Talk:Lamotrigine/Archive 1

Regulation Changes
From what my psychiatrist told me, this drug is now approved for the treatment of bipolar. I think this is mentioned, and contradicted by saying it was an off label treatment. Also, I have been told that within weeks the 200mg tablet will become generic. This will require a further update. —Preceding unsigned comment added by 70.189.251.224 (talk) 06:29, 18 June 2008 (UTC)


 * The article says that Lamotrigine is approved for treatment of bipolar I and is used off-label for treatment of bipolar II. These are two different diagnoses (although one could argue that they are just two arbitrary points on a continuum from depression to mania). DES (talk) 00:00, 14 August 2008 (UTC)


 * The 200mg tablet is available.

Side Effects on Concentration
I cleaned up the concentration paragraph of the side effects section, and removed the following statement:

"Reported loss of concentration is mostly an issue only for people with intellectually demanding occupations; for example, people working in areas related to mathematical reasoning seem to have trouble in most cases."

It seemed a bit (albeit, unintentionally) classist to suggest that only intellectuals would "miss" their concentration, and the latter portion of the sentence requires a citation. However, I am unfamiliar with the relevant literature, so perhaps some version of this sentence would improve the article with a supporting reference. For the present, I just took it out. St3vo 14:56, 24 July 2007 (UTC)

Why was impairment of concentration mentioned in the article in the first place? I've seen a study that compared different anticonvulsants for their impact on cognitive function and the only category in which lamotrigine affected concentration negatively was verbal recall. GlaxoSmithKline has actually investigated lamotrigine as a potential treatment for ADHD.

http://ctr.gsk.co.uk/Summary/lamotrigine/studylist.asp

LAMOTRIGINE (Lamictal®) Treatment in adults with Attention Deficit Hyperactivity Disorder (ADHD), A pilot study.

Here was the conclusion of the study:

Of the 18 subjects entered in the study only nine subjects had complete data sets. Based on the limited data, no significant changes were observed in the ADHD ratings nor the other ratings scored in the study, with the exception of an increase in PASAT.

PASAT: Paced auditory serial addition test

--Substantiate 22:42, 1 September 2007 (UTC)

Rashes and Children
I would suggest that the rash may not limit the prescription of Lamotrigine for children, only require more careful dosing. My 4 year old was prescribed Lamictal for complex partial seizures once the first prescribed medication, Trileptal, stopped working. Thus, I'd think that there's not a real reluctance to prescribe for children. Or the neurologist is a maniac. :) --1Winston 20:23, 1 September 2005 (UTC)


 * No, I don't think the neurologist is a maniac, GlaxoSmithKline did extensive trials on pediatric patients. However, since they are at higher risk for SJS, the Prescribing Information indicates that titration and monitoring of possible SJS symptoms require extra care. Lamictal is only indicated though for partial seizures and generalized seizures from Lennox-Gastaut syndrome in children age 2 to 16. --Frankieist 22:07, 1 October 2005 (UTC)

Attaches to irises? (not appropriate talk page discussion)
How much does it alter your thinking? I'm not THAT depressed or bipolar. Not sure if I want to take this anymore... i'm a bit paranoid now.

I'm not a WikiHead, but this discussion is, in fact, very helpful to Wikipedia as the above individual has just given the same impression of the article I get. I think I'd rather risk suicide than take this drug, now that I've read the article. Wiki needs to know how its articles impact users. Also, the user raises a legitimate point. There is little indication from the article the relative frequencies of these side effects. —Preceding unsigned comment added by 69.180.208.44 (talk) 21:57, 27 January 2008 (UTC)

Citation needed for acute-symptom usage
The summary currently states that Lamotrigine "is the only anticonvulsant mood stabilizer that treats the depressive as well as the manic phases of bipolar disorders." However, the only clinical studies I've found show inconclusive effects for treatment of acute symptoms, with no statistically significant difference from placebo overall. Likewise, the page notes below that this usage is "off-label." The summary should either provide a citation supporting the claim, or clarify that such usage is not yet well-established.


