17 U.S. Code § 107 - Limitations on exclusive rights: Fair use
Notwithstanding the provisions of sections 106 and 106A, the fair use of a copyrighted work, including such use by reproduction in copies or phonorecords or by any other means specified by that section, for purposes such as criticism, comment, news reporting, teaching (including multiple copies for classroom use), scholarship, or research, is not an infringement of copyright. In determining whether the use made of a work in any particular case is a fair use the factors to be considered shall include—
(1) the purpose and character of the use, including whether such use is of a commercial nature or is for nonprofit educational purposes [all mirrored content falls under this clause, any ads present are mirrored from the original site, mirrored content earns me no revenue whatsoever];
(2) the nature of the copyrighted work [this is a unique resource for the mentally ill, and preservation of it can be argued to be incredibly important];
(3) the amount and substantiality of the portion used in relation to the copyrighted work as a whole; and
(4) the effect of the use upon the potential market for or value of the copyrighted work. [absolutely none whatsoever, as the original work no longer exists anywhere else (outside of whatever bits and pieces archive.org managed to capture) - the original site was intermittantly completely unavailable for a extended period of time before its SSL certificate expired (and was never renewed), and eventually the site went offline for good, then finally the DNS records were removed at some point prior to May 2018, so at this point it is well beyond the 'dead and rotting' stage]
The fact that a work is unpublished shall not itself bar a finding of fair use if such finding is made upon consideration of all the above factors.

This domain is not controlled by Jerod Poore, and I will NOT continue redirecting traffic from this domain to crazymeds.us [as I formerly did] while Jerod continues with his immature temper tantrum over adblock or continues to fail to maintain his site, fucking over his entire community and countless visitors in the process. [belated clarification: with specific regards to the adblock drama I was referring to Poore at one point replacing his entire site with a single page complaining about the amount of revenue lost to users with ad blocking active, which is something that I took extreme exception to because this affected ALL visitors to the site regardless of if or if not they were actually using ad blocking]
This mirror is unfortunately incomplete (and very slightly outdated), as /CrazyTalk/ was not included when I scraped the site (it was far too large to scrape given the site's extremely poor performance, my wish to avoid worsening the poor performance further, and other factors). If you're looking for a replacement forum, I suggest visiting https://www.crazyboards.org/forums/. There are issues with many of the mirrored pages, I am working on identifying and fixing them, but I do not have the time to address every single issue at this moment (although by now the majority of these issues have been resolved). Dynamic content is obviously completely broken (this is beyond my control), and the loss of /CrazyTalk/ is quite bad given how much good user-generated info was on there, but you have Jerod to "thank" for that. Maybe I'll bring it back online at some point, but it wouldn't be the same as before. For now, I suggest visiting CrazyBoards instead.
Note (Oct 9 2018): Infrequent additional updates regarding the status of this site will be posted on https://info.crazymeds.net


Part 1: Indications, efficacy, dosage, titration, discontinuation, pros and cons, adverse events, availability and how supplied.

> Lamictal (lamotrigine) Review


The Lamictal (lamotrigine) Overview is a briefer, more consumer-friendly version of this article. The information in this article comes from twelve separate pages, with more explanatory material, to which the overview links. The title of each section on both pages of this article is also a link to each of those pages.

Click here for Part 2: Warnings, clinical pharmacology, interactions, additional comments and consumer experiences

Abstract

Consumers need more information than what is provided in the patient information literature, but are intimidated by, or have no desire to read all of, the prescribing information for a drug. This review of the drug Lamictal (lamotrigine) provides what the educated consumer wants, highlighting its use as, and comparing it with other AntiepilepticDrugs. Also discussed are off-label uses, efficacy, adverse events and how to mitigate them, titration and discontinuation schedules, clinical pharmacology, other aspects of using Lamictal (lamotrigine), and consumer experiences.

Classification

Primary Drug Class

Lamictal (lamotrigine) is in the AntiepilepticDrugs/Anticonvulsants class of medications.

Additional Drug Categories

MoodStabilizers (approved) Antidepressants (off-label) Migraine/NeuropathicPain (off-label)

Indications

A review of Lamictal’s prescribing information, the literature, and consumer experience. Regarding off-label applications: if something is to be considered as “clinically significant” there need to be large, double-blind studies or clinical trials in addition to lots of consumer experiences, otherwise it will still be considered as experimental.

FDA-Approved Indications

Lamictal has some of the most complicated approvals of all crazy meds.

Bipolar disorder

Approved in June 2003 for the maintenance treatment of bipolar 1. Here it is the current approval from the PI sheet:

LAMICTAL is indicated for the maintenance treatment of Bipolar I Disorder to delay the time to occurrence of mood episodes (depression, mania, hypomania, mixed episodes) in adults (≥18 years of age) treated for acute mood episodes with standard therapy

. The effectiveness of LAMICTAL in the acute treatment of mood episodes has not been established.--Lamictal PI sheet

The emphasis is mine. Officially you must not be showing any symptoms of bipolar disorder, either because you’re taking another drug or you’re in a period of remission you know will be short-term, before you start taking Lamictal. If you’re symptoms aren’t under control, especially if you’re not taking another med, you’re technically using Lamictal off-label.

I cannot stress how much I agree with the FDA on this one. Lamictal is a very effective maintenance med - a drug you plan on taking for a very long time to keep your symptoms under control - with a very low side-effect profile. As a drug to stop your symptoms it’s OK.

Epilepsy

First approved for epilepsy

in April 1994. If you think the bipolar approval is complicated take a look at the approvals for epilepsy. Quoting again, from the PI sheet we see the approval for adjunctive therapy (taking Lamictal with other meds) is pretty straightforward:

Adjunctive Therapy: LAMICTAL is indicated as adjunctive therapy for the following seizure types in patients ≥2 years of age:

  • partial seizures
  • primary generalized tonic-clonic seizures
  • generalized seizures of Lennox-Gastaut syndrome

--ibid

It’s when you want to take Lamictal by itself that things get really complicated:

Monotherapy: LAMICTAL is indicated for conversion to monotherapy in adults (≥16 years of age) with partial seizures who are receiving treatment with carbamazepine, phenytoin, phenobarbital, primidone, or valproate as the single antiepileptic drug (AED)

.

Safety and effectiveness of LAMICTAL have not been established (1) as initial monotherapy; (2) for conversion to monotherapy from AEDs other than carbamazepine, phenytoin, phenobarbital, primidone, or valproate; or (3) for simultaneous conversion to monotherapy from 2 or more concomitant AEDs. --ibid

As with bipolar disorder, the FDA says you can take Lamictal by itself only if you’re already taking another drug that you want to stop taking. Unlike bipolar disorder, officially you can switch to Lamictal only if you’re taking the drugs they list, otherwise it’s an off-label use.

As with bipolar, I totally agree with the FDA. You either want to add Lamictal to whatever you’re currently taking to help it work better, or to switch to it because Lamictal sucks less than most other meds.

Drugs sometimes have different approvals in different countries.1 Consumers want to know this if they are running out of treatment options; or if they are researching their treatment options they may wish to know if, and why, a medication is approved for something in the US but not anywhere else.

Approved Uses Outside of the US

Clinically Significant or Otherwise Common Off-Label Uses

Less Common/Experimental Off-Label Uses

Failed off-label uses

Potentially dangerous off-label uses



Efficacy & Comparisons with Other AntiepilepticDrugs

A review of prescribing information, the literature and consumer experiences. In addition to review sites, which don’t skew as negative as one would think, consumer experiences with medications are frequently reported on social media sites that have nothing to do with medications or illnesses. There is such a consistent overlap in many demographics (e.g. women with bipolar 2 and/or migraines and scrapbooking) to provide a great deal of data on efficacy and adverse reactions from a very natural environment where consumers discuss their conditions and how to treat them that is free of almost all prejudices regarding medications and other treatment options.

