate or inducers) every time.
- Do not skip the titration; if ≥5 half-lives (~5 days) of missed doses, notify provider – restart may require re-titration.
- Any rash → hold dose and notify provider immediately, esp. in first 8 weeks.
Major interactions
- Valproate / divalproex: Doubles lamotrigine levels – use reduced titration; ↑ SJS/TEN risk.
Key teaching
- Take it every day exactly as prescribed. It starts at a very low dose and goes up slowly to lower the risk of a serious rash. Do not skip steps.
- If you miss it for 5 days or more, call your provider before restarting.
- STOP the medicine and call your provider or go to the ER at once if you get ANY rash, fever, swollen glands, or mouth sores – especially in the first 2 months.
Optional: AI explanation
Off by default. To enable, add your own API key in Settings (stored only on this device).
Boxed warning
- Serious skin rashes including Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and rash-related death. Risk is increased by coadministration with valproate, exceeding the recommended initial dose, or exceeding the recommended dose escalation. Discontinue at the first sign of rash unless clearly not drug-related.
Other serious warnings
- Hemophagocytic lymphohistiocytosis (HLH)
- Multi-organ hypersensitivity (DRESS) / fever, lymphadenopathy
- Aseptic meningitis
- Cardiac rhythm and conduction abnormalities (arrhythmia risk in structural/ischemic heart disease)
- Blood dyscrasias
- Suicidality (antiepileptic class)
- Medication-error risk (name confusion: Lamictal vs. Lamisil, labetalol, etc.)
Sources: FDA label (DailyMed): LAMICTAL (LAMOTRIGINE) TABLET / TABLET FOR SUSPE
- Skin (rash)When: Every contact, especially first 8 weeks and after dose changesAny rash → stop & call provider
- Titration adherence / missed doses
- Mood / suicidality
- Drug levelsNot routinely needed; may be considered in pregnancy or with interactions (usual reference 3–15 mcg/mL in epilepsy)
- Fever, lymphadenopathy, mouth sores
Sources: FDA label (DailyMed): LAMICTAL (LAMOTRIGINE) TABLET / TABLET FOR SUSPE
Assessment
- Document all current meds, especially valproate, carbamazepine, estrogen contraceptives.
- Baseline skin check; teach patient to self-inspect.
- Date/titration week and dose history; confirm correct starter pack.
- Mood, suicidality, coordination, vision.
Interventions
- Verify the correct titration schedule (with/without valproate or inducers) every time.
- Do not skip the titration; if ≥5 half-lives (~5 days) of missed doses, notify provider – restart may require re-titration.
- Any rash → hold dose and notify provider immediately, esp. in first 8 weeks.
- Check for interactions with each new drug; hormonal contraceptives (estrogen) lower lamotrigine levels.
- Double-check drug name when dispensing/administering (look-alike names).
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
- ANY new rash (especially in first 8 weeks), blisters, peeling skin, mouth/eye sores
- Fever, swollen lymph nodes, facial swelling
- Stiff neck, severe headache (aseptic meningitis)
- Unexplained bruising, fatigue, infections
- Fainting or irregular heartbeat
- Suicidal thoughts
- Missed ≥5 days of doses
Sources: FDA label (DailyMed): LAMICTAL (LAMOTRIGINE) TABLET / TABLET FOR SUSPE · General nursing drug reference conventions (e.g., Davis Drug Guide / L
- Headache
- Dizziness, ataxia, blurred/double vision
- Nausea
- Somnolence or insomnia
- Benign rash
- Tremor
- Rhinitis
Sources: FDA label (DailyMed): LAMICTAL (LAMOTRIGINE) TABLET / TABLET FOR SUSPE
- Valproate / divalproex MajorDoubles lamotrigine levels – use reduced titration; ↑ SJS/TEN risk.
- Carbamazepine, phenytoin, phenobarbital, rifampinLower lamotrigine levels – higher doses needed.
- Estrogen-containing contraceptivesLower lamotrigine levels (about 50%); levels rise during pill-free week.
- Other CNS depressantsAdditive dizziness/drowsiness.
Sources: FDA label (DailyMed): LAMICTAL (LAMOTRIGINE) TABLET / TABLET FOR SUSPE
- Take it every day exactly as prescribed. It starts at a very low dose and goes up slowly to lower the risk of a serious rash. Do not skip steps.
- If you miss it for 5 days or more, call your provider before restarting.
- STOP the medicine and call your provider or go to the ER at once if you get ANY rash, fever, swollen glands, or mouth sores – especially in the first 2 months.
- Tell your provider if you start or stop birth control pills or other medicines.
- It may cause dizziness or double vision – be careful driving.
Sources: General nursing drug reference conventions (e.g., Davis Drug Guide / L
Indications
- Bipolar I disorder – maintenance (delays mood episodes, esp. depression)
- Epilepsy (partial/generalized seizures, Lennox-Gastaut)
- Common off-label: bipolar depression
Dosing
- Bipolar maintenance target: 200 mg/day (no interacting drugs)Must titrate slowly: 25 mg/day wks 1–2, 50 mg/day wks 3–4, 100 mg/day wk 5, 200 mg/day wk 6.
- With valproate: 100 mg/day targetHalve titration: 25 mg every other day wks 1–2, 25 mg/day wks 3–4, 50 mg/day wk 5, 100 mg/day wk 6.
- With enzyme inducers (carbamazepine, phenytoin, rifampin): Up to 400 mg/day target
Sources: FDA label (DailyMed): LAMICTAL (LAMOTRIGINE) TABLET / TABLET FOR SUSPE
Prescriber-oriented details; limited in this beta.
titration
- Bipolar: 25 mg/d wk1–2; 50 mg/d wk3–4; 100 mg/d wk5; 200 mg/d wk6. With valproate halve; with inducers use faster schedule (see label).
renal Adjustment
- Reduced maintenance doses may be effective in significant renal impairment.
hepatic Adjustment
- Reduce doses ~25% moderate–severe impairment without ascites; ~50% with ascites (label).
pregnancy Lactation
- Clearance rises in pregnancy – levels may fall; monitor.
Sources: FDA label (DailyMed): LAMICTAL (LAMOTRIGINE) TABLET / TABLET FOR SUSPE
- Verified
- No – unverified beta
- Last reviewed
- 2026-10-29 (drafted; not clinician-reviewed)
- FDA label (DailyMed): LAMICTAL (LAMOTRIGINE) TABLET / TABLET FOR SUSPENSION / ODT [GLAXOSMITHKLINE]
- General nursing drug reference conventions (e.g., Davis Drug Guide / Lexicomp nursing) - summarized from standard practice; NOT line-by-line verified