 * I could find no published verification of that claim, so I removed it from the lead paragraph. In its place, I inserted a published assessment. —Aetheling 14:36, 22 November 2006 (UTC)

One could also mention the huge expense of this drug.

In the "Bipolar disorder" listing it states Lamotrigine is a mood stabilizer that stops depressive episodes (bipolar type 2). Yet in this article it states Lamotrigine is for the treatment of bipolar type 1 (mostly manic episodes). Something is not correct here? As a newbie I'm not making any changes, just raising the question??? Mrwise72 (talk) 12:06, 15 October 2010 (UTC)

Side Effects
Re insomnia, there was a non-referenced statement that lamotrigine can interfere with sleep. I did a literature search and found that it makes some people sleep better, and ~7% have intolerable insomnia. I included that under 'other types of effects. Milliemchi (talk) 04:08, 5 July 2010 (UTC)

About the insomnia... it can cause either that or drowsiness. So some people take it in the morning, and some people take it at night. I didn't have either side effect until I went up to 200mg, and it makes me drowsy, so I stopped having to use a sleep aid to get to sleep at night. I forgot to take it last night until 3:00am, which resulted in me being abnormally drowsy this Sunday at church. So I'm pretty sure it's what's doing it.Clarphimous 05:46, 1 January 2007 (UTC)

I used to take 100 mg/2x a day morning & night and I never had a problem with drowsiness unless I would forget to take it. January 2007 my Neurologist prescribed me 200mg/2x a day morning & night, now I can't go through the day without a nap. If I don't take it I can't stay awake during the day. About the weight loss, I've lost 25 pounds since January also. I was never large either. I'm 5'10'' and 135 now.

links
I am re-adding www.crazymeds.us/lamictal.html (Lamotrigine page at a consumer-run psychiatric drug information site). This is the best single consumer information site for psychiatric medications I have found, presenting collated results of studies, labeling technicalities and interactions in a layman-accessible form. Significant portions of my recent rewrites of this article are based on content from this site; it's far more useful and informative than the manufacturer's site in many ways. -- Akb4 18:56, 5 February 2007 (UTC)


 * Be careful with crazymeds.us as a reference. It's a site operated by a non-professional (but with good knowledge of medications), and unless you're already familiar with the pharmacology of the drugs he discusses, it's difficult to separate the wheat from the chaff. The author has a tendency to overgeneralize from personal experience to conclusions that may at times be totally unjustified and misleading. His intentions are good, but most of what he writes may not match with what you will find on professional medication websites. Porkchopmcmoose 19:53, 22 May 2007 (UTC)


 * I don't understand why one should link to crazymeds. If the site gets the info from reputable sources, we should be citing those sources. If it's original research, we shouldn't be citing it.99.140.224.254 (talk) 16:04, 5 July 2010 (UTC)

side effects
When jumping from the inital increases to full dosage, I had severe symptoms: hypersensitivity of skin-2 days(I couldn't stand clothing against my skin, especially seams), dizziness-3 days (the second being somewhat normal and the 3rd couldn't drive), out of it- I was a zombie at my in-laws. I would recommend a continued gradual progression to full dosage.

Side effects section of this entry is deficient in that this drug has a black box warning for severe cutaneous reactions that can be life threatening. I am adding this to the page. —Preceding unsigned comment added by 216.73.158.222 (talk) 12:07, 8 October 2007 (UTC)

citation needed
I can not believe someone used "crazymeds" as a reference. I can see why wikipedia is ridiculed and parodied by the media. —Preceding unsigned comment added by GingerDemarque (talk • contribs) 16:45, 15 September 2007 (UTC)
 * You're obviously not acquainted with crazymeds. --200.20.164.4 (talk) 14:09, 2 February 2010 (UTC)

