Information last reviewed: May 2026 — for educational purposes only.
What Is Lamictal (Lamotrigine)?
Lamotrigine, sold as Lamictal, is a phenyltriazine antiepileptic and mood stabiliser. It inhibits voltage-gated sodium and calcium channels, stabilising neuronal membranes and reducing glutamate release. Unlike many AEDs, it has a favourable cognitive side-effect profile, is weight-neutral, and is highly effective for bipolar I depression — an area where many mood stabilisers fall short. Critically, lamotrigine must be titrated very slowly to minimise the risk of serious skin reactions. When combined with valproate (which doubles lamotrigine levels via glucuronidation inhibition), the dose must be halved and titration slowed further. Available as standard tablets, chewable dispersible tablets, and XR tablets.
Prescription (Rx) Status
Lamotrigine is prescription-only. Key safety concern: Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN) — life-threatening skin reactions more frequent with rapid titration, concomitant valproate, and in children. Patients should be counselled to stop immediately and seek emergency care for any rash during titration. FDA black-box warning for serious skin reactions.
Uses of Lamotrigine
FDA-approved: adjunct and monotherapy for partial seizures (adults and children ≥2 years), primary generalised tonic-clonic seizures, generalised seizures of Lennox-Gastaut syndrome, and maintenance therapy in bipolar I disorder (delaying mood episode recurrence). Particularly valued for control of bipolar depression. Off-label: borderline personality disorder mood component and neuropathic pain.
Tablet Strengths
Standard tablets: 25 mg, 50 mg, 100 mg, 150 mg, and 200 mg. Chewable tablets: 2 mg, 5 mg, and 25 mg. XR tablets: 25–300 mg. Bipolar or epilepsy monotherapy starting dose: 25 mg once daily for 2 weeks, then 50 mg/day for 2 weeks, titrating to 200–400 mg/day. With valproate: start 25 mg every other day. With enzyme-inducing AEDs: faster titration to higher target doses permitted.
Price
Generic lamotrigine is inexpensive (~$15–$35/month). Lamictal XR generics are also available.
Frequently Asked Questions
Q: What should I do if I develop a rash on lamotrigine?
A: Stop the medication and contact your doctor immediately. Any rash occurring during titration is a medical emergency until proven otherwise, as SJS/TEN can progress rapidly. Do not restart without specialist consultation.
Q: Why is lamotrigine dose titrated so slowly?
A: Slow titration substantially reduces the risk of serious skin reactions (SJS/TEN). Rushing the dose most significantly raises this risk, especially in the first 8 weeks of treatment.
Q: Is lamotrigine a good mood stabiliser?
A: Lamotrigine is particularly effective for bipolar depression and long-term mood stabilisation. It is less effective for acute mania. Careful management of drug interactions (especially with valproate and oral contraceptives) is essential.
Disclaimer: This page is for informational purposes only and does not constitute medical advice. Lamotrigine requires a valid prescription. Always consult a qualified healthcare professional. See our full disclaimer.