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LAMICTAL

lamotrigine · Kit

Prescription NDA TE AB RLD Official labelling
Informational index, not medical advice. Content is reproduced from public FDA and NLM data. Always confirm against the manufacturer's current prescribing information.

Overview

Brand name
LAMICTAL ODT
Generic name
lamotrigine
Dosage form
Kit
Route
—
Marketing category
NDA · NDA
Labeler
GlaxoSmithKline LLC
Product type
Human Prescription Drug
DEA schedule
Not scheduled
Active ingredients
0
NDC product codes
8
Packages
8
Data completeness
82% of corroborating sources present

Forms, strengths and routes

Source: NDC Directory
Dosage form
Kit
Route of administration
—
Presentations
16

Regulatory status

Source: Drugs@FDANDC Directory
Application number
022251
Application type
NDA · New Drug Application
Approval date
May 8, 2009
Sponsor
GLAXOSMITHKLINE LLC
Products on application
4
Submissions recorded
26
Products approved under application 022251.
Product Trade name Form Strength Ingredient Status TE Flags
022251-001 LAMICTAL ODT TABLET, ORALLY DISINTEGRATING LAMOTRIGINE Prescription AB RLD
022251-002 LAMICTAL ODT TABLET, ORALLY DISINTEGRATING LAMOTRIGINE Prescription AB RLD RS
022251-003 LAMICTAL ODT TABLET, ORALLY DISINTEGRATING LAMOTRIGINE Prescription AB RLD
022251-004 LAMICTAL ODT TABLET, ORALLY DISINTEGRATING LAMOTRIGINE Prescription AB RLD

Therapeutic equivalence

Source: Orange Book
TE code
AB
Reference Listed Drug
Yes
Reference Standard
Yes

What this rating means: Therapeutically equivalent — bioequivalence demonstrated by in vivo or in vitro testing

Codes beginning with “A” indicate products the FDA considers therapeutically equivalent. Codes beginning with “B” indicate bioequivalence has not been established. See methodology.

Approval history

Source: Drugs@FDA
Most recent submissions on application 022251.
Type No. Action Status Date Review
Supplement 33 Labeling Approved October 10, 2025 Standard
Supplement 32 Labeling Approved October 10, 2025 Standard
Supplement 31 Labeling Approved April 25, 2025 Standard
Supplement 30 Labeling Approved April 25, 2025 Standard
Supplement 28 Labeling Approved March 31, 2021 Standard
Supplement 22 Labeling Approved October 9, 2020 Standard
Supplement 26 Labeling Approved August 31, 2020 Standard
Supplement 25 Labeling Approved August 19, 2020 Standard
Supplement 24 Labeling Approved September 25, 2019 Standard
Supplement 23 Labeling Approved August 14, 2019 Standard
Supplement 20 Labeling Approved July 23, 2018 Standard
Supplement 21 Labeling Approved June 27, 2018 Standard
Supplement 17 Efficacy Approved May 18, 2015 Standard
Supplement 14 Labeling Approved March 24, 2015 Standard
Supplement 7 Labeling Approved March 24, 2015 Unknown
Supplement 9 Labeling Approved December 30, 2014 Unknown
Supplement 2 Labeling Approved December 30, 2014 Unknown
Supplement 16 Labeling Approved June 10, 2014 Standard
Supplement 1 Labeling Approved December 20, 2013 Unknown
Supplement 13 Labeling Approved August 1, 2012 Unknown
Supplement 12 Labeling Approved November 29, 2011 Unknown
Supplement 10 Labeling Approved August 4, 2011 Unknown
Supplement 11 REMS Approved May 31, 2011 N/A
Supplement 6 Labeling Approved October 24, 2010 Unknown
Supplement 5 REMS Approved October 24, 2010 N/A
Original application 1 Type 3 - New Dosage Form Approved May 8, 2009 Standard

Review documents

  • 0 · Supplement · October 15, 2025
  • 0 · Supplement · October 15, 2025
  • 0 · Supplement · October 14, 2025
  • 0 · Supplement · October 14, 2025
  • 0 · Supplement · October 14, 2025
  • 0 · Supplement · May 1, 2025
  • 0 · Supplement · May 1, 2025
  • 0 · Supplement · April 29, 2025
  • 0 · Supplement · April 29, 2025
  • 0 · Supplement · April 1, 2021
  • 0 · Supplement · April 1, 2021
  • 0 · Supplement · October 14, 2020
  • 0 · Supplement · October 14, 2020
  • 0 · Supplement · September 11, 2020
  • 0 · Supplement · September 11, 2020
  • 0 · Supplement · September 4, 2020
  • 0 · Supplement · September 1, 2020
  • 0 · Supplement · September 26, 2019
  • 0 · Supplement · September 26, 2019
  • 0 · Supplement · August 15, 2019
  • 0 · Supplement · August 15, 2019
  • 0 · Supplement · July 26, 2018
  • 0 · Supplement · July 26, 2018
  • 0 · Supplement · July 24, 2018
  • 0 · Supplement · July 6, 2018
  • 0 · Supplement · July 5, 2018
  • 0 · Supplement · May 21, 2015
  • 0 · Supplement · May 20, 2015
  • 0 · Supplement · March 25, 2015
  • 0 · Supplement · March 25, 2015