Onset of Action

For epilepsy: However long it takes to get in the neighborhood of 200–400mg a day.
For bipolar: If you’re in a depressed phase Lamictal can work within a few days at 25mg, although the average dosage that works for depression is 100mg. That takes anywhere around four to five weeks. For mania/true mood stabilization it’s 150–200mg a day, and that usually happens in six to eight weeks.

Efficacy for its Approved Indications

For epilepsy: Decent. Lamictal is especially good for two forms of epilepsy - Lennox-Gastaut syndrome (for which it’s approved) and autosomal dominant nocturnal frontal lobe epilepsy, which is too unusual to be worth getting official approval for.
For bipolar 2: Best med on the market. For bipolar 1: If you take it like the FDA tells you to - after being stable on another med - the chances are pretty good you’ll stay stable.

For Off-Label Applications

Lamictal versus Other AntiepilepticDrugs/Anticonvulsants for Approved Indications

Epilepsy:

Carbamazepine is better than lamotrigine for time to first seizure, but this efficacy outcome might be dependent on initial dosing and could indicate that initial lamotrigine dosing in the trial was conservative, which would favour better tolerability outcomes, but detract from its efficacy early in the study. This inference is supported by the way in which per-protocol analysis of time to 12-month remission shows lamotrigine catching up with and eventually overtaking carbamazepine. There is also a lower rate of rash in patients randomised to lamotrigine in this arm of the study than might have been expected, a further potential consequence of conservative initial dosing. The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial

  • Lamictal vs. Topamax in people with partial epilepsy who are already taking Tegretol or Dilantin (phenytoin). Which med used as an add-on will have the greater adverse effect on cognitive performance? Any guesses? That’s right, Topamax makes you teh dum.
    • Lamictal vs. Topamax in AED polytherapy. In a study done previously to the one above, the cognitive performance tests were given to people who were taking Topamax or Lamictal as part of an AED cocktail. They found that Topamax is more likely than Lamictal to give you the stoopids. This is one of the few studies where cognitive side effects and dosage aren’t necessarily related, which is something we see a lot of.
  • AED geezer cagematch! Tegretol vs. clobazam vs. Neurontin vs. Keppra vs. Lamictal vs. Trileptal vs. Dilantin (phenytoin) vs. Topamax vs. Depakote vs. Zonegran in people 55 or older with a variety of types of epilepsy. The winner: Lamictal, with 79% of people staying on it for one year or longer and 54% seizure-free. Keppra was a close second with 73% staying on it and 43% seizure-free. The same was true even for refractory epilepsy, with 47.4% responding to Lamictal and 38.9% responding to Keppra. The biggest loser: Trileptal, with only 24% staying on and 4% remaining seizure-free.
  • Keppra vs. Tegretol vs. Lamictal. This study investigated the risk factors of cardiovascular disease in patients with epilepsy who take different AEDs. The results: Uh, well, Tegretol kind of made things a little worse, especially with women, who gained weight on it and Lamictal due to inactivity. Tegretol also raised total cholesterol (TC), low-density lipoprotein (LDL) and high-density lipoprotein in both men and women.
  • Keppra vs. Lamictal vs. phenobarbital in people with Alzheimer’s. You know someone is old if they’re taking pheno for epilepsy. The results: a tie! At least when it comes to seizures. Lamictal made them feel better and Keppra helped with the Alzheimer’s symptoms a little, neither of which is surprising.
  • Keppra vs. Lamictal - which one gets you more pissed off? Finally, a useful study! The results: a tie. Both in control of partial seizures and improvement of mood and lessening hostility, Keppra works as well as Lamictal.
  • AED stupidity cagematch! Depakote vs. Dilantin (phenytoin) vs. Keppra vs. Lamictal vs. Neurontin vs. Tegretol vs. Topamax vs. Trileptal vs. Zonegran in which makes you the stoopidedist. The wiener: Stupamax Dopamax Topamax, with 21.5% of people reporting intolerable (where they had to stop taking it) cognitive side effects. In second place was Zonegran with 14.9% and in third place was Trileptal with 11.6%. Keppra scored fairly high with 10.4%, but that includes people who were taking Keppra along with one or more other AEDs. When taking only Keppra it had the fewest (no number in the abstract) number of reported cognitive side effects.

For Off-Label Uses

Migraines and other headaches

  • Low-dosage Topamax vs. Lamictal vs. placebo for migraine prophylaxis. Lamictal? For migraines? Actually Lamictal is used off-label all the time for headaches, proving the adage2 that whatever adverse event (side effect) an AED causes it can also treat, and vice versa. Or the other way around. In any event the results: Topamax wins, probably because Lamictal usually needs a higher dosage and is most effective for migraine with aura.

These are not prescribing guidelines per se. For consumers they are an antidote to the direct-to-consumer marketing phrase “Talk to your doctor about…” regarding the advertised drug. For physicians they are likewise an antidote to drugs being pushed on them by pharm reps.

A synthesis of the literature and consumer experiences can provide good rules of thumb as to when consumers should and should not talk to their doctors, and when doctors should and should not talk to their patients, about particular drugs the first time they discuss treatment options. If at all.

Why/When Lamictal (lamotrigine) Should Be Recommended

  • You have bipolar 2.
  • You’re epileptic, or have something else commonly treated with AEDs, and want to get pregnant.
  • Your symptoms are under control, but whatever you’re now taking really sucks.

Why/When Lamictal (lamotrigine) Should Not Be Recommended

  • You’re bipolar and tend to run mainly manic.
    • Especially right now, or whenever you’re considering starting Lamictal.
    • Extra-especially if it’s a dysphoric mania, or you have dysphoric manias (you’re angry, anxious, and/or irritable instead of happy and productive along with not wanting to sleep, talking too fast and all the time, and all the other symptoms of mania you usually get).
  • You have a history of skin problems.
    • Unless you’re sure you and your doctor can tell the difference between all the skin problems you’ve had that might come back, and be worse, and something that is potentially a real problem.
    • But if you have a history of skin problems like SJS and TEN you shouldn’t even be reading about Lamictal.
  • Your symptoms aren’t under control.
    • Whether or not you’re taking any meds to control them.
    • Because Lamictal is for transitioning to NOT starting with!


Stick to the titration schedule with buttons and magnets. 2.25″ $4 & 3.5″ $4.50 at Straitjacket T-shirts
Pile of Pills buttons at Straitjacket T-shirts
Pile of Pills
Vaccines Cause Immunity buttons at Straitjacket T-shirts
Vaccines Cause Immunity
Brain Cooties Aren't Contagious buttons at Straitjacket T-shirts
Brain Cooties Aren’t Contagious
Team PTSD buttons at Straitjacket T-shirts
Team PTSD


Dosage, Titration, and Discontinuation

A review of Lamictal’s prescribing information, the literature, and consumer experience. We have found that for most consumers in an out-patient situation the titration schedule published in the prescribing information is often too aggressive. Many would often be better served by starting at a dosage lower than recommended by the manufacturer and, instead of a fixed target dosage, the dosage where symptoms are controlled within a given range is the goal. Patients could adjust their dosage as needed without having to schedule an appointment with their prescriber.

Dosage and Doses

Lamictal has the most complicated dosing instruction and schedule to increase the dosage (titration) of any crazy med. They take up 9 pages of the PI sheet.
Normally you would take regular Lamictal twice a day, but if the dosage is small enough, or you find it affects how you sleep, or for whatever reason, you can take it once a day, either in the morning, or at night, or the middle of the day. That’s one thing where Lamictal is really flexible.
Lamictal-XR is supposed to be a once-a-day med regardless. I haven’t collected enough data yet to know if that’s the case or not. Depakote ER is supposed to be once-a-day, but many people find they need to take it twice a day anyway.

As with all meds, taking Lamictal at the same time every day is recommended, and with some people it actually will make a difference if you do that or not.