Effect On Other Drugs
Here's my anecdotal experience: I've noticed that taking lamotrigine along with a number of different drugs (recreational drugs... I can't tell how it effects the effect of the other prescribed drugs I take every day) seems to decrease their effect ("affect"? whatever). On alcohol, I become very sober. To combat this, I've drank more and more during times when I took lamotrigine and stayed awake, and I continued to be largely sober and coherent (though my coordination was basically destroyed). A friend of a friend of mine was on DXM and he said it was bringing on a seizure, which he suffers from. He asked if I had any seizure medication in my bottle of pills, and I gave him some lamotrigine. He said the effects of the DXM quickly went away.

Okay, that's all totally anecdotal, which is why I'm not adding it to the article. However, I'm pretty convinced that it's true. Does anybody know of any study or respectable reference to back this up? --MQDuck 14:49, 7 October 2007 (UTC)
 * The medical industry as a whole does not do studies of combining any given drug with naughty recreational drugs so, no, you won't find a reference. More's the pity, given that depressed / bipolar young adults are probably drug use demographic group #1. Been there, done that, took off the t-shirt and wandered up a mountain during a psychotic episode. Be careful, MQDuck. Dhatfield (talk) 14:37, 4 April 2008 (UTC)


 * The only effect I've noticed (100mg a day dosage prescribed for Bipolar type 1) is that social drinking has become impossible for me if I do not discontinue this drug 2 days prior to the social occasion. The effect for me is that upon waking up the next morning I find myself in a sheer state of anxiety with panic attacks to the extent which I've never felt before in my life. I've found I lose an entire day or more due to this oversight. And yes this is the only "recreation drug" I care for and not frequently either. I'm thinking I should go back to lithium bicarbonate regardless of my fear of needles (the blood level monitoring thing is a necessity for lithium). Perhaps my job performance will improve, considering that i work in a technical field.  —Preceding unsigned comment added by 97.76.17.23 (talk) 01:19, 19 December 2008 (UTC)

Local anesthetic effects?
Being that lamotrigine is a sodium channel blocker, does it have any local anesthetic properties? I don't know if it could not. Both extracelluar & intracelluar sodium channel blockers have local anesthetic effects. Nagelfar (talk) 06:25, 17 February 2008 (UTC)
 * It is actually not yet known if lamotrigine is a sodium channel blocker or not. (BTW, I have never been aware of sodium channel blockers having said effect).--Metalhead94 (talk) 00:54, 16 January 2009 (UTC)

approval history for bipolar I
In the approval history section, the FDA approval for use with bipolar I is shown as June 2003. In the Indications and usage section the date for this event is 1994. Which is correct? Ghosts&amp;empties (talk)
 * June 2003 is correct—more precisely, June 20, 2003, see . This article is in serious need of some cleanup. Fvasconcellos (t·c) 23:23, 10 December 2008 (UTC)

false positive urine for PCP's
I am on Lamictal 200mg/day. I was required to take a urine test and it came up initially positive for PCP's which was a shocker for a middle aged woman who doesn't even smoke cigarettes!!! When they sent the urine sample away to the lab, I was cleared but I did find out in the process that Lamictal anecdotally caused this initial false positive. My question is: has there been any "official" nod to this side effect?

Also, I read through the comments section on the side effect of lack of concentration. It is a huge problem for me. My neurologist told me there would be "issues with retrieval", and he wasn't kidding! I have what seems to be major short term memory loss since taking Lamictal. But the seizures have abated and I am grateful for that. Any helpful comments to mitigate the STM loss? Thanks. —Preceding unsigned comment added by Womaninashoe (talk • contribs) 13:54, 1 February 2009 (UTC)

Diagram
Sorry, don't know the proper terms, but: the simple chemical map and corresponding "graphic" map do not match. —Preceding unsigned comment added by Eb10023 (talk • contribs) 01:03, 21 January 2010 (UTC)

