Lamotrigine, Oral Tablet

1. Lamotrigine oral tablet is available as brand-name drugs and as generic drugs. Brand names: Lamictal, Lamictal XR, Lamictal CD, and Lamictal ODT.
2. Lamotrigine comes in four forms: immediate-release oral tablets, extended-release oral tablets, chewable oral tablets, and orally disintegrating tablets (can be dissolved on the tongue).
3. Lamotrigine oral tablet is a prescription drug used to treat certain types of seizures in people with epilepsy. It’s also used to treat bipolar disorder.

Lamotrigine is a prescription drug. It comes in four forms to be taken by mouth (orally): immediate-release oral tablets, extended-release oral tablets, chewable oral tablets, and orally disintegrating tablets (can be dissolved on the tongue).

Lamotrigine is available as the brand-name drugs Lamictal, Lamictal XR (extended-release), Lamictal CD (chewable), and Lamictal ODT (dissolves on the tongue).

It’s also available as generic drugs. Generic drugs usually cost less than brand-name versions. In some cases, they may not be available in every strength or form as the brand-name drugs.

Lamotrigine may be used as part of a combination therapy. This means that you may need to take it with other medications.

Why it’s used

Lamotrigine is used to treat certain types of seizures in people with epilepsy. It can be used in combination with other antiseizure medications. Or it can be used alone when switching from other antiseizure medications.

Lamotrigine is also used for long-term treatment of a mood disorder called bipolar disorder. With this condition, a person has extreme emotional highs and lows.

How it works

Lamotrigine belongs to a class of drugs called anticonvulsants or antiepileptic drugs (AEDs). A class of drugs is a group of medications that work in a similar way. These drugs are often used to treat similar conditions.

For people with epilepsy, this drug reduces the release of a substance in your brain known as glutamate. This action prevents the neurons in your brain from becoming too active. As a result, you may have fewer seizures.

For people with bipolar disorder, this drug may affect certain receptors in your brain that help control your mood. This could decrease the number of mood episodes you have.

Lamotrigine oral tablet may cause drowsiness. Do not drive, use heavy machinery, or do other dangerous activities until you know how this drug affects you.

Lamotrigine can also cause other side effects.

More common side effects

The more common side effects that can occur with use of lamotrigine include:

• dizziness
• drowsiness
• headache
• double vision
• blurred vision
• nausea and vomiting
• diarrhea
• stomach pain
• trouble with balance and coordination
• trouble sleeping
• back pain
• stuffy nose
• sore throat
• dry mouth
• fever
• rash
• tremor
• anxiety

If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, talk with your doctor or pharmacist.

Serious side effects

Call your doctor right away if you have serious side effects. Call 911 if your symptoms feel life threatening or if you think you’re having a medical emergency. Serious side effects and their symptoms can include the following:

• Serious skin rashes called Stevens-Johnson syndrome and toxic epidermal necrolysis. Symptoms can include:
  • blistering or peeling of your skin
  • hives
  • rash
  • painful sores in your mouth or around your eyes
• Multi-organ hypersensitivity, which is also called drug reaction with eosinophilia and systemic symptoms (DRESS). Symptoms can include:
  • fever
  • rash
  • swollen lymph glands
  • severe muscle pain
  • frequent infections
  • swelling of your face, eyes, lips, or tongue
  • unusual bruising or bleeding
  • weakness or tiredness
  • yellowing of your skin or the white part of your eyes
• Low blood cell counts. Symptoms can include:
  • tiredness
  • weakness
  • frequent infections or an infection that won’t go away
  • unexplained bruising
  • nosebleeds
  • bleeding from the gums
• Changes in mood or behavior. Symptoms can include:
  • thoughts about killing yourself
  • attempts to harm or kill yourself
  • depression or anxiety that’s new or gets worse
  • restlessness
  • panic attacks
  • trouble sleeping
  • anger
  • aggressive or violent behavior
  • crankiness that’s new or gets worse
  • dangerous behavior or impulses
  • extreme increase in activity and talking
• Aseptic meningitis (inflammation of the membrane that covers your brain and spinal cord). Symptoms can include:
  • headache
  • fever
  • nausea and vomiting
  • stiff neck
  • rash
  • being more sensitive to light than usual
  • muscle pains
  • chills
  • confusion
  • drowsiness
• Hemophagocytic lymphohistiocytosis (HLH, a life threatening immune system reaction). Symptoms can include:
  • high fever, typically over 101°F
  • rash
  • enlarged lymph nodes
• Irregular heart rhythm. Symptoms can include:
  • a fast, slow, or pounding heartbeat
  • shortness of breath
  • chest pain
  • feeling lightheaded

