What is Lamotrigine?
Lamotrigine is a prescription drug that belongs to a class of drugs known as anticonvulsants or antiepileptic drugs (AEDs) [1]. It has multiple formulations, all of which can be taken orally, either as immediate-release oral tablets, extended-release tablets, chewable or orally disintegrating tablets [2]. The formulation of lamotrigine you take should have minimal impact on its efficacy for treating your underlying symptoms, but immediate-release tablets may be essential if you wish to have immediate symptom relief, such as in acute seizures [2].
Uses of Lamotrigine
Lamotrigine, a medication commonly prescribed for various neurological and mental health conditions, is primarily used to treat seizures in people with seizures and Lennox Gestault Syndrome [3, 4, 2]. It is commonly combined with anti-epileptic drugs, such as phenobarbital, ritonavir, vaproic acid, phenytoin or carbamazepine.
Other off-label uses include:
- binge eating disorder
- as a mood stabilizer in bipolar disorder
- panic disorder
- basilar migraine with aura [5]
- trigeminal neuralgia [5]
The lamotrigine's mechanism of action is not entirely understood clear. It is known that lamotrigine acts on voltage-gated sodium channels that regulate neural activation. This can regulate the overal activation and synchrony of the brain. Because of this, lamotrigine is a critical regulator of seizure-like activity and neuropathic pain. This is because these disorders occur when changes to the excitation-inhibition balance in the spinal cord and/or brain arise.
Lamotrigine Withdrawal Symptoms
Lamotrigine can cause withdrawal symptoms, especially if you abruptly stop taking the medication or significantly reduce the dose of lamotrigine you are taking. These symptoms can vary among individuals and can be quite distressing.
First of all, let us discuss a regular dose of lamotrigine. The usual dose can vary from 25mg to 200mg, depending on the health condition for which you have been prescribed lamotrigine and the form in which you take the medication. Therefore a change in dose will depend on the initial lamotrigine dose you were taking.
Generally, the United Kingdom medical guidelines indicate that lamotrigine can be stopped immediately if used for bipolar disorder, but the dose should first be reduced before stopping if you are taking lamotrigine for epilepsy [6].
With this in mind, let us discuss common symptoms of lamotrigine withdrawal.
- Anxiety. Lamotrigine is used to treat panic disorders, which indicates that it can reduce anxiety and panic attacks. Therefore stopping lamotrigine abruptly can increase anxiety, even if you were not taking lamotrigine for panic attacks. Anxiety symptoms after lamotrigine withdrawal can manifest as a feeling of unease, such as worry or fear, which can be mild or severe [7].
- Mood swings are another side effect that you may notice after stopping lamotrigine suddenly. This is particularly likely if you were taking lamotrigine for bipolar disorder [7].
- Increased irritability and agitation can also be symptoms of lamotrigine withdrawal. This can make a person easily annoyed and short-tempered [7].
- Psychomotor inhibition, characterized by slowing physical and psychological activity, can also occur after stopping lamotrigine. One may notice this as reduced physical movements and slower thought processes [8].
- Tremor or hyperkinesia, an unintentional, rhythmic muscle movement involving to-and-fro movements (oscillations) of one or more body parts is also [8].
- Excessive sweating, particularly of the hands, can also be a symptom of lamotrigine withdrawal [8].
It's important to note that these symptoms can occur even in patients on stable medication doses and can occur as an end-of-dose phenomenon [7]. Note that these are different from the common side effects of lamotrigine, which also include a severe skin rash or short-term increased suicidal thoughts. You should seek medical supervision if you notice these symptoms while taking or after stopping lamotrigine.
Lamotrigine Withdrawal Timeline
When a patient discontinues the use of lamotrigine or goes a longer period of time without a dose, they may experience withdrawal symptoms, as discussed above. Early symptoms of withdrawal can occur as soon as 1-2 hours before your next dose, even if you have not discontinued lamotrigine. These early withdrawal symptoms should resolve once you take your next lamotrigine dose [7].
However, if you have discontinued lamotrigine, the timeline of withdrawal symptoms is less well-defined. In a single epilepsy patient case study from 2002, psychomotor symptoms of lamotrigine withdrawal resolved by themselves after a couple of days without taking lamotrigine [8].
It's important to note that other medications can influence the clearance of lamotrigine from the body. For instance, when lamotrigine was administered with acetaminophen, its half-life decreased by 15% [9], eliminating lamotrigine more quickly.
However, the exact timeline for lamotrigine withdrawal can vary greatly depending on individual factors such as the patient's metabolism, the duration of treatment, the dosage, and whether other medications are being taken concurrently, as demonstrated by combining lamotrigine and acetaminophen. Therefore, it's crucial to consult a healthcare provider when discontinuing lamotrigine.