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Take lamotrigine only as directed by your doctor to help your condition as much as possible and to decrease the chance of unwanted effects. Do not take more or less of this medicine, and do not take it more or less often than your doctor ordered.

Lamotrigine may be taken with or without food or on a full or empty stomach. However, if your doctor tells you to take the medicine a certain way, take it exactly as directed.

If you are taking the chewable/dispersible tablets : These tablets may be swallowed whole, chewed and swallowed, or dispersed in a small amount of liquid and swallowed. If the tablets are chewed, they should be followed with a small amount of water or diluted fruit juice to aid in swallowing. If tablets are to be dispersed: Place tablets in enough water or diluted fruit juice to cover the tablets (about a teaspoonful), wait until the tablets are completely dispersed (about 1 minute), then swirl the solution and swallow it immediately.

Dosing

The dose of lamotrigine will be different for different patients, and depends on what other medicines you are taking. Follow your doctor's orders or the directions on the label. The following information includes only the average doses of lamotrigine. If your dose is different, do not change it unless your doctor tells you to do so.

The number of tablets that you take depends on the strength of the medicine.

• For oral dosage forms (tablets):
  • For treatment of epilepsy:
    • Adults not taking valproic acid (e.g., Depakote) but taking carbamazepine (e.g., Tegretol), phenobarbital (e.g., Luminal), phenytoin (e.g., Dilantin), and/or primidone (e.g., Mysoline) At first, 50 milligrams (mg) of lamotrigine once a day for two weeks, then a total of 100 mg divided into two smaller doses each day for two weeks. After this, your doctor may increase the dose gradually if needed. However, the dose is usually not more than 500 mg a day.
    • Adults taking valproic acid (e.g., Depakote) and also taking carbamazepine (e.g., Tegretol), phenobarbital (e.g., Luminal), phenytoin (e.g., Dilantin), and/or primidone (e.g., Mysoline) At first, 25 mg of lamotrigine once every other day for two weeks, then 25 mg once every day for two weeks. After this, your doctor may increase the dose gradually if needed. However, the dose is usually not more than 400 mg a day.
    • Children 2 to 12 years of age:
      • Children not taking valproic acid (e.g., Depakote) but taking carbamazepine (e.g., Tegretol), phenobarbital (e.g., Luminal), phenytoin (e.g., Dilantin), and/or primidone (e.g., Mysoline): At first, 0.6 milligrams (mg) per kilogram (kg) (0.27 mg per pound) of body weight of lamotrigine once a day for two weeks, then 1.2 mg/kg (0.54 mg per pound) of body weight divided into two smaller doses each day for two weeks. After this, your doctor may increase the dose gradually if needed. However, the dose is usually not more than 400 mg a day.
      • Children taking valproic acid (e.g., Depakote) and also taking carbamazepine (e.g., Tegretol), phenobarbital (e.g., Luminal), phenytoin (e.g., Dilantin), and/or primidone (e.g., Mysoline): At first, 0.15 mg per kg (0.07 mg per pound) of body weight of lamotrigine given in one dose or two smaller doses each day for two weeks, then 0.3 mg/kg (0.136 mg per pound) of body weight given in one dose or two smaller doses each day for two weeks. After this, your doctor may increase the dose gradually if needed. However, the dose is usually not more than 200 mg a day.
    • Children older than 12 years of age usually receive the adult dose.

Missed dose

If you miss a dose of this medicine, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular dosing schedule. Do not double doses.

Storage

To store this medicine:

• Keep out of the reach of children.
• Store away from heat and direct light.
• Do not store in the bathroom, near the kitchen sink, or in other damp places. Heat or moisture may cause the medicine to break down.
• Do not keep outdated medicine or medicine no longer needed. Be sure that any discarded medicine is out of the reach of children.

In deciding to use a medicine, the risks of taking the medicine must be weighed against the good it will do. This is a decision you and your doctor will make. For lamotrigine, the following should be considered:

Allergies Tell your doctor if you have ever had any unusual or allergic reaction to lamotrigine. Also tell your health care professional if you are allergic to any other substances, such as foods, preservatives, or dyes.

Pregnancy Lamotrigine has not been studied in pregnant women. However, if you might become pregnant while taking lamotrigine, your doctor may want you to take folic acid supplements. Studies in animals have shown that lamotrigine, even when given to the mother in doses smaller than the largest human dose, may cause some offspring to die. Before taking this medicine, make sure your doctor knows if you are pregnant or if you may become pregnant.

Breast-feeding Lamotrigine passes into breast milk. However, it is not known whether this medicine causes problems in nursing babies. Mothers who are taking lamotrigine and who wish to breast-feed should discuss this with their doctor.

Children Skin rashes may be more likely to occur in children younger than 16 years of age than in adults. Some of these rashes may be serious and life-threatening. It is especially important that you discuss with the child's doctor the good that this medicine may do as well as the risks of using it.

Older adults Lamotrigine is removed from the body more slowly in elderly people than in younger people. Higher blood levels of the medicine may occur, which may increase the chance of unwanted effects. Your doctor may give you a different lamotrigine dose than a younger person would receive.

Other medicines Although certain medicines should not be used together at all, in other cases two different medicines may be used together even if an interaction might occur. In these cases, your doctor may want to change the dose, or other precautions may be necessary. When you are taking lamotrigine, it is especially important that your health care professional know if you are taking any of the following:

• Carbamazepine (e.g., Tegretol) or
• Phenobarbital (e.g., Luminal) or
• Phenytoin (e.g., Dilantin) or
• Primidone (e.g., Mysoline) or
• Valproic acid (e.g., Depakote) These medicines may increase or decrease the blood levels of lamotrigine, which may increase the chance of unwanted effects; your doctor may need to change the dose of either these medicines or lamotrigine

• Heart disease It is not clear if patients who have problems with heart rhythms will have increased problems while taking lamotrigine

• Kidney disease or
• Liver disease Higher blood levels of lamotrigine may occur, which may increase the chance of unwanted effects; your doctor may need to change your dose

• Thalassemia Lamotrigine may cause your body to stop making or to make fewer red blood cells