Take side effect warning seriously on this one
just an anecdote, but if you read the product monograph http://www.gsk.ca/english/docs-pdf/Lamictal_PM_20090703_EN.pdf

there is a specific, seperate, capitalized paragraph (at least from glaxo kline smith) warning regarding the "rare" side effect of the rash from lamotrigine. i have one friend on it with no negative consequence. however, another friends spouse nearly died. i dont want to be the one to die taking a drug like this when there are safer alternatives. it can have serious effect on your liver, kidneys, heart etc. but my friends husband, after only a few doses developed the rash, doctor did not believe him when told it was the lamotrigine. he said it was flu. after they returned and the same doc was on duty, he got rude and loud with them until another doctor intervened. this doctor ended up admitting my friend to hospital, and a day or two later he was transferred to another cities burn unit after much swelling, rash all over body changed his skin green, then white bumps on top. docs have been doing repeated tests on his liver and kidneys. luckily he survived. in some if stevens johnson syndrome develops and progresses into a worse version, cell death can occur causing the epidermis to seperate from the dermis. (skin seperates from body and you die) too gross for me to risk

De9Olamor (talk) 08:13, 21 April 2010 (UTC)De9OlamorDe9Olamor (talk) 08:13, 21 April 2010 (UTC)


 * Here in the UK they are very fussy about increasing titration gently with big warnings about "any rash, stop taking and call us". The rash may be rare, but it is a sign of a serious problem. Data on the side effect/risk/consequences could benefit the article

I took out the crazy
In the interactions part of the page, there was this lump of text where it was pretty obvious that the person who typed it in there had a bias.

The section I removed basically accused the drug company of lying about the incidence of side effects, and accused the medical professionals who encounter these side effects of not reporting them to the FDA. The phrase "it is likely" was used twice, but at no point in time did I notice any reference materials cited.

This kind of grandiose and persecutory statement is indicative of someone suffering an episode of paranoid schizophrenia, and as such has no place in the medical description of a chemical compound. This isn't about anyone's political philosophies (sane or otherwise). This is supposed to be about medicine. 98.250.49.66 (talk) 04:19, 16 June 2010 (UTC)

Bipolar Disorder Section
"In the interactions part of the page, there was this lump of text where it was pretty obvious that the person who typed it in there had a bias.

The section I removed basically accused the drug company of lying about the incidence of side effects, and accused the medical professionals who encounter these side effects of not reporting them to the FDA. The phrase "it is likely" was used twice, but at no point in time did I notice any reference materials cited.

This kind of grandiose and persecutory statement is indicative of someone suffering an episode of paranoid schizophrenia, and as such has no place in the medical description of a chemical compound. This isn't about anyone's political philosophies (sane or otherwise). This is supposed to be about medicine." 98.250.49.66 (talk) 04:19, 16 June 2010 (UTC)

From reading the above statement it would seem you have made a persecutory (if not grandiose) comment yourself though, both towards the person you say (alledgedly) had a "pretty obvious bias" towards a company, and also to those who you think may be suffering from an "episode of paranoid schizophrenia".

Firstly, to liken someone who may have a bias against a drug company as being in any way similar to someone suffering from paranoid schizophrenia seems peculiar. Secondly, to flippantly state that making a persecutory and grandiose statement (something many people do) is "indicative" of people who suffer from schizophrenia is discriminatory on your part.

It would appear you have your own biases which you should consider first before judging and making medical assessments of others. In the event a person who has schizophrenia does attempt to imput into this organisation why should they be discriminated against in any case based on their illness type. Shouldn't people encourage those with the illness to try and become educated and imput into the things they are interested in, or is the general prognosis a life time of detention and being told they should not say anything that cannot be properly understood or does not make any sense to those academically enlightened people as you seem to be.