However, if you scroll down a bit to the titration schedule you’ll see that if you take any other medications, you can be forced to take Lamictal in a particular way.

Dosing Schedule

There are far too many variables to determine a best way to take Lamictal. Taking it with food doesn’t affect how well it’s absorbed, so if Lamictal causes any gastrointestinal problems, try taking it on a full stomach.

Although regular Lamictal tablets are scored, indicating you can split them in half (Lamictal-XR is NOT scored and, like all extended-release drugs should NEVER be split, cut, chewed, folded, spindled, or mutilated.), throughout the PI sheet GSK indicates that it’s not that good of an idea to split them after all. They crumble easily and are really difficult to cleanly split into two pieces that are close to the same dosage. Most generic lamotrigine tablets are the same way, although Teva’s is fairly robust and splits somewhat cleanly.

Titration Schedule

Living in a Perfect World

GSK has made if very, very simple to start taking Lamictal and increase your dosage on a schedule (titrate) until you reach a target dosage by distributing free starter packs to doctors with two months worth of Lamictal. Two entire months worth of free pills is one of the best medication deals on the planet. And there isn’t just one, but three color-coded starter packs to use depending on the other meds you’re taking. Because Lamictal is only approved to transfer to after your symptoms (bipolar or epilepsy) are under control. Lamictal is NOT approved to take as a drug to get your symptoms under control, but to keep them under control.

Here are some3 of the titration schedules from the PI sheet, along with comments and suggestions. I added the brand names. The different valproates are Depakote (divalproex sodium), Depakene/Stavzor (valproic acid), and whatever they call sodium valproate where you live.
First up, adding Lamictal to an existing drug for bipolar disorder4

 For Patients
TAKING a valproate
(Blue Starter Kit)
For Patients
NOT TAKING
Tegretol/Equetro (carbamazepine),
Dilantin (phenytoin), phenobarbital,
primidone, or a valproate
(Orange Starter Kit)
For Patients TAKING
Tegretol/Equetro (carbamazepine),
Dilantin (phenytoin), phenobarbital,
primidone and
NOT TAKING a valproate
(Green Starter Kit)
Weeks 1 and 225 mg every other day25 mg daily50 mg daily
Weeks 3 and 425 mg daily50 mg daily100 mg daily,
in divided doses
Week 550 mg daily100 mg daily200 mg daily,
in divided doses
Week 6100 mg daily200 mg daily300 mg daily,
in divided doses
Week 7100 mg daily200 mg dailyup to 400 mg daily,
in divided doses

Whether to cover their asses about doctors going rogue and starting their patients on Lamictal as monotherapy, or just out of incompetence, GSK left out estrogen-based birth control and rifampin (a TB med), from the list of drugs where you need to use the green starter pack5, the instructions in the packs, and the titration schedules. Estrogen-based birth control and rifampin are listed in the drug-drug interactions as affecting Lamictal enough to require dosage increases. Smoking may also speed up the clearance of Lamictal, but the data are still hazy on this one. The data are conflicting if taking 400mg a day or more of Topamax will also cause Lamictal to clear faster. It seems like each edition of the PI sheet has a new opinion as to if there may or may not be enough data to indicate a potential interaction with Topamax.

Let’s take a look at the titration schedule for adding Lamictal to another med for epilepsy. While GSK hasn’t changed the bipolar titration, they’ve certainly rationalized Lamictal’s titration schedule for epilepsy. Since 2010, perhaps earlier (but not before the 2006 edition of the PDR), it’s looked like this:

 For Patients
TAKING a valproate
(Blue Starter Kit)
For Patients
NOT TAKING
Tegretol/Equetro (carbamazepine),
Dilantin (phenytoin), phenobarbital,
primidone, or a valproate
(Orange Starter Kit)
For Patients TAKING
Tegretol/Equetro (carbamazepine),
Dilantin (phenytoin), phenobarbital,
primidone and
NOT TAKING a valproate
(Green Starter Kit)
Weeks 1 and 225 mg every other day25 mg daily50 mg daily
Weeks 3 and 425 mg daily50 mg daily100 mg daily
in two divided doses
Week 5 onwards
to maintenance
Increase by 25 to 50 mg/day
every 1 to 2 weeks
Increase by 50 mg/day
every 1 to 2 weeks
Increase by 100 mg/day
every 1 to 2 weeks
Usual
maintenance dose
100 to 200 mg/day
with valproate alone
100 to 400 mg/day
with valproate and other drugs
that induce glucuronidation
(in 1 or 2 divided doses)
225 to 375 mg/day
in two divided doses
300 to 500 mg/day
in two divided doses

That’s actually slower than for bipolar disorder, and the maintenance dosage is pretty broad, especially since Lamictal is rated for a maximum dosage of 500 mg if you’re not taking a drug that affects its metabolism. I totally agree with their schedule for epilepsy.

You’ll note there is no schedule for anyone taking both an enzyme-inducing AED and a valproate. Why? Do you realize how fucking crazy-making it is to figure that out? Especially since Tegretol and Depakote affect each other’s clearance as it is! And at its maximum dosage Lamictal may slow the clearance of Tegretol and can increase the clearance of Depakote enough to possibly make a difference in both efficacy and the pharmacokinetics of your cocktail. So if you were taking 800mg a day of Lamictal (which is not an uncommon dosage for someone who is epileptic and also taking Tegretol), 1,200mg a day of Tegretol and 1,500mg a day of Depakote the drug-drug interactions of taking just two of those drugs would normally make it look as if you were actually taking:
Lamictal + Tegretol ≈ 400 mg of Lamictal, 1,200 mg (perhaps more) of Tegretol
Lamictal + Depakote ≈ 1,600 mg of Lamictal, 1,800 mg of Depakote
Depakote + Tegretol ≈ 1,800 mg of Tegretol, 1,500 mg of Depakote
So taking all three = you’re going to have to get monthly blood levels for each med until the numbers are consistent, because my head nearly exploded when someone on that cocktail asked me what the dosage equivalents were. She may have been taking birth control as well. It wasn’t until 2009 that GSK addressed that issue (excluding the birth control), as far as you can see in the very last row of the column for taking Lamictal with a valproate: take 400 mg of Lamictal a day, divided into two 200 mg doses.

OK, so if you are taking Lamictal with another med and want to take only Lamictal, how do you go about doing that? According to GSK it depends on what you have. If you’re bipolar it’s fairly easy. Just discontinue whatever you’re taking per that med’s discontinuation instructions, even if it affects Lamictal’s clearance. If you need to adjust your dosage because of the med you were taking, then either increase your dosage by 50mg a day per week if you were taking a valproate, or decrease your dosage by 100mg a day per week if you were taking an enzyme-inducing med, until you reach the target dosage of 200mg a day.
I honestly doubt it’s that easy for everyone. You may want to get a prescription for 25mg of Lamictal in case you need to adjust your dosage of Lamictal as you discontinue the other med(s). You won’t know if you actually need to adjust the Lamictal dosage until you begin to discontinue the other med(s).

As for epilepsy, you and your doctor are going to have to work that one out yourselves. The maintenance dosage of Lamictal is too broad and, unlike bipolar disorder, the odds are a lot better for something to go wrong as you reduce the dosage of one of your other meds.

Living in the Material World

In reality most people who are prescribed Lamictal for bipolar disorder, especially bipolar 2, are probably going to take it as their first or second med. When they’re not stable. Which means they face weeks of being less stable than they were to start with.

This is where I don’t like the starter kits. Why? Because the kits are geared for people with bipolar 1, and Lamictal works best for bipolar 2. Plus, I hate target dosages when you don’t know what the correct dosage is going to be.

