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Lamotrigine

Lamotrigine

Lamotrigine is an FDA-approved drug and is prescribed either as a standalone treatment or in combination with other medications to manage and prevent seizures. It is also used in adults to reduce the severe mood swings related to bipolar disorder. Classified as an anticonvulsant or antiepileptic drug, Lamotrigine is available in four oral forms: tablets, extended-release tablets, chewable tablets, and orally disintegrating tablets that dissolve on the tongue. It functions by reinstating the brain’s equilibrium of specific natural substances. However, Lamotrigine is not approved for children under the age of 2 due to a heightened risk of side effects, such as infections. So, if you want to buy Lamotrigine to prevent seizures, you need to get a prescription from your doctor. 

Product Overview

Lamotrigine is an FDA-approved medication primarily used to manage and prevent seizures and to reduce severe mood swings associated with bipolar disorder. It belongs to a class of drugs known as anticonvulsants or AEDs (antiepileptic drugs). Available in various oral forms, including standard tablets, chewable tablets, extended-release tablets, and orally disintegrating tablets, Lamotrigine offers flexibility in administration according to patient needs and preferences. This medication functions by restoring the balance of particular natural substances in the brain, which helps to control neurological and psychological symptoms. 

Despite its effectiveness, Lamotrigine is not recommended for children under the age of 2 due to an increased risk of side effects like infections, highlighting the need for careful consideration in pediatric use. Lamotrigine’s uses extend to treating partial seizures, primary generalized tonic-clonic seizures, and Lennox-Gastaut syndrome in the realm of epilepsy. This medication is also approved for the maintenance treatment of bipolar I disorder, helping to prevent mood swings. Off-label uses of Lamotrigine include treatment for acute bipolar depression, fibromyalgia, schizophrenia, and unipolar depression, though these uses require careful medical supervision. 

The dosage of Lamotrigine must be carefully adjusted to minimize side effects. The approach typically involves a slow increase in dosage to avoid any severe adverse reactions, such as skin rashes or hypersensitivity. For instance, when used in patients on enzyme-inducing AEDs but not on valproic acid, the starting dose is generally low and gradually increased. A similar cautious approach is taken with patients on valproic acid, with even slower dosage increments. Patients must adhere strictly to the prescribed dosing schedule to optimize effectiveness and minimize risks. It’s crucial for those taking Lamotrigine to discuss their full medical history with a healthcare provider, as the drug’s interactions with other medications can significantly impact its efficacy and safety.

Uses of Lamotrigine

Approved Uses of Lamotrigine to Treat:

  • Partial seizures
  • Primary generalized tonic-clonic seizures
  • Maintenance treatment for bipolar I disorder
  • Lennox-Gastaut syndrome

Off-Label Uses of Lamotrigine to Treat:

  • Acute bipolar depression
  • Fibromyalgia
  • Schizophrenia
  • Unipolar depression

How to Use Lamotrigine?

Dosage

This medication is available in 4 forms and has the following strengths:

Tablets

  • 25mg
  • 100mg
  • 150mg
  • 200mg

Tablets, Chewable

  • 2mg
  • 5mg
  • 25mg

Tablet, Oral-disintegrating

  • 25mg
  • 50mg
  • 100mg
  • 200mg

 Extended-Release Tablets

  • 25mg
  • 50mg
  • 100 mg
  • 200 mg
  • 250 mg
  • 300 mg

Recommended Dosage for Different Patients

Seizure Disorder Treatment with Lamotrigine:

  1. Patients on enzyme-inducing antiepileptic drugs (AEDs) but not on valproic acid:
  • Start with 50 mg orally once daily for the first two weeks.
  • For the following two weeks, increase to 100 mg/day, divided into two doses every 12 hours.
  • From week 5 onwards, the dosage may be incremented by 100 mg/day every 1-2 weeks, aiming for a maintenance dose between 300-500 mg/day, divided every 12 hours.
  • For extended-release (XR) Lamotrigine, start with 50 mg orally daily for the first 2 weeks, then 100 mg daily for weeks 3 and 4. Increase by 100 mg weekly up to 400 mg daily by week 7. Maintenance starts at week 8, with 400-600 mg daily.
  1. Patients on valproic acid:
  • Begin with 25 mg orally every other day for two weeks, followed by 25 mg daily for the next two weeks.
  • From week 5, increase the dosage by 25-50 mg/day every 1-2 weeks, aiming for a maintenance dose of 100-400 mg/day, which can be taken once daily or divided every 12 hours.
  • For Lamotrigine XR, the regimen starts with 25 mg every other day for two weeks and then 25 mg daily for the next two weeks. It increases to 50 mg daily at week 5, then 100 mg at week 6, and 150 mg at week 7, reaching a maintenance dose of 200-250 mg daily.
  1. Patients not on enzyme-inducing AEDs or valproic acid:
  • Initiate with 25 mg orally once daily for two weeks, followed by 50 mg of Lamotrigine daily for another two weeks.
  • Post four weeks, increase the dose by 50 mg/day every 1-2 weeks to a maintenance dose of 225-375 mg/day, divided every 12 hours.
  • For XR formulation, start with 25 mg daily for two weeks, followed by 50 mg daily for the next two weeks. Increase to 100 mg daily by week 5, 150 mg by week 6, and 200 mg by week 7, with a maintenance dose of 300-400 mg daily.

Partial-Onset Seizures (Conversion to Monotherapy):

  1. Patients taking valproic acid transitioning to immediate-release Lamotrigine:
  • Initiate Lamotrigine at a dose of 200 mg/day.
  • Concurrently, reduce valproic acid by 500 mg/day weekly until reaching 500 mg/day, maintain for one week, then decrease to 250 mg/day while increasing Lamotrigine to 300 mg/day. Eventually, discontinue valproic acid and adjust Lamotrigine to a maintenance dose of 500 mg/day.
  1. Conversion to XR Lamotrigine:
  • Start with 25 mg every other day for the first two weeks, then 25 mg daily for the next two weeks. Increase to 50 mg daily by week 5, progress to 100 mg daily by week 6, and reach a maintenance dose of 200-300 mg daily by week 23, alongside phasing out valproic acid over a 5-7 week period.

Bipolar Disorder Treatment with Lamotrigine:

  1. Monotherapy or without enzyme inducers/valproic acid:
  • Start with 25 mg orally once daily for two weeks, then increase to 50 mg daily for another two weeks, and 100 mg daily for one more week. Doubling the dose weekly until reaching a maintenance dose of 200 mg/day.
  1. Patients with AEDs but no valproic acid:
  • Initiate at 50 mg daily for two weeks, then 100 mg per day divided every 12 hours for another two weeks. Increment by 100 mg weekly to a divided dose of 400 mg/day.
  1. With valproic acid:
  • Start with 25 mg of Lamotrigine every other day for 4 weeks. Then, double the dose weekly until a maintenance dose of 100 mg/day is achieved.

Dosing Modifications for Lamotrigine:

  1. Renal impairment: Exercise caution. Consider dose reduction in cases of significant renal impairment.
  2. Hepatic impairment: Data are limited, but the manufacturer suggests decreasing the dose by 25% (moderate to severe without ascites) or by 50% (severe with ascites).

[Note: These recommendations for Lamotrigine doses may vary from person to person. Discuss it with your doctor or pharmacist, and they’ll customize your Lamotrigine dosage accordingly.]

How to Take Lamotrigine?

General Administration Advice

  • Medication can be taken with or without food.
  • Always use whole tablets for dosing; if the exact prescribed dose can’t be achieved with whole tablets, round down to the nearest whole tablet.

For Tablets (Immediate-Release and Extended-Release)

  • Swallow tablets whole; do not chew, crush, or split them.
  • If there is difficulty swallowing tablets whole, consider using a different formulation suited for easier ingestion.

For Orally Disintegrating Tablets (ODT)

  • Place the tablet on the tongue.
  • Allow the tablet to move around the mouth, where it will rapidly disintegrate.
  • Swallow the disintegrated material with or without water. There is no need to take additional water unless preferred.

[Note: Your doctor or healthcare giver will decide the right amount of Lamotrigine for you based on your condition, following guidelines & studies on the drug. They’ll adjust it as needed over time.]

How Does Lamotrigine Work?

