From the Research
The maximum daily dose of Lamictal (lamotrigine) is typically 500 mg per day for adults with epilepsy and 400 mg daily for bipolar disorder. This recommendation is based on the most recent and highest quality study available, which suggests that lamotrigine is effective in the prevention of recurrence and relapse, particularly depressive relapse, in stabilized patients with bipolar disorder 1.
Key Considerations
- The dose of lamotrigine may vary based on the condition being treated and individual factors, such as liver or kidney impairment.
- It is crucial to start with a low dose (usually 25 mg) and gradually increase over several weeks to reduce the risk of serious skin rashes, including Stevens-Johnson syndrome.
- The titration schedule is especially important when taking Lamictal with other medications - particularly valproate, which requires slower titration and lower target doses.
- Divided doses (twice daily) are often recommended for higher amounts.
- Patients with liver or kidney impairment may require lower maximum doses.
- Never suddenly stop taking Lamictal as this can trigger seizures, and always take it exactly as prescribed.
Potential Side Effects
- Side effects at higher doses may include dizziness, headache, double vision, and coordination problems.
- The optimal dose is the lowest effective amount that controls symptoms with minimal side effects.
- Other studies have reported that lamotrigine is well tolerated and has a favorable pharmacokinetic profile 2, 3, but it is essential to monitor patients for potential side effects and adjust the dose accordingly.
Clinical Evidence
- The evidence for the efficacy of lamotrigine in bipolar disorder is stronger for the prevention of depressive episodes than for manic episodes 1, 3.
- Lamotrigine has also been used in the treatment of epilepsy, with doses commonly ranging up to 500 mg daily 2.
- While there is some evidence to suggest that lamotrigine may have psychotogenic effects in rare cases 4, this is not a common side effect and should not preclude its use in patients who may benefit from it.