Here’s what I suggest you talk to your doctor about: If you’re taking Lamictal for bipolar 2 or depression you want to start at 25mg a day and increase the dosage following the titration schedule until your symptoms stop. Then get a prescription for whatever dosage you’re taking. Better yet, talk to your doctor about stopping at the dosage where your symptoms stop and have prescriptions already written for 25, 50, 100, and, if you’re taking an enzyme-inducing med, 200mg tablets. While Lamictal does work for some people at 25mg a day, even those who are not taking any other med, for most people with bipolar or unipolar depression, 50–100mg is the range where it will start to work.

If you are taking Lamictal for bipolar 1 and are getting hypomanic on the lower dosages, why isn’t your other medication working? You aren’t taking another medication? Then you shouldn’t be taking Lamictal by itself. There’s a reason why it’s not approved to start as monotherapy for bipolar 1.

One aspect of taking a medication that is frequently missing from patient information, as well as prescribing information, is how to stop taking it. Consumers are left with nothing more than the warning to not stop taking their medication without first talking to their doctor. Circumstances do not always allow for that. Many consumers feel better if they have the knowledge about what they should do.

How to Discontinue

Manufacturer’s Recommendations

Here’s whatGlaxo-Smith Kline’s (GSK) says to do

Discontinuation Strategy:
Epilepsy: For patients receiving LAMICTAL in combination with other AEDs, a reevaluation of all AEDs in the regimen should be considered if a change in seizure control or an appearance or worsening of adverse reactions is observed. If a decision is made to discontinue therapy with LAMICTAL, a step-wise reduction of dose over at least 2 weeks (approximately 50% per week) is recommended unless safety concerns require a more rapid withdrawal [see Warnings and Precautions (5.9)].
Discontinuing carbamazepine, phenytoin, phenobarbital, primidone, or other drugs such as rifampin that induce lamotrigine glucuronidation should prolong the half-life of lamotrigine; discontinuing valproate should shorten the half-life of lamotrigine.

Bipolar Disorder: In the controlled clinical trials, there was no increase in the incidence, type, or severity of adverse reactions following abrupt termination of LAMICTAL. In clinical trials in patients with Bipolar Disorder, 2 patients experienced seizures shortly after abrupt withdrawal of LAMICTAL. However, there were confounding factors that may have contributed to the occurrence of seizures in these bipolar patients. Discontinuation of LAMICTAL should involve a step-wise reduction of dose over at least 2 weeks (approximately 50% per week) unless safety concerns require a more rapid withdrawal [see Warnings and Precautions (5.9)]. --the PI sheet

You know they actually give a damn, or at least want to cover their asses against the inevitable class action lawsuits, when they spell out a “discontinuation strategy.” More manufacturers need to follow GSK’s lead on this.

Crazymeds’ Suggestions

Our rule of thumb: decrease the dosage at the same rate you increased it. Otherwise as slowly as you can. 25–50mg a day every week until you’re down to 100mg a day, then 25mg a day per week. If you have to stop due to a really serious side effect, such as SJS (Stevens-Johnson Syndrome, a.k.a. The Rash or the Lamictal rash), then you and your doctor (or whoever is in the emergency room) will have to figure out a faster schedule.

This is where the starter kit has a huge advantage - you know exactly what your titration schedule was.

Discontinuation Symptoms

Due to its antidepressant effect, Lamictal may have a discontinuation syndrome, similar to that of SSRIs and SNRIs.

Like all AEDs, if you discontinue too rapidly you might start having seizures. Even if you’re not epileptic.

Notes, Tips, etc. About Discontinuing Lamictal

If you need to rapidly discontinue Lamictal your new best friend will be a benzodiazepine, preferably Klonopin (clonazepam) or Ativan (lorazepam), but good old Valium (diazepam) will work if nothing else is available. If you’re discontinuing because of a rash, your other new best friend will be Benadryl (diphenhydramine HCl).



Pros, Cons, and Interesting Information

Even though they want more information than the patient information literature provides, consumers also want a very high-level synopsis. A synthesis of the prescribing information, the literature, and consumer experience provides the pros and cons of using Lamictal (lamotrigine) for its approved indications and clinically-significant or otherwise common off-label uses.

Pros

  • The best medication on the market to deal with bipolar depression without the risks of mania or lowering the seizure threshold associated with antidepressants.
  • Just the best med on the market for bipolar depression.
  • Weight neutral.
  • One of the safest meds to use during pregnancy.
  • The side effects suck less than the other meds with FDA approval for maintenance treatment of bipolar disorder.

Cons

  • That “without the risk of mania” is only after you’re taking enough, usually 200mg a day. You might get a little too happy the first couple of weeks. Or too irritable, anxious and otherwise unpleasant to be around.
  • Easily affected by drug-drug interactions, in spite of being metabolized in such a way that only a few meds should affect it.
  • Can mess with your skin in all sorts of ways that could cause you to panic and stop taking it when you don’t have to.
  • Which is really a shame, because Lamictal is one of those drugs where if you stop taking it then try it again later it may or may not work as well the next time.

When doing their own research about a medication, the educated consumer, and perhaps medical students and healthcare professionals may find interesting pieces of information that are rarely discussed in a prescriber-patient setting. Such information may be rarely discussed because it is trivial, but many people tend to remember interesting, albeit trivial information about something along with other information associated with it. There may be something here to get a patient to remember a more important point about a medication. The other side of that mnemonic coin is what a medication is best known for, something a drug-naïve consumer might not know. While prescribers don’t always assume their patients are aware of a drug’s trait that is “common knowledge,” consumers who do some research don’t want to feel like idiots. They want to know something that isn’t misinformation. Prescribers can always couch questions about well-known traits in forms like “You’re aware that Panacea can cause significant giddiness, right?”

Interesting Things Doctors Rarely Tell Their Patients

Bonus irony: Given all the dermatological problems Lamictal causes, it’s possible someone would need prescriptions for both Lamictal and Lamisil.
  • Lamictal was originally developed as a folate antagonist, like how many antimalarial drugs work, except targeting your brain. It was supposed to be a side effect in a pill to test if folate had anything to do with seizures. The consensus is “probably not,” but at least with Lamictal we know why you need to take a folic acid supplement.

What Lamictal (lamotrigine) is Best Known for

  • The Rash. Everyone is scared shitless of The Lamictal Rash.
  • Totally kicking the assess of Symbyax, Seroquel, and whichever atypical antipsychotic has the latest FDA approval / big pharma ad campaign to treat bipolar depression. Despite the fact that Lamictal doesn’t have FDA approval to treat bipolar depression.
  • Working as an antidepressant at 25mg a day for some people.
  • Lamictal is notorious for causing multiday hangovers if you drink the least amount of alcohol.
    • Drinking while taking AEDs isn’t that great an idea, but unless you enjoy waking up with an epic hangover, don’t even drink half a lite beer if you’re taking Lamictal.

Noted Traits & Effects

Being the only AED affected by estrogen-based birth control (BCP) while only rarely affecting BCP.



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Adverse Events

A review of prescribing information, the literature, and consumer experiences. One thing this review has found is no matter which neurological/psychiatric drug someone takes, one or more of these adverse events will happen and usually be gone, or at least will diminish to the point where they are barely noticed, within a week or two.

  • Headache
  • Drowsiness/fatigue - even when taking stimulants in some circumstances.
  • Insomnia, instead of or alternating with the drowsiness.
  • Nausea
  • Assorted other minor GI complaints (constipation, diarrhea, etc.)
  • Generally feeling spacey / out of it
    • Which can all add up to the ever-helpful ”flu-like symptoms” listed as an adverse event on the PI sheet of practically every medication on the planet used to treat almost any condition humans and other animals could have.
  • Will affect dreams. There is no way of telling if that will be good or bad, the extent of the change, let alone if this side effect is permanent or temporary.

Potential side effects are often used as a rationalization to not take a medication, and that is a valid reason why prescribers don’t like their patients looking up medications on The Internet. It’s a delicate balancing act between providing too little or too much information about side effects. What may be contrary to popular belief, reports of side effects from consumers on sites run by either medical professionals or consumers themselves are generally not too far outside what is published in the literature after a drug has been on the market.

