Medically reviewed by:
Dr. Elena Vasquez, MD, FAAN, FAES
Board-Certified Neurologist & Epileptologist
Last updated: November 18, 2025
Black Box Warning: Serious, life-threatening skin reactions (SJS/TEN, DRESS) have occurred. Risk highest in first 2–8 weeks and with rapid titration or concomitant valproate. Discontinue at first sign of rash unless clearly unrelated.
What Is Lamotrigine (Lamictal) Used For?
Lamotrigine is a phenyltriazine-class antiepileptic drug that stabilizes neuronal membranes by inhibiting voltage-sensitive sodium channels and reducing glutamate release. It is FDA-approved for:
- Adjunctive therapy or monotherapy of focal (partial-onset) seizures in patients ≥2 years
- Primary generalized tonic-clonic seizures ≥2 years
- Seizures associated with Lennox-Gastaut syndrome ≥2 years
- Conversion to monotherapy in adults with focal seizures
- Maintenance treatment of bipolar I disorder to delay time to mood episodes (depression, mania, hypomania, mixed episodes)
EMA and international guidelines also approve lamotrigine for prevention of depressive episodes in bipolar disorder (strongest evidence among all mood stabilizers for depression prevention).
2025 Comparison Table: Lamotrigine vs Other Antiepileptics & Mood Stabilizers
| Parameter | Lamotrigine | Valproate | Carbamazepine | Levetiracetam | Lithium | Oxcarbazepine |
|---|---|---|---|---|---|---|
| Seizure types | Broad (focal + generalized) | Broad | Focal only | Broad | None | Focal only |
| Bipolar maintenance | Best for depression prevention | Strong (mania) | Moderate | No | Gold standard | Limited |
| Serious rash risk | 0.08–0.3% (titration-dependent) | None | Low | None | None | Low |
| Weight change | Neutral / loss | ↑↑ | ↑ | Neutral | ↑ | Neutral |
| Pregnancy risk | Low (cleft ~1:1000) | High (10–11%) | High | Low | Ebstein | Moderate |
| Cognitive side effects | Minimal | Moderate | Moderate | Irritability | Minimal | Moderate |
| Titration needed | Yes (5–11 weeks) | No | Yes | No | Yes | Yes |
Dosing & Titration Schedules (Must Follow Exactly)
Epilepsy – Adults (not taking valproate or enzyme inducers)
| Weeks 1–2 | 25 mg once daily |
| Weeks 3–4 | 50 mg once daily |
| Week 5 onward | Increase by 50 mg/week |
| Maintenance | 225–375 mg/day (divided BID) |
| Max | 400 mg/day |
Bipolar Disorder – Adults (no interacting drugs)
| Weeks 1–2 | 25 mg daily |
| Weeks 3–4 | 50 mg daily |
| Week 5 | 100 mg daily |
| Week 6+ | 200 mg daily (target) |
| With valproate | Halve all doses |
| With carbamazepine/phenytoin | Double all doses |
Children 2–12 years – Epilepsy
- Without valproate: start 0.6 mg/kg/day → target 5–15 mg/kg/day
- With valproate: start 0.15 mg/kg/day → target 1–5 mg/kg/day
Side Effects Profile (2025 Data)
- Common (>10%): dizziness, headache, diplopia, ataxia, nausea, somnolence
- Serious rash: 0.08% adults, 0.3% children (with proper titration)
- Weight neutral – often slight weight loss
- No significant cognitive impairment
- Sexual side effects extremely rare
Pregnancy & Breastfeeding
Category C. Largest prospective registry data (2024) shows major malformation rate ~2.5% (background 2–3%). Lowest teratogenicity among mood stabilizers. Recommended first-line in women planning pregnancy.
Official Sources
- FDA Label 2024: Lamictal Prescribing Information
- North American AED Pregnancy Registry 2024: PubMed – Lamotrigine Safety in Pregnancy
Verified Patient Reviews
"Sarah P., 34, bipolar I – 200 mg for 5 years. No more cycling. Lost 12 lbs. Life is stable now." ★★★★★
"rian L., 41, epilepsy – Seizure-free 7 years on 350 mg/day. No side effects after titration." ★★★★★
"mily R., 29, planning pregnancy – Switched from valproate. Healthy baby girl, no mood episodes." ★★★★★
"ames K., 52 – Mild dizziness first month, then perfect. Best AED I’ve used." ★★★★★
"ophia M., 37 – 150 mg + therapy = no hospitalizations in 4 years." ★★★★★
"ark T., 45 – Took 9 weeks to reach 200 mg but worth every day. Finally normal life." ★★★★★
Frequently Asked Questions (FAQ)
Full mood stabilization effect usually 6–12 weeks at 200 mg/day.
No – risk of seizure or mood episode rebound. Taper over ≥2 weeks.
Yes – FDA rates all approved generics AB bioequivalent to Lamictal.