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this information includes all possible side effects. This information is not a substitute for medical advice. Always discuss possible side effects with a healthcare provider who knows your medical history.

Lamotrigine oral tablet can interact with other medications, vitamins, or herbs you may be taking. An interaction is when a substance changes the way a drug works. This can be harmful or prevent the drug from working well.

To help avoid interactions, your doctor should manage all of your medications carefully. Be sure to tell your doctor about all medications, vitamins, or herbs you’re taking. To find out how this drug might interact with something else you’re taking, talk to your doctor or pharmacist.

Examples of drugs that can cause interactions with lamotrigine are listed below.

Antiseizure drugs

Taking certain other antiseizure drugs with lamotrigine can lower the level of lamotrigine in your body. This can affect how well lamotrigine works. Examples of these drugs include:

• carbamazepine
• phenobarbital
• primidone
• phenytoin

Valproate, on the other hand, can raise the level of lamotrigine in your body. This can cause increased side effects that may be dangerous.

Heart arrhythmia drug

Dofetilide is used to treat heart arrhythmias. When used with lamotrigine, the levels of dofetilide in your body may be increased. This may cause fatal arrhythmias.

HIV drugs

Taking lamotrigine with certain drugs used to treat HIV can lower the level of lamotrigine in your body. This can affect how well lamotrigine works. Examples of these drugs include:

• lopinavir/ritonavir
• atazanavir/ritonavir

Oral contraceptives

Taking lamotrigine with combination oral contraceptives (those that contain estrogen and progesterone) can lower the level of lamotrigine in your body. This can affect how well lamotrigine works.

Tuberculosis drug

Rifampin is used to treat tuberculosis. When used with lamotrigine, it can lower the level of lamotrigine in your body. This can affect how well lamotrigine works.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs interact differently in each person, we cannot guarantee that this information includes all possible interactions. This information is not a substitute for medical advice. Always speak with your healthcare provider about possible interactions with all prescription drugs, vitamins, herbs and supplements, and over-the-counter drugs that you’re taking.

This drug comes with several warnings.

Life threatening immune system reaction

In rare cases, this drug can cause a severe immune system reaction called hemophagocytic lymphohistiocytosis (HLH). This reaction leads to severe inflammation throughout the body, and without prompt treatment, it can cause death. Common symptoms include fever, rash, and enlarged lymph nodes, liver, and spleen. They also include decreased blood cell counts, decreased liver function, and blood clotting problems.

Organ damage warning

This drug can cause serious problems to certain parts of your body. These include your liver and your blood cells.

Suicide warning

This drug may cause thoughts of hurting yourself. Call your doctor if you notice any sudden changes in your mood, behaviors, thoughts, or feelings.

Heart disease warning

If you have had a fast heartbeat, heart failure, or other heart problems, you should not take lamotrigine. This drug may cause you to have an abnormal heartbeat, which could lead to sudden death. Symptoms include a fast, slow, or pounding heartbeat, shortness of breath, chest pain, and feeling lightheaded. Call your doctor if you experience any of these symptoms.