Lamotrigine is part of a category known as anticonvulsants or antiepileptic drugs (AEDs). Medications within this category share a similar mechanism of action and are generally prescribed for comparable health issues.

In individuals with epilepsy, Lamotrigine helps in moderating the levels of glutamate, a chemical in the brain. By controlling glutamate, it keeps the brain’s neurons from becoming overly active, thus potentially reducing the frequency of seizures.

For those with bipolar disorder, Lamotrigine is believed to influence specific brain receptors that regulate mood. This interaction can help stabilize mood fluctuations and reduce the occurrence of mood episodes.

Important Safety Information

Lamotrigine Side Effects

Common side effects of Lamotrigine may include:

  • Anxiety
  • Tremor
  • Rash
  • Fever
  • Dry mouth
  • Sore throat
  • Stuffy nose
  • Back pain
  • Trouble sleeping
  • Trouble with balance and coordination
  • Stomach pain
  • Diarrhea
  • Nausea and vomiting
  • Blurred vision
  • Double vision
  • Headache
  • Drowsiness
  • Dizziness

Serious side effects of Lamotrigine may include:

Stevens-Johnson syndrome and toxic epidermal necrolysis symptoms:

  • Painful sores in or around the mouth and eyes
  • Blistering or peeling skin
  • Rash
  • Hives

Mood and Behavioral Changes

  • Symptoms can include:
    • Trouble sleeping
    • New or worsening depression or anxiety
    • Panic attacks and restlessness
    • Thoughts or attempts of self-harm
    • Excessive increase in activity and talking
    • Crankiness that worsens
    • Increased anger or aggression
    • Dangerous impulses or behavior

Aseptic Meningitis

  • Symptoms can include:
    • Drowsiness
    • Headache
    • Fever
    • Muscle pains
    • Stiff neck
    • Nausea and vomiting
    • Increased sensitivity to light
    • Confusion
    • Chills

Multi-Organ Hypersensitivity (DRESS)

  • Symptoms can include:
    • Rash
    • Fever
    • Swollen lymph glands
    • Frequent infections
    • Severe muscle pain
    • Unusual bruising or bleeding
    • Swelling of the face, eyes, lips, or tongue
    • Yellowing of the skin or the whites of the eyes
    • Weakness or tiredness

Low Blood Cell Counts

  • Symptoms can include:
    • Tiredness
    • Persistent or frequent infections
    • Weakness
    • Nosebleeds
    • Unexplained bruising
    • Bleeding from the gums

Hemophagocytic Lymphohistiocytosis (HLH)

  • Symptoms can include:
    • High fever (typically over 101°F)
    • Rash
    • Enlarged lymph nodes

Irregular Heart Rhythm

  • Symptoms can include:
    • Fast, slow, or pounding heartbeat
    • Shortness of breath
    • Chest pain
    • Feeling lightheaded

[Note: This list may not cover all side effects of Lamotrigine. Always consult with your healthcare giver or a doctor for medical advice about side effects.]

Lamotrigine Warnings

Lamotrigine Boxed Warning 

This medication carries the most severe type of alert issued by the FDA (Food and Drug Administration), known as a black box warning. These warnings are designed to inform both healthcare professionals & patients about potential risks associated with a drug that could be severe or even fatal.

Life-Threatening Rash: Although rare, these serious rashes are a significant concern and can develop at any point during treatment. However, they are most likely to occur within the first two to eight weeks after beginning the medication. It is crucial that patients adhere strictly to the dosing instructions or guidance provided by a doctor and avoid increasing the dose more rapidly than recommended.

Other Warnings

Life-Threatening Immune System Reaction: This medication may trigger a critical and life-threatening immune system response known as hemophagocytic lymphohistiocytosis (HLH). This condition leads to widespread inflammation throughout the body and, if not addressed swiftly, can be fatal. HLH is characterized by several symptoms, including fever, a rash, & swelling of the lymph nodes, liver, and spleen. Additional signs include a reduction in blood cell counts, impaired liver function, and issues with blood clotting. Immediate medical intervention is crucial to manage this severe reaction.

Organ Damage Warning: This drug has the potential to cause significant harm to specific organs, particularly the liver and blood cells. The damage can be severe, impacting the function of these organs and overall health.

