From the Research
Lamictal (lamotrigine) for bipolar disorder is typically started at a low dose of 25 mg daily and gradually increased to minimize the risk of serious rash, with a target maintenance dose of 100-200 mg daily for bipolar depression, as supported by the most recent and highest quality study 1. The standard titration involves increasing by 25 mg every 1-2 weeks to 50 mg daily, then to 100 mg daily. Some patients may require up to 400 mg daily, though doses above 200 mg generally provide limited additional benefit. For bipolar maintenance therapy to prevent mood episodes, the typical range is 100-400 mg daily, with most patients maintained on 200 mg daily. Key points to consider when prescribing lamotrigine include:
- Slow titration is essential for safety, as rapid dose increases significantly raise the risk of Stevens-Johnson syndrome and other serious skin reactions.
- Patients taking valproate will need lower lamotrigine doses, while those on carbamazepine may need higher doses due to drug interactions.
- Lamotrigine is particularly effective for preventing depressive episodes in bipolar disorder and has fewer metabolic side effects than many other mood stabilizers, making it a valuable option for long-term maintenance treatment, as noted in 2. The efficacy and safety of lamotrigine in the treatment of bipolar disorder have been extensively studied, with low- to moderate-certainty evidence suggesting that lamotrigine may be superior to placebo as a treatment modality for bipolar disorder, and similar in efficacy to lithium, but with better tolerability, as shown in 1.