Prescribing information

Source: openFDA Drug Labeling

Reproduced verbatim from the Structured Product Labeling submitted to the FDA (effective 20251010). This is the manufacturer's labelling text, not a summary and not advice.

HUMAN PRESCRIPTION DRUG · 20251010

Boxed Warning

openFDA Drug Labeling

WARNING: SERIOUS SKIN RASHES LAMICTAL can cause serious rashes requiring hospitalization and discontinuation of treatment. The incidence of these rashes, which have included Stevens-Johnson syndrome, is approximately 0.3% to 0.8% in pediatric patients (aged 2 to 17 years) and 0.08% to 0.3% in adults receiving LAMICTAL. One rash-related death was reported in a prospectively followed cohort of 1,983 pediatric patients (aged 2 to 16 years) with epilepsy taking LAMICTAL as adjunctive therapy. In worldwide postmarketing experience, rare cases of toxic epidermal necrolysis and/or rash-related death have been reported in adult and pediatric patients, but their numbers are too few to permit a precise estimate of the rate. In addition to age, factors that may increase the risk of occurrence or the severity of rash caused by LAMICTAL include (1) coadministration of LAMICTAL with valproate (includes valproic acid and divalproex sodium), (2) exceeding the recommended initial dose of LAMICTAL, (3) exceeding the recommended dose escalation for LAMICTAL, or (4) the presence of the HLA-B*1502 allele. However, cases have occurred in the absence of these factors. Nearly all cases of life-threatening rashes caused by LAMICTAL have occurred within 2 to 8 weeks of treatment initiation. However, isolated cases have occurred after prolonged treatment (e.g., 6 months). Accordingly, duration of therapy cannot be relied upon as means to predict the potential risk heralded by the first appearance of a rash. Although benign rashes are also caused by LAMICTAL, it is not possible to predict reliably which rashes will prove to be serious or life threatening. Accordingly, LAMICTAL should ordinarily be discontinued at the first sign of rash, unless the rash is clearly not drug related. Discontinuation of treatment may not prevent a rash from becoming life threatening or permanently disabling or disfiguring [see Warnings and Precautions ( 5.1 )] . WARNING: SERIOUS SKIN RASHES See full prescribing information for complete boxed warning. • Cases of life-threatening serious rashes, including Stevens-Johnson syndrome and toxic epidermal necrolysis, and/or rash-related death have been caused by lamotrigine. The rate of serious rash is greater in pediatric patients than in adults. Additional factors that may increase the risk of rash include: o coadministration with valproate. o exceeding recommended initial dose of LAMICTAL. o exceeding recommended dose escalation for LAMICTAL. o presence of the HLA-B*1502 allele. ( 5.1 ) • Benign rashes are also caused by lamotrigine; however, it is not possible to predict which rashes will prove to be serious or life threatening. LAMICTAL should be discontinued at the first sign of rash, unless the rash is clearly not drug related. ( 5.1 )

Recent Major Changes

openFDA Drug Labeling

Boxed Warning 10/2025 Dosage and Administration ( 2.1 , 2.2 , 2.4 ) 4/2025 Warnings and Precautions, Serious Skin Rashes ( 5.1 ) Concomitant Use with Estrogen-Containing Products, Including Oral Contraceptives ( 5.9 ) Sudden Unexplained Death in Epilepsy (5.12) – removal 10/2025 4/2025 4/2025