You state this isn't about anyone's political philosophies, but if people who work in the medical profession were to label members of the public as paranoid schizophrenics based on the criteria you have used, then that could be used as a means to detain people under mental health laws with no credible justification. Even if someone is a schizophrenic and states a political view it is surely incorrect to castigate them for doing so.Interactivesolarsystem (talk) 00:30, 31 August 2010 (UTC)

Effectiveness of use for bipolar/severe depression
I was prescribed this med today and have been researching the use of this drug for bipolar/severe depression. The original 2008 study by Geddes was re-analyzed by Geddes and colleagues and it has been found the drug does work better for those catagorized as severely depressed but not as well for those with mild/moderate depression. I will likely be making more changes as I continue researching as it looks like most of the references used on this page are from 2008. BTW, this is my first wiki edit, so be nice to me if I screwed up my ref or something. Dagrrl (talk) 17:47, 10 September 2010 (UTC)

Also added support that lamotrigine is not associated with destabilizing patients causing hypomania. Think I'm done -- looks like '08 and '09 were big research years on this drug but not much published this year. Dagrrl (talk) 18:08, 10 September 2010 (UTC)

Legality/approval in other countries
I'm posting this on the discussion page instead of editing the main page: Lamictal is classed as a narcotic in Japan (don't ask me why) and travelers bringing it into the country need to apply for a special license to import narcotics (NOT the yakkan shoumei, but rather the same license you would need to bring in Hydrocodone). Source: Japanese Consulate General at Houston. The appropriate paperwork can be acquired by contacting their consulate/embassy. I'm lucky that I thought to ask the consulate ahead of time instead of finding out the hard way. Perhaps it would be worthwhile to make a note of this somewhere? I'm sure other countries have similar restrictions. z.rayen (talk) 22:37, 23 September 2010 (UTC)

Lamotrigine for Bipolar type II
this page seems to contradict to the page on Wikipedia for [[Bipolar II disorder]]. I know that many psychiatrists prefer to use either lithium or Lamotrigine as a first step in treating a patient with BP type II (folks that are mostly depressed). It can be combined with antidepressants (SSRI or NDRI) or sometimes is used as a maintenance monotherapy.

This one guy seems to be particularly convinced this is the case, but I don't know if we can use him as a source... http://www.psycheducation.org/depression/APAguide.htm http://www.psycheducation.org/depression/meds/lamotrigine.htm

Other sources I've found: http://www.crazymeds.us/pmwiki/pmwiki.php/Meds/LamictalBasicOverview?from=Meds.Lamictal http://www.revolutionhealth.com/drugs-treatments/rating/lamictal-for-bipolar-ii-disorder http://www.ncbi.nlm.nih.gov/pubmed/12677469 http://blogs.psychcentral.com/bipolar/2008/08/bipolar-medication-spotlight-lamictal-lamotrigine/

Another thing of concern is that many users of Lamotrigine report in internet forums that on higher doses it makes them "dumb". If there's any research on that, this would also be welcome. — Preceding unsigned comment added by 84.50.160.112 (talk) 02:37, 27 June 2011 (UTC)

I found this article on the use of Lamictal for treatment of Bipolar Disorder, however no type (I or II) was indicated: http://www.lifeloveandbipolar.com/lamictal_bipolar_disorder.html. — Preceding unsigned comment added by 1.152.73.202 (talk) 06:23, 23 July 2011 (UTC)
 * I have added some requests for citations related to this issue. Doug (talk) 22:01, 9 August 2011 (UTC)

effective dose
"Side effects Common side effects include headaches, dizziness and insomnia. In very rare cases, Lamotrigine has been known to cause the development of a dangerous rash in some people called Stevens-Johnson syndrome. The rash is more common in children, so this medication is often reserved for adults. There is also an increased incidence of this rash in patients who are currently on, or recently discontinued a valproates anti-convulsant drug, as these medications interact in such a way that the clearance of both is decreased and the effective dose of lamotrigine is increased."