Common Adverse Events

In case you missed it on the previous page: women taking Lamictal (lamotrigine) are more likely to be affected by side effects than men.
  • Rashes
  • Insomnia
  • Itchy skin
  • Lethargy
  • Photosensitivity
  • Memory and cognitive problems
  • Contact dermatitis
  • Headaches that are sometimes really bad
  • Did I mention rashes and assorted other skin problems? Actually the rash thing is blown way out of proportion. Lamictal does tend to exacerbate any existing dermatological problems you already have and/or might make you susceptible to ones you didn’t have before. Such as:
    • Fungal infections like athlete’s foot/ring worm/jock itch6
    • Dry, itchy skin
    • Acne
    • Poison oak & poison ivy may bother you more - and it can really suck if you wind up reacting to them after touching a pet when you previously never knew there was any poison oak or ivy in the area

But serious, life-threatening rashes aren’t really common.

The Lamictal headache is usually temporary, and if you do get it, the odds are it will be when you change the dosage. The lethargy, insomnia, and stupids usually diminish in severity and may even go away. Because Lamictal is a folate antagonist7 you should talk to your doctor about taking 400–1,000mcg of folic acid a day. That will probably help with the lethargy and might help with the stupids.
If you get stupid, Do.Not.Panic. The stupids tend to be dose-dependent. No need to throw the whole bottle in the toilet8, as not taking one 25mg tablet will probably make you smart again. Assuming you were smart before Lamictal9. (You do know to get your psychiatrist’s/neurologist’s/prescriber’s okay before changing your dosage, don’t you? I thought so.)

Uncommon Adverse Events

  • A specific type of insomnia where you’re really sleepy but just can’t fall asleep. It’s different from not being able to sleep due to racing thoughts and other symptoms of hypomania10.
  • But don’t be surprised if do get symptoms of hypomania, even if you’re not bipolar.
  • Muscle aches, everything from just a twinge in your neck or back to full-body aches that make you wonder if you were possessed by some spirit that made you participate in a triathalon the day before and have no memory of it. Similar to what you get with Topamax.11
  • Dry mouth
  • OCD-like symptoms
  • Hair thinning / loss

Potentially Dangerous Adverse Events

Here is how you determine if a Lamictal-caused rash is dangerous:

  • If you have a rash that itches AND a fever you need to call and talk to your doctor immediately.
  • If you have an itchy rash AND you can see it spreading OR your fever is above 100F/38C you need to see your doctor right now. If your doctor isn’t available you need to get to an emergency room right now.
  • If you have a rash that doesn’t meet the above criteria (it itches but you don’t have a fever, or you have a bit of a fever but the rash doesn’t itch) you need to discuss it with your doctor as soon as possible. As we, GSK, and everyone else with a clude repeatedly tell you

Although benign rashes are also caused by LAMICTAL, it is not possible to predict reliably which rashes will prove to be serious or life threatening. Accordingly, LAMICTAL should ordinarily be discontinued at the first sign of rash, unless the rash is clearly not drug related. Discontinuation of treatment may not prevent a rash from becoming life threatening or permanently disabling or disfiguring. --Lamictal US PI sheet

While the majority of rashes and other dermatological problems caused by Lamictal are benign, albeit annoying, actual Stevens-Johnson Syndrome (SJS) - better known as The Rash or the Lamictal rash - and toxic epidermal necrolysis (TEN) are potentially life threatening.

There’s more detail about The Lamictal Rash on the black box and other warnings page.

Never underestimate the value of gallows humor when confronted with a condition that comes with the dual stigmata of having a mental illness or other neurological disorder and treating it with a medication that everyone from family members to movie stars and other misinformed celebrities say is worse than the condition itself. It’s not for all consumers, but those who have been using the Internet most of their lives generally appreciate it.

Freaky Rare Side Effects:

Now that is a recipe for the weirdest phone sex service ever.

Ways to counter / minimize / mitigate / deal with some side effects

  • Normal insomnia can often be fixed by taking most or all of your Lamictal in the morning.
  • Insomnia of any kind tends to be dosage-dependent, but decreasing the dosage isn’t always an option.
  • As with all AEDs, the same applies to various cognitive effects. A 25mg reduction (or even increase) in your dosage might make all the difference in the world as far as clarity of thought, word finding, and similar problems are concerned.
  • As with Topamax, daily stretching helps most people with muscle aches.
  • Many people swear by biotin- and selenium-based products to deal with hair thinning or hair loss. Shampoos, supplements, or both. The studies and anecdotal evidence are all contradictory. Just be careful with any selenium supplements you take, because it’s really easy to take too much. One of the symptoms of selenium toxicity: hair loss.
  • Various skin problems can be treated with everyday lotions & ointments. Be careful with these as well, because…
  • Many of the benign rashes and assorted dermatological issues are caused or exacerbated by ingredients in soaps, shampoos, detergents, etc. You may have to change some, or all of the products you use. If you recently changed something and then had a rash, get rid of whatever is new and go back to whatever it was you used to use. Or do without.

Have I gone on about the rash long enough yet? Thanks to Lamictal kids with Lennox-Gastaut are able to live marginally normal lives, and skads of people with bipolar 2 and otherwise treatment-resistant forms of depressive disorders are able to function. Oh, and many of those depressed people started to feel a hell of a lot better in a couple of days. But when you ask teh intergoogles about it, you’d think the stuff was made out of poison ivy fermented in wet diapers.

Lamictal is not alone in this rash thing.

All AEDs can make you more susceptible to skin irritants and dermatological problems. Lamictal is just the worst when it comes to that. Contact dermatitis, eczema, and similar problems can be caused by any number of things. Some of the most likely sources are:

  • Soap
  • Cosmetics
  • Household cleaners
  • Fabric softener and dryer sheets
  • Clothing - either the fabrics or something the clothes came in contact with
  • Latex
  • Facial creams
  • Sunscreen

Because they contain:

  • Fragrances. Used in cosmetics, insecticides, antiseptics, soaps, perfumes, and dental products.
  • Formaldehyde. Used as a preservative in fiberboard (that new office smell), paints, medications, household cleaners, cosmetic products, and fabric finishes.
  • Quaternium 15. A preservative in self-tanners, shampoo, nail polish, sunscreen.
  • Neomycin sulfate. An antibiotic in first aid creams and ointments.
  • Several metals, especially cobalt chloride, nickel, and gold. While mostly used in the obvious places, cobalt chloride is also used in hair dyes and antiperspirants.
  • Poison ivy, poison oak, poison sumac, and other natural things that are outdoors and always trying to kill us.

Sometimes it really is Lamictal’s fault

In spite of all of the above, Lamictal, and, to a lesser extent, other AEDs, will give you a rash for no good reason. OK, there’s probably a good reason - Lamictal is a folate antagonist, and by messing with the absorption and distribution of folate through your system, your skin becomes susceptible to various dermatological problems. More often than not these rashes are not serious, but you can’t just ignore them. Once again - a rash means trouble if:

  • It itches
  • You have a fever

If you have one of two of the above symptoms along with the rash, call your doctor ASAP. If you have both you need to see a doctor (shrink, PCP, anyone with a license to practice real medicine on humans) immediately. If you are unable to see a doctor, have a high fever, and/or the rash is spreading quickly, call your doctor and head to the ER immediately with a bottle of Lamictal and an empty bottle12 of all the other meds you take, crazy or otherwise, so there are no mistakes about your cocktail.