Allergy warning

This drug can cause a severe allergic reaction. Symptoms can include:

• rash
• trouble breathing
• swelling of your face, throat, tongue
• hives
• itching
• painful sores in your mouth

If you develop these symptoms, call 911 or go to the nearest emergency room.

Don’t take this drug again if you’ve ever had an allergic reaction to it. Taking it again could be fatal (cause death).

Warnings for people with certain health conditions

For people with liver disease: This drug is processed by your liver. If your liver isn’t working well, more of the drug may stay in your body longer. This puts you at risk for increased side effects. Your doctor may lower your dosage of this drug.

For people with kidney disease: This drug is removed from your body by your kidneys. If your kidneys aren’t working well, more of the drug may stay in your body longer. This puts you at risk for increased side effects. Your doctor may lower your dosage of this drug. If your kidney problems are severe, your doctor may stop your use of this drug or may not prescribe it at all.

For people with heart disease: This drug may lead to a fast heartbeat and cause sudden death. If you have a history of second or third-degree heart block, heart failure, abnormal heartbeat, or other heart problems, you should not use this drug.

Warnings for other groups

For pregnant women: This drug is a category C pregnancy drug. That means two things:

1. Research in animals has shown adverse effects to the fetus when the mother takes the drug.
2. There haven’t been enough studies done in humans to be certain how the drug might affect the fetus.

Talk with your doctor if you’re pregnant or planning to become pregnant. This drug should be used only if the potential benefit justifies the potential risk.

If you become pregnant while taking this drug, call your doctor right away.

For women who are breastfeeding: This drug is present in breast milk and may cause serious side effects in a child who is breastfed. Tell your doctor if you’re breastfeeding your child. Ask about the best way to feed your child while you’re on this medication.

If you breastfeed while taking this drug, watch your child closely. Look for symptoms such as trouble breathing, temporary episodes when breathing stops, extreme sleepiness, or poor sucking. Call your child’s doctor right away if any of these symptoms occur.

For children: It isn’t known if the immediate-release version of this drug is safe and effective for treating seizures in children younger than 2 years. It also isn’t known if the extended-release version of this drug is safe and effective for children younger than 13 years.

In addition, it isn’t known if the immediate-release version of this drug is safe and effective for treating bipolar disorder in children younger than 18 years.

All possible dosages and drug forms may not be included here. Your dosage, form, and how often you take the drug will depend on:

• your age
• the condition being treated
• the severity of your condition
• other medical conditions you have
• how you react to the first dose

Drug forms and strengths

Generic: Lamotrigine

• Form: oral tablet
• Strengths: 25 mg, 50 mg, 100 mg, 150 mg, 200 mg
• Form: chewable tablet
• Strengths: 2 mg, 5 mg, 25 mg
• Form: orally disintegrating tablet (can be dissolved on the tongue)
• Strengths: 25 mg, 100 mg, 200 mg
• Form: extended-release tablet
• Strengths: 25 mg, 50 mg, 100 mg, 200 mg, 250 mg, 300 mg

Brand: Lamictal

• Form: oral tablet
• Strengths: 25 mg, 100 mg, 150 mg, 200 mg

Brand: Lamictal CD

• Form: chewable tablet
• Strengths: 2 mg, 5 mg, 25 mg

Brand: Lamictal ODT

• Form: orally disintegrating tablet (can be dissolved on the tongue)
• Strengths: 25 mg, 50 mg, 100 mg, 200 mg

Brand: Lamictal XR

• Form: extended-release tablet
• Strengths: 25 mg, 50 mg, 100 mg, 200 mg, 250 mg, 300 mg

Dosage for seizures in people with epilepsy

Adult dosage (ages 18–64 years)

Immediate-release form (tablets, chewable tablets, orally disintegrating tablets)

