From the Research
Lamictal (lamotrigine) for bipolar disorder should be initiated at a low dose of 25 mg daily for the first two weeks, then increased gradually to minimize the risk of serious rash, with a typical maintenance dose of 200 mg daily. This recommendation is based on the most recent and highest quality study available, which suggests that lamotrigine is effective in the maintenance treatment of bipolar disorder, with a possible advantage over placebo in preventing recurrence of manic symptoms and clinical worsening 1. The study also found that lamotrigine is generally well-tolerated, with a similar incidence of adverse effects compared to placebo, and a lower incidence of adverse effects compared to lithium.
The dosage of lamotrigine should be titrated over a 6-week period to minimize the incidence of serious rash, with adjustments to the initial and target dosages required if coadministered with valproate semisodium or carbamazepine 2, 3. The medication should be taken consistently, either once or twice daily depending on the prescription, and patients should immediately report any rash, which could indicate a serious reaction.
Some key points to consider when prescribing lamotrigine for bipolar disorder include:
- The medication works primarily for bipolar depression rather than mania, by stabilizing mood through modulation of sodium channels and glutamate release in the brain 2, 3
- Lamotrigine should be taken under the supervision of a psychiatrist who can monitor effectiveness and adjust dosing as needed 1
- The medication is generally well-tolerated, but can cause adverse effects such as headache, nausea, infection, and insomnia 2, 3
- The incidence of serious rash with lamotrigine treatment is low, but can be minimized by gradual dose titration and close monitoring 2, 3
Overall, the evidence suggests that lamotrigine is a effective and well-tolerated treatment option for bipolar disorder, particularly for patients with bipolar depression. However, it is essential to follow the recommended dosage and titration schedule, and to monitor patients closely for adverse effects and treatment response.