How to avoid rash decisions

Eliminating common skin irritants from your life may prevent you from needlessly discontinuing Lamictal - or any other drug for that matter - due to something like contact dermatitis.
For even more information about household products, skin allergies and irritants see:

As has been recently pointed out to me, there has been all of one report of Lamictal-induced perfume sensitivity out of over 35,000 users. They’ve also found 99 reports on social media and the FDA’s side effect reports.13 Asking their patients about new perfumes and scented products when they present a rash, and warning them about how Lamictal (and other meds) can exacerbate or cause sensitivity to various products, has been recommended to prescribers. Also in this not-free article.

Names, Availability, Brand vs. Generic Issues, Forms

Consumers not only travel, they often live in other countries for extended periods. Thus they need to know if the medications they take are available in those countries, what trade names are used, and if the less-expensive generic version is available.

Available as Lamictal in these countries

* Australia
  • Canada
  • EU
  • Ireland
  • Israel
  • Japan
  • Lebanon
  • New Zealand
  • Russia
  • UK

Other trade name(s) for Lamictal used in these countries

  • Amitral: Algeria
  • Crisomet: Spain
  • Labileno: Spain
  • Loxol: Iraq, Jordon, Saudi Arabia
  • لاميكتال: Algeria, Egypt, Saudi Arabia - “Lamictal” transliterated into Arabic
  • لامكتال: Jordon
  • أميترال: Algeria
  • لوكسول: Saudi Arabia
  • 라믹탈: Korea
  • Ламиктал: Russia - “Lamictal” transliterated into Cyrillic
  • למיקטל: Israel - “Lamictal” transliterated into Hebrew

Generic Name and Availability

US Generic name/INN:lamotrigine
US Generic available?Yes

lamotrigine is available in these countries14

  • Australia
  • Canada
  • Egypt
  • EU
  • Ireland
  • Israel
  • New Zealand
  • Peru
  • South Africa
  • UK
  • Yemen

Branded Generic Names15 & Transcribed or Transliterated INN/Generic Name16

  • Lamictin: South Africa
  • Lamitor: South Africa
  • lamotrigin: Austria, Czech Republic, Denmark, Finland, Germany, Norway, Sweden, Switzerland
  • lamótrigín: Iceland
  • lamotrigina: Argentina, Brazil, Chile, Italy, Mexico, Peru, Portugal, Spain, and probably everywhere else they speak Italian, Portuguese, or Spanish
  • Lamotrine: Egypt, Yemen
  • למוג’ין: Israel - “lamotrigine” transliterated into Hebrew


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Not all generic medications are created equal. Consumers have noted differences in the quality of medications produced by different manufacturers. See the article on on the differences between brand and generic medications for more information.

Specific generics with complaints, or preferred generics manufacturers

  • Teva’s lamotrigine is universally acknowledged to be as good as, if not better than, GSK’s branded Lamictal. How can it be better? In addition to being indistinguishable from brand once you swallow it:
    • Teva’s pill is easier to split. Although if you’re having problems with generic meds messing with you, you shouldn’t be splitting any pills in the first place.
    • Their split pills hold together better than GSK’s, as well as all the others.
    • Split or not they don’t dissolve in your mouth as if they were unflavored orally disintegrating tablets like GSK’s and every other generic.
    • The diamond shape makes them easier to swallow than GSK’s weird-ass shield shape - although not as easy as the round pills most of the other generics are supplied as.
  • Many people have found Dr. Reddy’s lamotrigine to be little better than a placebo.
  • Reports are mixed regarding Mylan’s and Taro’s lamotrigine. I’ve found more complaints about Mylan’s. For me Taro is acceptable, but barely.
  • We also have two general topics on generic Lamictal. One in the Lamictal forum, and one in the forum on brand vs. generic medications, where there are also topics on specific manufacturers’ lamotrigine.

Generics with independently-tested bioequivalence

How Supplied

Available/Supplied As

  • Difficult-to-swallow, shield-shaped, immediate-release Lamictal:
    • 25 mg tablets
    • 100 mg tablets
    • 150 mg tablets
    • 200 mg tablets
    • Generic lamotrigine comes in various shapes (see pictures below)
  • Lamictal ODT:
    • 25 mg orally disintegrating tablets
    • 50 mg orally disintegrating tablets
    • 100 mg orally disintegrating tablets
    • 200 mg orally disintegrating tablets
  • Lamictal Chewable:
    • 2 mg chewable dispersible tablets
    • 5 mg chewable dispersible tablets
    • 25 mg chewable dispersible tablets
  • Lamictal-XR (round with a white center):
    • 25 mg extended-release tablets
    • 100 mg extended-release tablets
    • 150 mg extended-release tablets
    • 200 mg extended-release tablets
    • 300 mg extended-release tablets
Lamictal and lamotrigine 25 mg tablets
Left: Brand Lamictal 25 mg Tablets. Right: Teva Generic Lamotrigine 25 mg Tablets.
Generic lamotrigine 100 mg tablets
Left: Teva Generic Lamotrigine 100 mg Tablets. Center: Taro Generic Lamotrigine 100 mg Tablets. Right: Dr. Reddy Generic Lamotrigine 100 mg Tablets.

Lamictal also comes in liquid capsules, but those aren’t available in the US.

Shelf Life

2mg chewable & ODTs: 2 years. Tablets and other chewable & ODTs: 3 years.

Rate this article

If you feel like it, you may rate this article on a scale of 0 (worst) to 5 (best). The more value-judgments the better, even if you can criticize each only once.

Please rate Lamictal (lamotrigine): a review of the literature and consumer experience.

5 stars Rates 4.8 out of 5 from 12 value judgments.
Vote Distribution: 0 – 0 – 0 – 0 – 3 – 9


Click here for Part 2: Warnings, clinical pharmacology, interactions, additional comments and consumer experiences