• TAKING with valproate:
  • Weeks 1–2: Take 25 mg every other day.
  • Weeks 3–4: Take 25 mg per day.
  • Week 5 onward: Your doctor will increase your dose by 25–50 mg once per day every 1 to 2 weeks.
  • Maintenance: Take 100–400 mg per day.
• NOT TAKING carbamazepine, phenytoin, phenobarbital, primidone, or valproate:
  • Weeks 1–2: Take 25 mg per day.
  • Weeks 3–4: Take 50 mg per day.
  • Week 5 onward: Your doctor will increase your dose by 50 mg once per day every 1 to 2 weeks.
  • Maintenance: Take 225–375 mg per day, in 2 divided doses.
• TAKING carbamazepine, phenytoin, phenobarbital, or primidone and NOT TAKING valproate:
  • Weeks 1–2: Take 50 mg every day.
  • Weeks 3–4: Take 100 mg per day, in 2 divided doses.
  • Week 5 onward: Your doctor will increase your dose by 100 mg once per day every 1 to 2 weeks.
  • Maintenance: Take 300–500 mg per day, in 2 divided doses.

Extended-release form (tablets)

• TAKING with valproate:
  • Weeks 1–2: Take 25 mg every other day.
  • Weeks 3–4: Take 25 mg per day.
  • Week 5: Take 50 mg per day.
  • Week 6: Take 100 mg per day.
  • Week 7: Take 150 mg per day.
  • Maintenance: Take 200–250 mg per day.
• NOT TAKING carbamazepine, phenytoin, phenobarbital, primidone, or valproate:
  • Weeks 1–2: Take 25 mg every day.
  • Weeks 3–4: Take 50 mg per day.
  • Week 5: Take 100 mg per day.
  • Week 6: Take 150 mg per day.
  • Week 7: Take 200 mg per day.
  • Maintenance: Take 300–400 mg per day.
• TAKING carbamazepine, phenytoin, phenobarbital, or primidone and NOT TAKING valproate:
  • Weeks 1–2: Take 50 mg per day.
  • Weeks 3–4: Take 100 mg per day.
  • Week 5: Take 200 mg per day.
  • Week 6: Take 300 mg per day.
  • Week 7: Take 400 mg per day.
  • Maintenance: Take 400–600 mg per day.

Conversion from adjunctive therapy to monotherapy

Your doctor may choose to stop your other antiseizure medications and have you take lamotrigine by itself. This dosing will be different from what is outlined above.

Your doctor will slowly increase your dosage of lamotrigine and slowly decrease the dosages of your other antiseizure medications.

Conversion from immediate-release to extended-release (XR) lamotrigine

Your doctor can switch you directly from the immediate-release form of lamotrigine to the extended-release (XR) form. This dosing will be different from what is outlined above.

Once you switch to the XR form, your doctor will monitor you to make sure your seizures are under control. Your doctor may change your dosage based on how you respond to treatment.

Child dosage (ages 13–17 years)

Immediate-release form (tablets, chewable tablets, orally disintegrating tablets)

• TAKING with valproate:
  • Weeks 1–2: Take 25 mg every other day.
  • Weeks 3–4: Take 25 mg per day.
  • Week 5 onward: Your doctor will increase your dose by 25–50 mg once per day every 1 to 2 weeks.
  • Maintenance: Take 100–400 mg per day.
• NOT TAKING carbamazepine, phenytoin, phenobarbital, primidone, or valproate:
  • Weeks 1–2: Take 25 mg per day.
  • Weeks 3–4: Take 50 mg per day.
  • Week 5 onward: Your doctor will increase your dose by 50 mg once per day every 1 to 2 weeks.
  • Maintenance: Take 225–375 mg per day, in 2 divided doses.
• TAKING carbamazepine, phenytoin, phenobarbital, or primidone and NOT TAKING valproate:
  • Weeks 1–2: Take 50 mg every day.
  • Weeks 3–4: Take 100 mg per day, in 2 divided doses.
  • Week 5 onward: Your doctor will increase your dose by 100 mg once per day every 1 to 2 weeks.
  • Maintenance: Take 300–500 mg per day, in 2 divided doses.