Shouldn't this read that the "effective dose of lamotrigine is decreased" since less would have to be taken for a given level of effectiveness? Or the above passage could be changed to "the effectiveness of a given dose of lamotrigine is increased."

=
====

Sorry, I don't know how to respond to this, so I just chose to "Edit" this section. The text is accurate as written. The reason is that the body is constantly working on clearing out drugs from its system. Let's assume that the half-life of lamotrigine is 14 hours. That means that if the dose is 200mg, then the effective amount in the serum is 100mg at 14 hours. If the clearance of lamotrigine is decreased, then there may be (completely made up) 125mg at 14 hours, which would be comparable to a dosage of 250mg at a normal clearance rate. This means that the peak amount would be higher, as would the steady state amount, than what you would normally expect at a 200mg dosage.

The phrase "the effective dose of lamotrigine is increased" is accurate. — Preceding unsigned comment added by 192.91.147.35 (talk) 15:01, 17 October 2011 (UTC)

=
=== I am not a physician or pharmacologist, but did take a course in pharmacology at Boston University Medical School. The effective dose of a drug varies with the patient, and can change. In this case with reduced clearance, a lesser amount of the drug is needed to maintain a serum level that will be effective for this patient while taking the two drugs. The effective dose has decreased. Effective dose refers to the amount you have to dose yourself to reach a blood level that will be effective in relieving symptoms. An example of use of the phrase "effective dose" in a changing circumstance appears in SAMHSA/CSAT Treatment Improvement Protocols, chapter 4 "Physical Detoxification Services for Withdrawal From Specific Substances" (http://www.ncbi.nlm.nih.gov/books/NBK26177/#A85720):

Pregnant women should be maintained on an adequate (i.e., therapeutic) methadone dose. An effective dose prevents the onset of withdrawal for 24 hours, reduces or eliminates drug craving, and blocks the euphoric effects of other narcotics. An effective dose usually is in the range of 50–150mg (Drozdick et al. 2002). Dosage must be individually determined, and some pregnant women may be able to be successfully maintained on less than 50mg while others may require much higher doses than 150mg. The dose often needs to be increased as a woman progresses through gestation, due to increases in blood volume and metabolic changes specific to pregnancy (Drozdick et al. 2002; Finnegan and Wapner 1988). — Preceding unsigned comment added by Dlugose (talk • contribs) 20:55, 19 October 2011 (UTC)

Dosage
I removed this section because wikipedia should not discuss doses (per WP:MEDMOS) or act as a how to guide. There may be some useful information that can be incorporated into the side effect section so I'll leave it here until I can get back to it.


 * Lamotrigine must be dose titrated carefully. Different doctors will follow different titration policies based on their experience and the specific condition of the patient. For this reason the titration information must be viewed purely as an example -and never to be adopted directly. Any proposal to take Lamotrogine must be discussed with a suitably qualified doctor, and their prescriptions followed, and any warning signs -such as a rash- responded to immediately.
 * The normal starting dose is 25 mg a day week 1-2, which may be increased 50 mg a day a week 2-3, 100 mg week 5 and 200 mg week 6. If the patient also takes valproate the dosage should be halved; if taken with carbamazepine the dosage needs to be doubled since they both interfere with lamotrigine's metabolism.
 * The normal maintenance dose for bipolar depression is 200 mg, but some patients may require up to 600 mg a day. Some patients who cannot tolerate 200 mg have to take a lower dose. In clinical trials doses up to 400 mg for bipolar disorder and 500 mg but it's common that higher doses are prescribed.
 * Too high starting doses and fast dose increase increases the risk of developing serious rashes and in worst case Stevens–Johnson syndrome. Pediatric patients have a higher risk of developing rashes and bad skin reactions.
 * The consensus is that the dose titration should be taken slow in small steps. Many patients develop benign rashes when starting treatment but the patient doesn't have to stop take lamotrigine if the same dose is withheld for some time the rash usually goes away and then the dose can be increased again. If a patient has stopped taking lamotrigine for a period of more than 5 times the half life of its metabolism (approximately two-and-a-half days), the dose titration has to start over again from zero. As stopping any anti-epilepsy drug may trigger seizures, this implies that stopping taking lamotrogine is a serious action. Reducing dosage of the drug must also be performed after consultation with a suitably qualified doctor -and their prescriptions strictly followed.