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References

  1. Hughes, Shannon, and David Cohen. “Can online consumers contribute to drug knowledge? A mixed-methods comparison of consumer-generated and professionally controlled psychotropic medication information on the internet.” Journal of medical Internet research 13.3 (2011).
  2. Faught, Edward. “Topiramate in the treatment of partial and generalized epilepsy.” Neuropsychiatric disease and treatment 3.6 (2007): 811-821.
  3. Lamictal’s Full US Prescribing Information
  4. Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 ISBN:978-0323040587
  5. Article I, Section 8 of the US Constitution
  6. Greenstone Pharmaceuticals’ Product List. Greenstone LLC Last accessed 04 July 2014
  7. History of Pfizer and Warner-Lambert; 2000 to Present. Pfizer.com Last accessed 04 July 2014
  8. Marson, Anthony G., Asya M. Al-Kharusi, Muna Alwaidh, Richard Appleton, Gus A. Baker, David W. Chadwick, Celia Cramp et al. “The SANAD study of effectiveness of carbamazepine, gabapentin, lamotrigine, oxcarbazepine, or topiramate for treatment of partial epilepsy: an unblinded randomised controlled trial.” The Lancet 369, no. 9566 (2007): 1000-1015.
  9. Marson, Anthony G., Asya M. Al-Kharusi, Muna Alwaidh, Richard Appleton, Gus A. Baker, David W. Chadwick, Celia Cramp et al. “The SANAD study of effectiveness of valproate, lamotrigine, or topiramate for generalised and unclassifiable epilepsy: an unblinded randomised controlled trial.” The Lancet 369, no. 9566 (2007): 1016-1026.
  10. Arif, Hiba, Richard Buchsbaum, Joanna Pierro, Michael Whalen, Jessica Sims, Stanley R. Resor, Carl W. Bazil, and Lawrence J. Hirsch. “Comparative effectiveness of 10 antiepileptic drugs in older adults with epilepsy.” Archives of neurology 67, no. 4 (2010): 408-415.
  11. Fuller, Matthew A. “Medical Management of Bipolar Disorder: A Pharmacologic Perspective.” ANNALS OF CLINICAL PSYCHIATRY (2011): 23-48.
  12. Skonicki, J. J., and J. K. Warnock. “Drug eruptions: Is your patient’s rash dangerous or benign?.” Current Psychiatry 7.3 (2008): 42.
  13. “Lamictal (lamotrigine) and Lamisil (terbinafine hydrochloride) ‘Dear Healthcare Professional Letter.’” U.S. Food and Drug Administration website. 2000 Last Updated: 08/03/2009. Last Accessed: 17 July 2014.
  14. Stahl, Stephen M. Stahl’s Essential Psychopharmacology: Neuroscientific Basis and Practical Applications (Essential Psychopharmacology Series) Third edition Cambridge University Press 2008. ISBN:978–0521673761
  15. Julien, Robert M. Ph.D, Claire D. Advokat, and Joseph Comaty Primer of Drug Action: A comprehensive guide to the actions, uses, and side effects of psychoactive drugs 12th edition Worth Publishers 2011. ISBN:978–1429233439
  16. Stahl, Stephen M. The Prescriber’s Guide (Essential Psychopharmacology Series) Third edition Cambridge University Press 2009. ISBN:978–0521743990
  17. Virani, Adil S., K. Bezchlibnyk-Butler, and J. Jeffries Clinical Handbook of Psychotropic Drugs 18th edition Hogrefe & Huber Publishers 2009. ISBN:978–0889373693
  18. Silberstein, Stephen D., Michael J. Marmura Essential Neuropharmacology: The Prescriber’s Guide Cambridge University Press 2010. ISBN:978–0521136723
  19. Stein, Dan, Bernard Lerer, Stephen Stahl Evidence-based Psychopharmacology Cambridge University Press 2005. ISBN:978–0521531887
  20. Clinical Neurology for Psychiatrists David Myland Kaufman MD © 2001 W.B. Saunders Company. An imprint of Elsevier
  21. Antiepileptic Drugs René H. Levy, Richard H. Mattson, Brian S. Meldrum, Emilio Perucca © 2003
  22. Mosby’s Drug Consult 2007 (Generic Prescription Physician’s Reference Book Series) © 2007 ISBN:978-0323040587 An imprint of Elsevier.
  23. PDR: Physicians’ Desk Reference 2010 64th edition
  24. Hikma Pharmaceuticals Central Nervous System Portfolio Last Accessed 04 July 2014
  25. ChemSpider’s lamotrigine page Last Accessed 04 July 2014
  26. New Zealand Medicines and Medical Devices Safety Authority Medicine Data Sheet for Lamictal Dispersible/Chewable Tablets Last Accessed 04 July 2014
  27. electronic Medicines Compendium Summary of Product Characteristics for Lamictal Tablets SPC Last updated 08 April 2014. Last Accessed 04 July 2014

Studies and trials referenced:

  • The Standard and New Antiepileptic Drugs (SANAD) ISRC Trial number 38354748

1 Before Cymbalta (duloxetine) was approved as an antidepressant in the US it was already approved in the EU, but only for stress urinary incontinence and sold under the trade name Yentreve. Duloxetine is now sold in the EU as an antidepressant under the trade name Cymbalta.
A better known, if slightly different example is bupropion. According to the 2007 edition of Mosby's Drug Consult, and my highly-skilled Google-fu, in the US, Canada and Singapore you can get both Wellbutrin (bupropion) as an antidepressant or as Zyban (bupropion) to stop smoking. In Korea, Thailand and most of South America (but not Brazil) you can get bupropion (under various trade names) only as an antidepressant. In Brazil, the EU & UK, Israel, India, Australia and New Zealand it's only available as Zyban to help you stop smoking.

2 If you can call something I made up an adage.

3 Some meaning only those for adults. As I keep writing, Crazymeds is primarily a site for adults.

4 Because there's no way a reputable drug company like GSK is going to give your doctor the means to prescribe Lamictal off-label by starting you on Lamictal when you're not taking any other medication for bipolar disorder or epilepsy. That would be illegal, and GSK could be fined the equivalent of a couple days', or even one or two weeks' worth of profits.

5 That was the case the last time I had access to a bunch of starter packs.

6 They're all tinea and the only differences in the species are where they happen to be on your body. The only difference in the various treatments with the same active ingredients are marketing and price. Compare all the ringworm, athlete's foot, and jock itch products at a large chain drugstore and ringworm treatments usually cost more than jock itch treatments that cost more than athlete's foot treatments with the same active ingredients and mostly the same inactive ingredients. You can apply the athlete's foot ointment wherever you want. Vaginal cream has the same active ingredient as many tinea treatments - clotrimazole - but at a far less concentration, so it would be more expensive to use.

7 In case you didn't read it on the previous page: Lamictal was originally developed as a folate antagonist, just like antimalarial medications, in order to determine if folate had anything to do with seizures. At least we know for sure why Lamictal messes with folate. It's not any good for malaria.

8 That's only a metaphor. Never flush any meds, crazy or otherwise, down the toilet. Donate them to a free clinic or take them to a pharmacy for proper disposal.

9 You're probably smarter than the average nutjob if you're reading this site. Crazier, too.

10 This may be due to Lamictal's usefulness in treating nocturnal frontal lobe seizures, especially the uncommon autosomal dominant nocturnal frontal lobe epilepsy.

11 As Topamax and Lamictal are both approved to treat Lennox-Gastaut syndrome, and are particularly good at dealing with atonic, or drop seizures, my guess is this side effect is a result of that. Sort of like how allergies are immune responses to germs that no longer exist, in that you get this side effect if you don't have atonic/drop seizures. So the next time you feel like bitching about this side effect, Google Lennox-Gastaut syndrome imagine what your life would be like if your kid had that. Unless you're in pain most of the day, day after day, shut up and take your meds.

12 Empty, because those bottles don't always come back. Or someone won't like what is in one of them and will be doing you a great favor by emptying it out. Yes, that has happened to me.

13 I have no idea what qualifies as "social media".

14 Generic availability isn't fully harmonized in the EU. Sometimes a drug is available everywhere as a generic, sometimes it's available only in a few member states. We'll provide the best information we have.

15 The term "branded generic" has three meanings:
1) A generic drug produced by a generics manufacturer that is a wholly-owned subsidiary of the company that makes the branded version. E.g. Greenstone Pharmaceuticals makes gabapentin, and they are owned by Pfizer, who also own Parke-Davis, the makers of Neurontin.
2) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Teva's Budeprion), but otherwise has the same active ingredient as the original branded version (Wellbutrin).
3) A branded generic is also a generic drug given a 'brand' name by the manufacturer (e.g. Sanofi-Aventis' Aplenzin, which is bupropion hydrobromide) and uses a salt of the active ingredient that is different from the original branded version and other generics (Wellbutrin, Budeprion and all the others are bupropion hydrochloride). We aren't sure if that really makes a difference or not. The FDA says they're the same thing. As usual, the data are contradictory, but most evidence indicates that the FDA is right and the differences are negligible.
For our purposes a "branded generic name" refers to the second and third definitions. We'll note if any preferred generics are manufactured by the pioneering company's subsidiary.

16 In some countries the INN / generic name is transcribed into a local phonetic equivalent. In Spanish it's often so close as to be redundant (e.g. topiramato vs. topiramate). In Finnish it's close to being a different drug (e.g. escitalopram vs. essitalopraami). I can understand the need to transliterate the INN / generic name into another alphabet (topiramate becomes топирамат in Russian), but giving a med a different generic name using the Latin alphabet just makes it difficult to find.