Extended-release form (tablets)

• TAKING with valproate:
  • Weeks 1–2: Take 25 mg every other day.
  • Weeks 3–4: Take 25 mg per day.
  • Week 5: Take 50 mg per day.
  • Week 6: Take 100 mg per day.
  • Week 7: Take 150 mg per day.
  • Maintenance: Take 200–250 mg per day.
• NOT TAKING carbamazepine, phenytoin, phenobarbital, primidone, or valproate:
  • Weeks 1–2: Take 25 mg every day.
  • Weeks 3–4: Take 50 mg per day.
  • Week 5: Take 100 mg per day.
  • Week 6: Take 150 mg per day.
  • Week 7: Take 200 mg per day.
  • Maintenance: Take 300–400 mg per day.
• TAKING carbamazepine, phenytoin, phenobarbital, or primidone and NOT TAKING valproate:
  • Weeks 1–2: Take 50 mg per day.
  • Weeks 3–4: Take 100 mg per day.
  • Week 5: Take 200 mg per day.
  • Week 6: Take 300 mg per day.
  • Week 7: Take 400 mg per day.
  • Maintenance: Take 400–600 mg per day.

Conversion from adjunctive therapy to monotherapy

Your doctor may choose to stop your other antiseizure medications and have you take lamotrigine by itself. This dosing will be different from what is outlined above.

Your doctor will slowly increase your dose of lamotrigine and slowly decrease the doses of your other antiseizure medications.

Conversion from immediate-release to extended-release (XR) lamotrigine

Your doctor can switch you directly from the immediate-release form of lamotrigine to the extended-release (XR) form. This dosing will be different from what is outlined above.

Once you switch to the XR form, your doctor will monitor you to make sure your seizures are under control. Your doctor may change your dose based on how you respond to treatment.

Child dosage (ages 2–12 years)

Immediate-release form (tablets, chewable tablets, orally disintegrating tablets)

• TAKING with valproate:
  • Weeks 1–2: Take 0.15 mg/kg per day, in 1–2 divided doses.
  • Weeks 3–4: Take 0.3 mg/kg per day, in 1–2 divided doses.
  • Week 5 onward: Your doctor will increase dose by 0.3 mg/kg per day every 1 to 2 weeks.
  • Maintenance: Take 1–5 mg/kg per day, in 1–2 divided doses (maximum of 200 mg per day).
• NOT TAKING carbamazepine, phenytoin, phenobarbital, primidone, or valproate:
  • Weeks 1–2: Take 0.3 mg/kg per day, in 1–2 divided doses.
  • Weeks 3–4: Take 0.6 mg/kg per day, in 2 divided doses
  • Week 5 onward: Your doctor will increase dose by 0.6 mg/kg per day every 1 to 2 weeks.
  • Maintenance: Take 4.5–7.5 mg/kg per day, in 2 divided doses (maximum of 300 mg per day).
• TAKING carbamazepine, phenytoin, phenobarbital, or primidone and NOT TAKING valproate:
  • Weeks 1–2: Take 0.6 mg/kg per day, in 2 divided doses.
  • Weeks 3–4: Take 1.2 mg/kg per day, in 2 divided doses.
  • Week 5 onward: Your doctor will increase dose by 1.2 mg/kg per day every 1 to 2 weeks.
  • Maintenance: Take 5–15 mg/kg per day, in 2 divided doses (maximum of 400 mg per day).

Extended-release form (tablets)

It has not been confirmed that lamotrigine is safe and effective for use in children younger than 13 years. It should not be used in these children.

Child dosage (ages 0–1 year)

Immediate-release form (tablets, chewable tablets, orally disintegrating tablets)

It has not been confirmed that these forms of lamotrigine are safe and effective for use in children younger than 2 years. They should not be used in these children.

