What is Lamictal (lamotrigine) Used For?
Lamictal is used for epileptic seizure prevention and control, and as a mood stabilizer to treat the manic and depressive episodes of adult bipolar disorder.
It is FDA-approved for use in children as young as 2 years old as well as for adults as an anticonvulsant medication to prevent epileptic seizures.24
At Alternative to Meds Center, we often see instances where Lamictal has been prescribed as an adjunct to antipsychotic medication. Lamictal is used as a mood stabilizer and when combined with an antipsychotic, creates an inhibition of both glutamate and dopamine. This also leaves a person with Lamictal reactions such as difficulty perceiving natural reward or stimulation, which is why the consumer may be driven to seek lower dosing or non-medicating alternatives.
Lamictal Alternative Names and Slang (lamotrigine)
Lamictal is the brand or trade name for the generic drug lamotrigine. There is no known slang or street name for the drug, and there is no evidence that the drug has been associated with street or illicit use or sale. There are many alternate names for Lamictal, including domestically:
International names include:
- Lamictal CD®
Lamictal Adverse Effects
In April 2018 the FDA issued a new warning regarding anti-seizure medications including Lamictal precipitating a rare but life-threatening reaction. This reaction is described as a severe immune system inflammation, called HLH or hemophagocytic lymphohistiocytosis which can quickly escalate, and if not treated quickly, can lead to death.1
Some signs of HLH include persistent fever and low or absent natural killer cells, and certain other characteristics in the blood that are markers for HLH. Mortality rates for HLH are 50%, and it occurs in children more often than in adults, which is a concern since Lamictal is approved for patients aged two years of age and older.24
Anti-seizure medication (ASM) may lead to further seizure activity in certain patients, as hypothesized by authors Khateb et al in their 2021 research on the subject. While researchers are looking over this phenomenon more closely, patients taking ASM should be monitored for this potential Lamictal side effect.26
What are the Most Severe Lamictal Adverse Effects?
According to the information published by the 2021 Prescriber’s Digital Reference12 and mentioned on the drug insert 24 the following severe Lamictal adverse effects have been reported:
- Kidney failure
- Repeating seizures, loss of consciousness between episodes
- Severe rash
- Stevens-Johnson syndrome (life-threatening ulcers, eruptions, blistering, peeling, open sores, and discolorations of the skin with other complications involving the mucous membranes or other areas, requiring immediate cessation and emergency treatment in ICU or burn unit)
- Impaired liver function
- Anemia (low red blood cell count)
- Various movement disorders, including dyskinesias, tics, parkinsonism, etc. 27
- Loss of hearing
- Dyskinesia (an involuntary movement disorder)
- Tumors in breast tissue
- Blood disorders
- Decreased white blood cells
- Decreased blood platelets
- Meningitis (inflammation of the brain, rigidity, intense fever, and pain, may lead to coma or death)
- Epididymitis (infection/inflammation of the testicles)
- DRESS syndrome (severe rash, hypersensitivity event, that has a 10% mortality rate)
- Hypersensitivity drug reaction (allergic-type reaction to a drug)
- Erythema Multiforme (mucous membrane/skin reaction can be mild or can be life-threatening in rare cases)
- Lowered resistance to infection
- Purplish spots on the skin
- Stopped breathing
- Multiple organ failure
- Toxic epidermal necrolysis (similar to Stevens-Johnson syndrome, the skin falls away, leads to sepsis, and requires emergency treatment)
- Vasculitis (inflammation of the blood vessels)
What are the Most Common Lamictal Adverse Effects?
- Altered mental states
- Mood swings
- Joint pain
- Loss of appetite
- Weight changes
- Painful menstruation
- Neck pain
- Involuntary eye movements
- Irritable, easily upset or angered
- Worsening depression
- Loss of coordination
- Pain in stomach
- Back pain
- Flu-like symptoms such as sore throat, runny nose, nasal inflammation, etc.
- Double vision or blurring of the vision
- Dry mouth
- Chest pain
- Tiredness, fatigue
- Sensitivity to light
- Swelling of the hands, feet, limbs
- Stiff neck
- Fainting, losing consciousness
It should be noted that since many very young children are placed on Lamictal for epilepsy disorders, careful monitoring should be ongoing for any signs of these or other unusual or adverse Lamictal reactions, especially because a child may not be able to articulate such experiences easily.
Lamictal Withdrawal: Getting Off Lamictal (lamotrigine) Gradually
Lamictal should never be stopped abruptly, unless as in the case of HLH, Stevens-Johnson syndrome, or other dire situations as noted above, that require a life-saving medical intervention. These require immediate hospitalization.
According to medical consensus, for the vast majority of cases, a gradual taper is the recommended procedure for coming off Lamictal. Gradual Lamictal cessation can avoid a sudden shock to the body that could leave the person in a worse off state than before the prescription was initiated.25
Lamictal influences two amino acids, aspartate, and glutamate. These are excitatory neurotransmitters, which Lamictal restricts the release of, thereby causing a calming effect. When Lamictal tapering is occurring, more of these excitatory agents may start to release into the system and this may cause rebound excitability. A gradual approach can soften the adverse effects that Lamictal cessation may otherwise cause.
Let’s talk about rebound excitability and why it may occur if the drug is reduced too fast. Lamictal restricts the presynaptic permeability of the excitatory amino acids aspartate and glutamate. When a person is withdrawing from the medication, it is generally accepted that more of these excitatory amino acids, with stimulatory neuromodulating capabilities, will begin to flood into the synapse, and there may be rebound excitability. This can be further compounded if foods containing versions of aspartate and glutamate are consumed during the withdrawal period. Therefore, foods such as diet sodas, processed foods, and artificial sweeteners (which break down into aspartate) should be restricted. One can do a search for foods that contain aspartate and glutamate to avoid these. Modifying the diet in this way may help reduce the flood of excitatory neurotransmitters during Lamictal withdrawal.