If you have any questions not answered here, please see the Crazymeds Lamictal discussion board. We welcome criticisms of the articles, notifications of bad links, site problems, consumer experiences with medications, etc. I’m not always able to write back. Hence I never answer questions about meds via e-mail that are answered by this or other articles. Especially if they have been repeatedly asked on the forum. That’s why we write these damn things. Questions about which meds are best for your condition should also be asked on the forum; because this is a free site, so the price of admission is making things easier for somebody else searching for the same answer. We don’t deal with children on the forum or in private because after doing this for ten years I don’t have the emotional stamina to deal with kids who have brain cooties. How to contact Crazymeds. — Jerod Poore, CME, Publisher Crazymeds (crazymeds.net)


Last modified on Thursday, 17 July, 2014 at 18:11:53 by JerodPoorePage Author Date created Monday July 14, 2014, at 15:16:23
“Lamictal (lamotrigine): a Review for the Educated Consumer.” by Jerod Poore is copyright © 2014 Jerod Poore Published online 2014/07/14
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with Microdata: <span itemprop='citation'>Poore, Jerod. "Lamictal (lamotrigine)." <em>Crazymeds (crazymeds.net)</em>.(2014).</span>
Linked:<a href="http://scholar.google.com/citations?user=5rkux7sAAAAJ&hl=en&oi=sra">Poore, Jerod</a>. <a href='https://crazymeds.net/pmwiki/pmwiki.php/Meds/LamictalAReview'>"Lamictal (lamotrigine): a Review for the Educated Consumer."</a>. <a href="https://crazymeds.net/pmwiki/pmwiki.php/Main/HomePage"> <em>Crazymeds (crazymeds.net)</em></a>. (2014).
with Microdata:<span itemprop='citation'> <a href="http://scholar.google.com/citations?user=5rkux7sAAAAJ&hl=en&oi=sra">Poore, Jerod</a>. <a href='https://crazymeds.net/pmwiki/pmwiki.php/Meds/LamictalAReview'>"Lamictal (lamotrigine): a Review for the Educated Consumer."</a>. <a href="https://crazymeds.net/pmwiki/pmwiki.php/Main/HomePage"> <em>Crazymeds (crazymeds.net)</em></a>. (2014).</span>

Lamictal, and all other drug names on this page and used throughout the site, are a trademark of someone else. Lamictal’s PI Sheet will probably have the name of the manufacturer and trademark owner (they’re not always the same company) at or near the very bottom. Or ask Google who the owner is. The way pharmaceutical companies buy each other and swap products like Monopoly™ real estate, the ownership of the trademark may have changed without my noticing. It may of changed hands by the time you finished reading this article.




Page design and explanatory material by Jerod Poore, copyright © 2003 - 2015. All rights reserved.
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Almost all of the material on this site is by Jerod Poore and is copyright © 2003, 2004, 2005, 2006, 2007, 2008, 2009, 2010, 2011, 2012, 2013, 2014, and 2015 Jerod Poore. Except, of course, the PI sheets - those are the property of the drug companies who developed the drugs the sheets are about - and any documents that are written by other people which may be posted to this site will remain the property of the original authors. You cannot reproduce this page or any other material on this site outside of the boundaries of fair use copying without the express permission of the copyright holder. That’s usually me, so just ask first. That means if want to print out a few pages to take to your doctor, therapist, counselor, support group, non-understanding family members or something like that - then that’s OK to just do. Go for it! Please. As long as you include this copyright notice and something along the lines of following disclaimer, I’m usually cool with it.



All rights reserved. No warranty is expressed or implied in this information. Consult one or more doctors and/or pharmacists before taking, or changing how you take any neurological and/or psychiatric medication. Your mileage may vary. What happened to us won’t necessarily happen to you. If you still have questions about a medication or condition that were not answered on any of the pages you read, please ask them on Crazy Talk: the Crazymeds Forum.
The information on Crazymeds pertains to and is intended for adults. While some information about children and adolescents is occasionally presented (e.g. US FDA approvals), pediatric-specific data such as dosages, side effects, off-label applications, etc. are rarely included in the articles on drugs or discussed on the forum. If you are looking for information regarding meds for children you’ll have to go somewhere else. Plus we are big pottymouths and talk about S-E-X a lot.
Know your sources!
Nobody on this site is a doctor, a therapist, or a pharmacist. We don’t portray them either here or on TV. Only doctors can diagnose and treat an illness. While it’s not as bad as it used to be, some doctors still get pissed off by patients who know too much about medications, so tread lightly when and where appropriate. Diagnosing yourself from a website is like defending yourself in court, you suddenly have a fool for a doctor. Don’t be a cyberchondriac, thinking you have every disease you see a website about, or that you’ll get every side effect from every medication1. Self-prescribing is as dangerous as buying meds from fraudulent online pharmacies that promise you medications without prescriptions.
All information on this site has been obtained from the medications’ product information / summary of product characteristic (PI/SPC) sheets and/or medication guides - which is all you get from sites like WebMD, RxList, NAMBLA NAMI, etc., the sources that are referenced throughout the site, our personal experience and the experiences family, friends, and what people have reported on various reputable sites all over teh intergoogles. As such the information presented here is not intended as a substitute for real medical advice from your real doctor, just a compliment to it. You should never, ever, replace what a real doctor tells you with something from a website on the Internet. The farthest you should ever take it is getting a second opinion from another real doctor. Educate yourself - always read the PI/SPC sheet or medication guide/patient information leaflet (PIL) that comes with your medications and never ever throw them away. OK, you can throw away duplicate copies, but keep at least one, as that’s your proof of purchase of having taken a med in case a doctor doubts your medical history. Plus they take up less space than a bottle, although keeping one inside of a pill bottle is even better.
Crazymeds is not responsible for the content of sites we provide links to. We like them, or they’re paid advertisements, or they’re something else we think you should read to help you make an informed decision about a particular med. Sometimes they’re more than one of those things. But what’s on those sites is their business, not ours.
Very little information about visitors to this site is collected or saved. From time to time I look at search terms used and which pages they bring up in an effort to make the information I present more relevant. And the country of origin, just because I’m geeky like that. That’s about it. Depending on how you feel about Schrodinger, our privacy policy should either assuage or exacerbate your paranoia.
Crazymeds is optimized for ridiculously large screens and browsers that don’t block ads. I use Firefox and Chrome, running under Windows 72. On a computer that sits on top of my desk. With a 23 inch monitor. Hey, at least you can make the text larger or smaller by clicking on the + or - buttons in the upper right hand corner. If you have Java enabled. Like 99% of the websites on the planet, Crazymeds is hosted on domain running an open source operating system with a variety of open source applications, including the software used to display what you’ve been reading. As such Crazymeds is not responsible for whatever weird shit your browser does or does not do when you read this site3.
No neurologists, psychiatrists, therapists or pharmacists were harmed in the production of this website. Use only as directed. Void where prohibited. Contains nuts. Certain restrictions may apply. All data are subject to availability. Not available on all mobile devices, in the 12 Galaxies Guiltied to a Zegnatronic Rocket Society, or in all dimensions of reality. Hail Xenu!

‘Everything is true, nothing is permitted.’ - Jerod Poore


1 While there are plenty of books to help you with hypochondria, for some reason there’s not much in the way of websites. Then again, staying off of the Internet is a large part of curing/managing the disorder.

2 Remember kids, Microsloth operating systems are like TOS Star Trek movies with in that every other one sucks way, way more. With TOS Star Trek movies you don’t want to bother watching the odd-numbered ones. With Microsloth OS you don’t want to buy and install the even-numbered ones. Anyone who remembers ME and Vista knows what I mean.

3 Have I mentioned how open source operating systems for commercial applications is one of the dumbest ideas in the history of dumb ideas?* I don’t even need my big-ass rant any more. Heartbleed has made my case for me. And that’s just the one that got all the media attention. The very nature of an open source operating system makes security as much of an illusion as anonymity on teh Intergoogles. Before you flip out too much: the domain Crazymeds is hosted on uses a version of SSL that is not affected by the Heartbleed bug. That’s one of the many reasons why I pay a lot of money and keep this site on Lunarpages.

* Yes, I know I’m using open source browsers. I also test the site using the now-defunct IE and Safari browsers. Their popularity - and superiority - killed IE and Safari, so that’s why I rely on the open source browsers. It’s like brand vs. generic meds. Sometimes the generic is better than the brand.

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