Indications and Usage

openFDA Drug Labeling

1 INDICATIONS AND USAGE LAMICTAL is indicated for: Epilepsy—adjunctive therapy in patients aged 2 years and older: • partial-onset seizures. • primary generalized tonic-clonic (PGTC) seizures. • generalized seizures of Lennox-Gastaut syndrome. ( 1.1 ) Epilepsy—monotherapy in patients aged 16 years and older: Conversion to monotherapy in patients with partial-onset seizures who are receiving treatment with carbamazepine, phenytoin, phenobarbital, primidone, or valproate as the single antiepileptic drug. ( 1.1 ) Bipolar disorder: Maintenance treatment of bipolar I disorder to delay the time to occurrence of mood episodes in patients treated for acute mood episodes with standard therapy. ( 1.2 ) Limitations of Use: Treatment of acute manic or mixed episodes is not recommended. Effectiveness of LAMICTAL in the acute treatment of mood episodes has not been established. 1.1 Epilepsy Adjunctive Therapy LAMICTAL is indicated as adjunctive therapy for the following seizure types in patients aged 2 years and older: • partial-onset seizures. • primary generalized tonic-clonic (PGTC) seizures. • generalized seizures of Lennox-Gastaut syndrome. Monotherapy LAMICTAL is indicated for conversion to monotherapy in adults (aged 16 years and older) with partial-onset seizures who are receiving treatment with carbamazepine, phenytoin, phenobarbital, primidone, or valproate as the single antiepileptic drug (AED). Safety and effectiveness of LAMICTAL have not been established (1) as initial monotherapy; (2) for conversion to monotherapy from AEDs other than carbamazepine, phenytoin, phenobarbital, primidone, or valproate; or (3) for simultaneous conversion to monotherapy from 2 or more concomitant AEDs. 1.2 Bipolar Disorder LAMICTAL is indicated for the maintenance treatment of bipolar I disorder to delay the time to occurrence of mood episodes (depression, mania, hypomania, mixed episodes) in patients treated for acute mood episodes with standard therapy [see Clinical Studies ( 14.2 )] . Limitations of Use Treatment of acute manic or mixed episodes is not recommended. Effectiveness of LAMICTAL in the acute treatment of mood episodes has not been established.

Dosage and Administration

openFDA Drug Labeling

2 DOSAGE AND ADMINISTRATION • Dosing is based on concomitant medications, indication, and patient age. ( 2.1 , 2.2 , 2.3 , 2.4 ) • To avoid an increased risk of rash, the recommended initial dose and subsequent dose escalations should not be exceeded. LAMICTAL Starter Kits and LAMICTAL ODT Patient Titration Kits are available for the first 5 weeks of treatment. ( 2.1 , 16 ) • Do not restart LAMICTAL in patients who discontinued due to rash unless the potential benefits clearly outweigh the risks. ( 2.1 , 5.1 ) • Adjustments to maintenance doses will be necessary in most patients starting or stopping estrogen-containing products, including oral contraceptives. ( 2.1 , 5.9 ) • Discontinuation: Taper over a period of at least 2 weeks (approximately 50% dose reduction per week). ( 2.1 , 5.10 ) Epilepsy: • Adjunctive therapy—See Table 1 for patients older than 12 years and Tables 2 and 3 for patients aged 2 to 12 years. ( 2.2 ) • Conversion to monotherapy—See Table 4 . ( 2.3 ) Bipolar disorder: See Tables 5 and 6 . ( 2.4 ) 2.1 General Dosing Considerations Rash There are suggestions that the risk of severe, potentially life-threatening rash may be increased by (1) coadministration of LAMICTAL with valproate, (2) exceeding the recommended initial dose of LAMICTAL, or (3) exceeding the recommended dose escalation for LAMICTAL. However, cases have occurred in the absence of these factors [see Boxed Warning ]. Therefore, it is important that the dosing recommendations be followed closely. The risk of nonserious rash may be increased when the recommended initial dose and/or the rate of dose escalation for LAMICTAL is exceeded and in patients with a history of allergy or rash to other AEDs. LAMICTAL Starter Kits and LAMICTAL ODT Patient Titration Kits provide LAMICTAL at doses consistent with the recommended titration schedule for the first 5 weeks of treatment, based upon concomitant medications, for patients with epilepsy (older than 12 years) and bipolar I disorder (adults) and are intended to help reduce the potential for rash. The use of LAMICTAL Starter Kits and LAMICTAL ODT Patient Titration Kits is recommended for appropriate patients who are starting or restarting LAMICTAL [see How Supplied/Storage and Handling ( 16 )] . It is recommended that LAMICTAL not be restarted in patients who discontinued due to rash associated with prior treatment with lamotrigine unless the potential benefits clearly outweigh the risks. If the decision is made to restart a patient who has discontinued LAMICTAL, the need to restart with the initial dosing recommendations should be assessed. The greater the interval of time since the previous dose, the greater consideration should be given to restarting with the initial dosing recommendations. If a patient has discontinued lamotrigine for a period of more than 5 half-lives, it is recommended that initial dosing recommendations and guidelines be followed. The half-life of lamotrigine is affected by other concomitant medications [see Clinical Pharmacology ( 12.3 )] . LAMICTAL Added to Drugs Known to Induce or Inhibit Glucuronidation Because lamotrigine is metabolized predominantly by glucuronic acid conjugation, drugs that are known to induce or inhibit glucuronidation may affect the apparent clearance of lamotrigine. Drugs that induce glucuronidation include carbamazepine, phenytoin, phenobarbital, primidone, rifampin, estrogen-containing products, including oral contraceptives, and the protease inhibitors lopinavir/ritonavir and atazanavir/ritonavir. Valproate inhibits glucuronidation. For dosing considerations for LAMICTAL in patients on estrogen-containing products, including contraceptives, and atazanavir/ritonavir, see below and Table 13 . For dosing considerations for LAMICTAL in patients on other drugs known to induce or inhibit glucuronidation, see Tables 1 , 2 , 5 - 6 , and 13 . Target Plasma Levels for Patients with Epilepsy or Bipolar Disorder A therapeutic plasma concentration range has not b …

