Lamotrigine must always be started slowly and increased gradually. Starting at a full dose or increasing too quickly significantly raises the risk of a dangerous skin reaction.
What it treats
Which conditions is Lamotrigine used for?
Overview
What is Lamotrigine?
Lamotrigine is a mood stabiliser and anticonvulsant that occupies a unique position in bipolar disorder treatment. While most mood stabilisers are better at preventing mania, lamotrigine is most effective at preventing depressive episodes.
It is listed in Kenya's Essential Medicines List 2023. Its tolerability profile is notably favourable: it does not cause weight gain, does not significantly affect blood sugar or cholesterol, and causes minimal cognitive impairment.
One important caution: a skin rash develops in some people taking lamotrigine, and in rare cases this can progress to a serious reaction. The risk is almost entirely prevented by starting at a very low dose and increasing slowly, exactly as prescribed.
How it works
What does it do in the brain?
Formulations in Kenya
How is it available?
Availability across Africa
Where is it available in Africa and what is it called?
| Country | Common Brand Name(s) | Notes |
|---|---|---|
| Uganda | Lamictal, Lamotrigine (generic) | Available at Butabika Hospital and private pharmacies in Kampala; limited in the wider public sector. |
| Tanzania | Lamotrigine (generic) | Available at Muhimbili National Hospital and select private pharmacies. |
| South Africa | Lamictal, Epitec, Lamotrigine (generic) | Widely available; generic dispensed in public sector for epilepsy and bipolar disorder. |
| Nigeria | Lamictal, Lamotrigine (generic) | Available at teaching hospitals and private pharmacies in major cities. |
| Ghana | Lamotrigine (generic) | Available at Korle-Bu and Accra Psychiatric Hospital. |
| Ethiopia | Lamotrigine (generic) | Available at Amanuel Hospital and Black Lion Hospital; listed in the Ethiopian EML. |
| Rwanda | Lamotrigine (generic) | Available at King Faisal Hospital and through the RBC pharmacy system. |
Side effects
What might you feel while taking it?
These are the most commonly reported effects. Not everyone experiences them, and many settle within the first few weeks.
- Headache
- Dizziness and double vision at higher doses
- Nausea, particularly early on
- Insomnia
- A rash in approximately one in ten people, most rashes are mild, but all must be assessed by a doctor
- No significant weight gain, a meaningful advantage over many other mood stabilisers
- Stevens-Johnson Syndrome, a rare but severe skin reaction. Any rash on the skin, inside the mouth, or around the eyes must be seen by a doctor promptly. Do not wait.
- If lamotrigine is stopped for any reason and then restarted, the full slow titration process must begin again from the beginning
Who should not take it
Important warnings before starting
- Previous serious skin reaction caused by lamotrigine
Special care needed
Situations that need extra attention
- Any rash must be reported to your doctor immediately. Do not assume it is minor or unrelated
- Never increase the dose faster than prescribed. The titration schedule exists for your safety.
- If you stop lamotrigine for any reason and restart, you must go back to the starting dose and titrate up again
- Tell your doctor about all other medicines, several significantly change lamotrigine levels
- If you take the oral contraceptive pill, tell your doctor, lamotrigine levels fluctuate across the menstrual cycle
Lamotrigine has a considerably better pregnancy safety profile than valproate or carbamazepine. Speak to your doctor if pregnant or planning pregnancy. Levels change significantly during pregnancy and need close monitoring.
Significant levels pass into breast milk. Monitor infant for unusual drowsiness. Specialist review is needed.
Other medicines
Medicines and substances that can interact with it
- Valproate: Doubles lamotrigine levels. If both medicines are prescribed together, your doctor uses a specifically different and slower titration schedule for lamotrigine.
- Carbamazepine: Reduces lamotrigine levels significantly. Your doctor will adjust the dose if both are needed.
- Combined oral contraceptive pill: Reduces lamotrigine levels by roughly half, with fluctuations across the pill cycle. Tell your doctor if you are on the pill.
- Rifampicin (TB treatment): Reduces lamotrigine levels. Common in Kenya given TB prevalence, inform your prescriber if on TB treatment.
Tests and follow-up
What your doctor will monitor
- Skin checks at every appointment in the first three months
- Blood lamotrigine levels if there is a question about whether the level is appropriate
- For women on the oral contraceptive pill: more frequent mood and seizure monitoring
- Liver function in significant liver disease
Stopping this medicine
What happens if you stop taking it?
In Kenya
What you should know about this medicine in Kenya
Lamotrigine is increasingly available in Kenya and represents an important option for bipolar maintenance, particularly because it addresses the depressive phase, which is often the more disabling part of bipolar disorder.
Its lack of weight gain and metabolic effects is a genuine advantage in Kenya's clinical context, where long-term metabolic consequences of psychiatric medicines increasingly intersect with rising prevalence of metabolic disease.
The interaction with rifampicin, used in tuberculosis treatment, is clinically relevant in Kenya given the country's TB burden. Patients on lamotrigine who start TB treatment must inform both prescribers so levels can be monitored.
Sources
References
- Ministry of Health, Kenya. (2023). Kenya Essential Medicines List 2023. Nairobi: Ministry of Health.
- Ministry of Health, Kenya. (2023). Kenya National Medicines Formulary, 1st Edition. Nairobi: Ministry of Health.
- Geddes, J. R., et al. (2009). Lamotrigine for treatment of bipolar depression. The Lancet, 373(9657), 53-62.
- World Health Organization. (2023). Model List of Essential Medicines, 23rd Edition. Geneva: WHO.