Suicide Warning: There is a risk that this drug might induce thoughts of self-harm or suicide. If you experience any abrupt shifts in mood, behavior, thoughts, or feelings, it is important to contact your healthcare provider immediately.

Heart Disease Warning: For individuals with a history of rapid heartbeats, heart failure, or other cardiac conditions, taking this medication is advised against. Lamotrigine, the active ingredient, can lead to abnormal heart rhythms, which might result in sudden death. Symptoms to watch for include unusually fast, slow, or pounding heartbeats, shortness of breath, chest pain, and feelings of lightheadedness. If any of these symptoms occur, you should seek medical attention quickly.

Lamotrigine Precautions

For Individuals with Liver Disease: This medication is metabolized by your liver. If your liver function is compromised, the drug may not be processed efficiently, resulting in higher concentrations remaining in your body for a longer duration. This increased presence can elevate the risk of experiencing more severe side effects. Consequently, your healthcare provider may adjust your dosage to a lower level to mitigate these risks.

For Individuals with Kidney Disease: The elimination of this drug from your system is primarily through your kidneys. Impaired kidney function means that the drug may not be cleared effectively, leading to an accumulation in your body. This accumulation can heighten the likelihood of adverse effects. Depending on the seriousness of your kidney issues, your doctor might reduce the dosage of this drug. In cases of severe kidney dysfunction, there may be a need to discontinue the drug or refrain from prescribing it altogether.

For Individuals with Heart Disease: This drug can potentially cause rapid heartbeat and might lead to sudden death. If you have any history of serious heart conditions such as second or third-degree heart block, heart failure, or other cardiac irregularities, using this medication is strongly discouraged. The risks associated with its effects on heart rhythm make it unsuitable for individuals with these heart conditions.

Other Important Precautions 

For Pregnant Women: This medication is classified as a Category C pregnancy drug. This classification implies two key points:

  1. Animal studies have shown various adverse effects on the fetus when the drug is administered to the mother.
  2. Human studies are insufficient to conclusively determine the impact of the drug on the fetus during pregnancy.

If you are pregnant or considering pregnancy, it is crucial to discuss the use of this drug with your healthcare provider. The decision to use this medication should be made only if the potential advantages to the mother outweigh the possible risks to the fetus. If you become pregnant while taking this drug, inform your doctor immediately.

For Women Who Are Breastfeeding: This drug can be transferred through breast milk and may lead to serious side effects in a breastfeeding infant. If you are nursing, you can inform your doctor. It’s important to discuss the safest way to feed your child while you are being treated with this medication. If you choose to breastfeed while on this drug, monitor your child for any adverse symptoms such as difficulty breathing, episodes of apnea (temporary cessation of breathing), excessive sleepiness, or poor feeding. Contact your child’s pediatrician immediately if any of these symptoms develop.

For Children: The safety and effectiveness of the immediate-release version of this drug for treating seizures in children under the age of 2 years have not been established. Similarly, the safety and efficacy of the extended-release version are not confirmed for children under the age of 13 years. Furthermore, it is not determined whether the immediate-release version of this medication is safe & effective for treating bipolar disorder in children under the age of 18 years.

Lamotrigine Missed Dose

If you forget to take your dose and remember it later, you should take it as soon as possible. However, if it’s only a few hours until your next scheduled dose, you can skip the missed dose & continue with your regular Lamotrigine dosing schedule by taking the next dose on time. It is important not to double up on your doses in an attempt to make up for a missed one. Taking two doses at once can lead to serious and potentially dangerous side effects.

[Note: If you have missed a dose of Lamotrigine and are not sure about when to take the next dose, immediately consult your doctor or pharmacist.]

Lamotrigine Overdose

If you take more of the medication than prescribed, you could end up with hazardous concentrations of the drug in your system. In the event that you suspect an overdose, it’s critical to act quickly. If you experience severe symptoms as a result of the overdose, such as extreme dizziness, breathing difficulties, or unconsciousness, it’s essential to seek emergency medical attention immediately. Call 911 or head to the closest emergency department without delay.

[Note: If you consumed more than the recommended Lamotrigine dose, get medical help quickly or call the Poison Help line at 1-800-222-1222.]