Senior dosage (ages 65 years and older)

Older adults may process drugs more slowly. A typical adult dose may cause drug levels in your body to be higher than normal. This can be dangerous. To help avoid this, your doctor may start you on a lower dose or a different schedule.

Dosage for bipolar disorder

Adult dosage (ages 18–64 years)

Immediate-release form (tablets, chewable tablets, orally disintegrating tablets)

• TAKING with valproate:
  • Weeks 1–2: Take 25 mg every other day.
  • Weeks 3–4: Take 25 mg per day.
  • Week 5: Take 50 mg per day.
  • Week 6: Take 100 mg per day.
  • Week 7: Take 100 mg per day.
• NOT TAKING carbamazepine, phenytoin, phenobarbital, primidone, or valproate:
  • Weeks 1–2: Take 25 mg per day.
  • Weeks 3–4: Take 50 mg per day.
  • Week 5: Take 100 mg per day.
  • Week 6: Take 200 mg per day.
  • Week 7: Take 200 mg per day.
• TAKING carbamazepine, phenytoin, phenobarbital, or primidone and NOT TAKING valproate:
  • Weeks 1–2: Take 50 mg per day.
  • Weeks 3–4: Take 100 mg per day, in divided doses.
  • Week 5: Take 200 mg per day, in divided doses.
  • Week 6: Take 300 mg per day, in divided doses.
  • Week 7: Take up to 400 mg per day, in divided doses.

Child dosage (ages 0–17 years)

Immediate-release forms (tablets, chewable tablets, orally disintegrating tablets)

It has not been confirmed that these forms of lamotrigine are safe and effective for use in children younger than 18 years for the treatment of bipolar disorder. They should not be used in children in this age range for the treatment of bipolar disorder.

Senior dosage (ages 65 years and older)

Older adults may process drugs more slowly. A typical adult dosage may cause drug levels in your body to be higher than normal. This can be dangerous. To help avoid this, your doctor my start you on a lower dosage or a different dosing schedule.

Special dosage considerations

• For people with liver disease: If you have moderate to severe liver problems, your doctor may lower your dosage of lamotrigine.
• For people with kidney disease: If you have kidney problems, your doctor may lower your dosage of lamotrigine. If your kidney problems are severe, talk with your doctor about whether you should use this drug.

Dosage warnings

Your starting dosage of lamotrigine should not be higher than the recommended starting dosage. Also, your dosage should not be increased too quickly.

If your dosage is too high or increased too quickly, you’re at higher risk for a serious or life threatening skin rash.

If you’re taking this drug to treat seizures and are supposed to stop taking it, your doctor will slowly lower your dosage over at least 2 weeks. If your dosage isn’t slowly lowered and tapered off, you will be at increased risk for having more seizures.

Disclaimer: Our goal is to provide you with the most relevant and current information. However, because drugs affect each person differently, we cannot guarantee that this list includes all possible dosages. This information is not a substitute for medical advice. Always speak with your doctor or pharmacist about dosages that are right for you.

Lamotrigine oral tablet is used for long-term treatment. It comes with risks if you don’t take it as prescribed.

If you stop taking the drug suddenly or don’t take it at all: If you take this drug to treat seizures, stopping the drug suddenly or not taking it at all may cause serious problems. These include an increased risk of seizures.

They also include risk of a condition called status epilepticus (SE). With SE, short or long seizures occur for 30 minutes or more. SE is a medical emergency.

If you take this drug to treat bipolar disorder, stopping the drug suddenly or not taking it at all may cause serious problems. Your mood or behavior may get worse. You may need to be admitted to the hospital.

If you miss doses or don’t take the drug on schedule: Your medication may not work as well or may stop working completely. In order for this drug to work well, a certain amount needs to be in your body at all times.

If you take too much: You could have dangerous levels of the drug in your body. If you think you’ve taken too much of this drug, call your doctor or seek guidance from the American Association of Poison Control Centers at 1-800-222-1222 or through their online tool. But if your symptoms are severe, call 911 or go to the nearest emergency room right away.