Watermelon mang (talk) 14:22, 7 April 2012 (UTC)
 * Anon IP reverted with no discussion so I reverted back. Please discuss here if my interpretation of WP:MEDMOS is incorrect. Watermelon mang (talk) 06:24, 12 April 2012 (UTC)

Effectiveness of Lamictal
That section appears to be wrong. Lamictal is effective at Prophylaxis or delaying the mania, depressive, or rapid cycle. It is not effective more than a placebo in current state of either of those. You can read citation 8 ( http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2580079/ ) whereas I think I read it and understand it more than whoever wrote that line. Lamictal's own perscriber guide says it is effective at DELAYING any of those three, INCLUDING RAPID CYCLE mania. It published those two studies. It did not publish the studies that say it is not effective at treating CURRENT any of those episodes. http://us.gsk.com/products/assets/us_lamictal.pdf. please agree somehow to fix that section. 173.55.18.122 Ur0pl (talk) 07:05, 29 November 2012 (UTC). I added the word "current" in the meantime. However, "seems ineffective" does not "sound well." You guys can figure all this out as a group. However, again, it actually is _effective_ at delaying or Prophylaxis of all those three. Thank you. Ur0pl (talk) 10:43, 29 November 2012 (UTC)

Rotating graphic is TERRIBLE web design
This page violates Wikipedia accesibility standards. See: Manual_of_Style_(accessibility)  "To be accessible, an animation (GIF – Graphics Interchange Format) should either: not exceed a duration of five seconds (which results in making it a purely decorative element),[6] or be equipped with control functions (stop, pause, play).[7]"  I find that rotating graphic extremely distracting and I know other users do as well. MadScientistX11 (talk) 19:50, 23 December 2013 (UTC)
 * I agree and have removed it. But unfortunately, there are many others in drug articles.  -- Ed (Edgar181) 02:05, 24 December 2013 (UTC)
 * Thanks! MadScientistX11 (talk) 05:46, 24 December 2013 (UTC)

Citation Needed Regarding Suddenly Stopping Then Resuming
Prior to my editing the article, it read "The manufacturer states that nearly all cases appear in the first 2 to 8 weeks of therapy and if medication is suddenly stopped then resumed at the normal dosage." The first part of this ("...in the first 2 to 8 weeks of therapy") is clearly stated in the prescribing information. However, the rest of the statement has two problems. First, the word "and" makes it unclear (does it imply that we're still in the first 2 to 8 weeks, or is stopping/resuming outside of the first 2 to 8 weeks also dangerous). The second problem is that the prescribing information does not clearly state anything regarding the specific dangers of stopping/resuming. The closest I can find regarding where the article might have sourced this from is "Patients should be advised to notify their physician if they stop taking LAMICTAL for any reason and not to resume LAMICTAL without consulting their physician." Because of this statement in the prescribing info, my assumption is that stopping/resuming outside of the first 2 to 8 weeks is also dangerous, and thus I changed the "and" to "or". But the statement doesn't clearly tie stopping/resuming to the skin reactions, so that's why I added the Citation Needed template. Gmporr (talk) 10:05, 27 August 2014 (UTC)

specific date needed
>"...and has been the first US Food and Drug Administration (FDA)-approved drug for this purpose since lithium, a drug approved almost 30 years earlier."