Lamotrigine Storage

  • Store oral, chewable, and extended-release Lamotrigine tablets at room temperature 77°F (25°C).
  • Store orally disintegrating Lamotrigine tablets at a temperature between 68°F & 77°F (20°C-25°C).
  • Keep away from light.
  • Avoid storing in moist or damp areas, such as bathrooms.
  • Keep the Lamotrigine tablets in their original container with the lid tightly closed.
  • Store the Lamotrigine out of reach of children & pets.
  • Do not use expired medication; check the expiration date regularly.
  • If traveling, keep the medication in a secure, climate-controlled environment.

[Note: Discuss with your doctor about the proper disposal of any unused Lamotrigine tablets and any questions you may have regarding their storage.]

Lamotrigine Interactions

Lamotrigine, an oral medication, has the potential to interact with various other substances, including prescribed medications, over-the-counter vitamins, and herbal products. An interaction occurs when another substance influences the effectiveness of the drug, which can be detrimental or inhibit the drug’s intended benefits. Common Interactions with Lamotrigine are:

Anti-Seizure Medications: Some anti-seizure medications can decrease Lamotrigine’s concentration in your bloodstream, potentially reducing its efficacy. Notable examples include:

  • Phenobarbital
  • Carbamazepine
  • Phenytoin
  • Primidone

Heart Arrhythmia Medication: Dofetilide, a drug used to manage heart arrhythmias, when taken with Lamotrigine, may see an increased level in the body. This elevation has the potential to induce life-threatening heart arrhythmias.

HIV Medications: Certain medications designed to combat HIV can lower the levels of Lamotrigine, thereby impacting its therapeutic effectiveness. Drugs known for this interaction include:

  • Atazanavir/Ritonavir
  • Lopinavir/Ritonavir

Oral Contraceptives: Using Lamotrigine in conjunction with combination oral contraceptives (those containing both estrogen and progesterone) may result in reduced Lamotrigine levels, affecting its effectiveness.

Tuberculosis Drug: Rifampin, used in the treatment of tuberculosis, can also decrease the levels of Lamotrigine when used concurrently, which may impair its efficacy.

[Note: This isn’t a complete list, & there could be other drugs that interact with Lamotrigine. Tell your doctor about any medication prescription, over-the-counter medicines, & herbal products you’re taking.]

Lamotrigine Alternatives

[Note: Your doctor will decide what’s best for you. Don’t use any of these alternative medications of Lamotrigine without consulting your doctor. Taking them by yourself may cause various serious side effects.] 

Frequently Asked Questions

Is Lamotrigine an antidepressant?

Lamotrigine is not classified as an antidepressant, but it is utilized in the management of Bipolar Disorder in adults aged 18 and older. Specifically, Lamotrigine serves as a maintenance treatment designed to stabilize mood fluctuations. Its role is to extend the period before the recurrence of mood episodes in patients who have previously been stabilized with standard treatments for acute mood disturbances. This medication helps to delay the onset of both manic and depressive phases, thereby contributing to overall mood stability in affected individuals.

Does Lamotrigine have mental side effects?

Lamotrigine, a medication commonly prescribed, can lead to several psychological side effects. Some individuals taking this drug might experience an increase in agitation and irritability. Additionally, it could lead to abnormal behaviors that are not typical for the individual prior to medication use. There is also a risk that some individuals might develop suicidal thoughts and tendencies. Furthermore, it might cause an increase in depressive symptoms for some users. These side effects vary widely among different people and should be closely monitored.

Does Lamotrigine cause memory loss?

Lamotrigine generally has minimal impact on memory. However, there are instances where word recognition might be difficult. Memory loss is a highly uncommon side effect associated with Lamotrigine use. Additionally, older adults using mood stabilizers, including Lamotrigine, may experience memory impairment, necessitating vigilant observation and monitoring.

Can Lamotrigine work immediately?

Lamotrigine, a medication used primarily to control seizures and manage mood disorders, does not typically provide immediate effects. The full benefits of Lamotrigine are generally realized after about six weeks of treatment. This gradual onset is necessary because the medication’s dosage must be carefully and slowly increased over time. This cautious approach helps to lower the risk of potential side effects. During the initial period of treatment, individuals may continue to experience seizures or mood instability until the therapeutic levels of the drug are reached.

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