What to do if you miss a dose: Take it as soon as you remember. If you remember just a few hours before the time for your next dose, only take one dose. Never try to catch up by taking two tablets at once. This could result in dangerous side effects.

How to tell if the drug is working: If you take this drug to treat seizures, you should have fewer seizures or less severe seizures. Be aware that you may not feel the full effect of this drug for several weeks.

If you take this drug to treat bipolar disorder, you should have fewer episodes of extreme moods. Be aware that you may not feel the full effect of this drug for several weeks.

Keep these considerations in mind if your doctor prescribes lamotrigine for you.

General

• All forms of this drug can be taken with or without food.
• Take this drug at the time(s) recommended by your doctor.
• You can cut or crush the chewable and regular oral tablets. You should not crush or cut the extended-release or orally disintegrating tablets.

Storage

• Store the oral, chewable, and extended-release tablets at room temperature at 77°F (25°C).
• Store orally disintegrating tablets at a temperature between 68°F and 77°F (20°C and 25°C).
• Keep these drugs away from light.
• Don’t store these drugs in moist or damp areas, such as bathrooms.

Refills

A prescription for this medication is refillable. You should not need a new prescription for this medication to be refilled. Your doctor will write the number of refills authorized on your prescription.

Travel

When traveling with your medication:

• Always carry your medication with you. When flying, never put it into a checked bag. Keep it in your carry-on bag.
• Don’t worry about airport X-ray machines. They can’t harm your medication.
• You may need to show airport staff the pharmacy label for your medication. Always carry the original prescription-labeled container with you.
• Don’t put this medication in your car’s glove compartment or leave it in the car. Be sure to avoid doing this when the weather is very hot or very cold.
• Swallow regular and extended-release tablets whole. If you have trouble swallowing, talk to your doctor. There may be another form of this drug you can take.
• If you’re taking an orally disintegrating tablet, place it under your tongue and move it around your mouth. The tablet will quickly dissolve. It can be swallowed with or without water.
• The chewable tablets can be swallowed whole or chewed. If you chew the tablets, drink a small amount of water, or fruit juice mixed with water, to help with swallowing. The tablets can also be mixed in water, or fruit juice mixed with water. Add the tablets to 1 teaspoon of liquid (or enough to cover the tablets) in a glass or spoon. Wait at least 1 minute or until the tablets are completely dissolved. Then mix the solution together and drink the whole amount.

Clinical monitoring

Your doctor will monitor you. During your treatment with this drug, you may have tests to check for:

• Liver problems: Blood tests will help your doctor decide if it’s safe for you to start taking the drug and if you need a lower dosage.
• Kidney problems: Blood tests will help your doctor decide if it’s safe for you to start taking the drug and if you need a lower dosage.
• Serious skin reactions: Your doctor will monitor you for symptoms of a serious skin reaction. These skin reactions can be life threatening.
• Suicidal thoughts and behaviors: Your doctor will monitor you for thoughts of hurting yourself or related behaviors. Call your doctor if you notice any sudden changes in your mood, behaviors, thoughts, or feelings.

In addition, if you take this drug to treat seizures, you and your doctor will need to monitor how often you have seizures. This will help you make sure that this drug is working for you.

And if you take this drug to treat bipolar disorder, you and your doctor will need to monitor how often you have mood episodes. This will help you make sure that this drug is working for you.

Availability

Not every pharmacy stocks this drug. When filling your prescription, be sure to call ahead to make sure your pharmacy carries it.

Prior authorization

Many insurance companies require a prior authorization for certain forms of this drug. This means your doctor will need to get approval from your insurance company before your insurance company will pay for the prescription.

There are other drugs available to treat your condition. Some may be better suited for you than others. Talk with your doctor about other drug options that may work for you.

Disclaimer: Healthline has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or other healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.