I think this needs to be more specific: "...for this purpose since lithium, a drug approved in 1960 (or whenever)." However, I don't know when the Lamotrigine and lithium came on the market. Could someone who does rewrite this? Rissa, Guild of Copy Editors (talk) 03:53, 19 June 2015 (UTC)

Iris
>"Lamotrigine binds to melanin-containing tissues such as the iris of the eye. "

To what end? Does the iris get darker, lighter, turns neon pink? Rissa, Guild of Copy Editors (talk) 04:04, 19 June 2015 (UTC)

External links modified
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Side effects
According to Bertram G. Katzung's 7th Edition of basic and clinical pharmacology on page 396, Lamotrigine's symptoms can include dizziness, somnolence, headache, diplopia, nausea, and rash. Sometimes the rash can be a mild and itchy adverse reaction in the skin (personal experience), since it has been said to bind to melanin there and in the eyes (I don't remember where I heard this, but it was a legitimate source). Lamotrigine has a serious risk in its potential for steven's johnson's syndrome, which begins manifestation as a rash. This is why it is essential that lamotrigine treatment begin slowly--the book mentioned above states that patients taking valproate must begin treatment at no more than 25mg every other day. Steven's Johnson's syndrome is rare, and it is almost unheard of after a patient has finished transitioning onto the medication.

As with any medication, it's a strain on the body, common sense indicates that users need more water while taking this medication. I think it made me sweat more as well, which might be attributable to its moderately high level of protein binding (the book says 55%). I am not an M.D., but an economics student and informed patient. good luck! (1st contribution to wikipedia, sorry if this is a poor one!) — Preceding unsigned comment added by 167.206.48.221 (talk • contribs) 22:57, 15 February 2012 (UTC)
 * the side effects sourced to the book have been already added to the article. Jytdog (talk) 07:05, 2 January 2017 (UTC)

Legal status in Japan
I'm not sure if I'm putting this in the correct section. However, here goes: as a user of Lamictal and frequent visitor to Japan I was concerned to read about lamotrigine's classification as a narcotic in Japan. Japan has some worryingly bureaucratic processes around the importation of medicines. After conversation with the local Japanese consulate, and some detailed web searching, I faxed some questions about lamotrigine to the relevant department in Japan. This is the reply I got: Dear Mr. [name removed] I got fax from you. Lamictal is NOT a narcotic drug (it is a prescription drug) in Japan, so you do not need to fill in an application form to import a narcotic. Under the Japanese regulation of importing drugs, people can import one month supply of prescription drugs without any procedures. If the quantity of Lamictal you intend to bring into Japan is less than one month supply, you do not need to fill in any forms. A prescription from your doctor would make customs clearance smooth. If you intend to bring more than one month supply, you need to fill in “Import Report for Medication” form and apply for the Yakkan Shoumei, a kind of import certification. You have to apply for the Yakkan Shoumei” every time you visit Japan if you bring more than one month supply each time. Regarding the Yakkan Shoumei, please check our website below: http://www.mhlw.go.jp/english/policy/health-medical/pharmaceuticals/01.html Regards. [name removed] Section Chief Section for Import Monitoring of Medical Products Compliance and Narcotics Division Pharmaceutical and Food Safety Bureau Ministry of Health, Labour and Welfare, JAPAN

Accordingly, unless someone has other information, I believe the section about the legal status of this drug needs to be changed. MMCW83 MMCW83 (talk) 08:14, 12 July 2012 (UTC)
 * per WP:RS we need published sources - an email you got is not a reliable source in WP. Jytdog (talk) 07:03, 2 January 2017 (UTC)

Half-life
Fix inconsistency re: half-life information. In the Pharmacokinetic data table it is listed as 29 hours and in the body (Pharmacokinetics) it is listed as 13.5 hours — Preceding unsigned comment added by 97.123.50.242 (talk • contribs) 15:51, 22 October 2014 (UTC)
 * this was done at some point. Jytdog (talk) 07:04, 2 January 2017 (UTC)