Dosage Forms and Strengths

openFDA Drug Labeling

3 DOSAGE FORMS AND STRENGTHS • Tablets: 25 mg, 100 mg, 150 mg, and 200 mg; scored. ( 3.1 , 16 ) • Tablets for oral suspension: 2 mg, 5 mg, and 25 mg. ( 3.2 , 16 ) • Orally disintegrating tablets: 25 mg, 50 mg, 100 mg, and 200 mg. ( 3.3 , 16 ) 3.1 Tablets 25-mg, white, scored, shield-shaped tablets debossed with “LAMICTAL” and “25.” 100-mg, peach, scored, shield-shaped tablets debossed with “LAMICTAL” and “100.” 150-mg, cream, scored, shield-shaped tablets debossed with “LAMICTAL” and “150.” 200-mg, blue, scored, shield-shaped tablets debossed with “LAMICTAL” and “200.” 3.2 Tablets for Oral Suspension 2-mg, white to off-white, round tablets debossed with “LTG” over “2.” 5-mg, white to off-white, caplet-shaped tablets debossed with “GX CL2.” 25-mg, white, super elliptical-shaped tablets debossed with “GX CL5.” 3.3 Orally Disintegrating Tablets 25-mg, white to off-white, round, flat-faced, radius-edged tablets debossed with “LMT” on one side and “25” on the other side. 50-mg, white to off-white, round, flat-faced, radius-edged tablets debossed with “LMT” on one side and “50” on the other side. 100-mg, white to off-white, round, flat-faced, radius-edged tablets debossed with “LAMICTAL” on one side and “100” on the other side. 200-mg, white to off-white, round, flat-faced, radius-edged tablets debossed with “LAMICTAL” on one side and “200” on the other side.

Contraindications

openFDA Drug Labeling

4 CONTRAINDICATIONS LAMICTAL is contraindicated in patients who have demonstrated hypersensitivity (e.g., rash, angioedema, acute urticaria, extensive pruritus, mucosal ulceration) to the drug or its ingredients [see Boxed Warning , Warnings and Precautions ( 5.1 , 5.3 )]. Hypersensitivity to the drug or its ingredients. ( Boxed Warning , 4 )

Warnings and Cautions

openFDA Drug Labeling

5 WARNINGS AND PRECAUTIONS • Life-threatening serious rash and/or rash-related death: Discontinue at the first sign of rash, unless the rash is clearly not drug related. ( Boxed Warning , 5.1 ) • Hemophagocytic lymphohistiocytosis: Consider this diagnosis and evaluate patients immediately if they develop signs or symptoms of systemic inflammation. Discontinue LAMICTAL if an alternative etiology is not established. ( 5.2 ) • Fatal or life-threatening hypersensitivity reaction: Multiorgan hypersensitivity reactions, also known as drug reaction with eosinophilia and systemic symptoms, may be fatal or life threatening. Early signs may include rash, fever, and lymphadenopathy. These reactions may be associated with other organ involvement, such as hepatitis, hepatic failure, blood dyscrasias, or acute multiorgan failure. LAMICTAL should be discontinued if alternate etiology for this reaction is not found. ( 5.3 ) • Cardiac rhythm and conduction abnormalities: Based on in vitro findings, LAMICTAL could cause serious arrhythmias and/or death in patients with certain underlying cardiac disorders or arrhythmias. Any expected or observed benefit of LAMICTAL in an individual patient with clinically important structural or functional heart disease must be carefully weighed against the risk for serious arrythmias and/or death for that patient. ( 5.4 ) • Blood dyscrasias (e.g., neutropenia, thrombocytopenia, pancytopenia): May occur, either with or without an associated hypersensitivity syndrome. Monitor for signs of anemia, unexpected infection, or bleeding. ( 5.5 ) • Suicidal behavior and ideation: Monitor for suicidal thoughts or behaviors. ( 5.6 ) • Aseptic meningitis: Monitor for signs of meningitis. ( 5.7 ) • Medication errors due to product name confusion: Strongly advise patients to visually inspect tablets to verify the received drug is correct. ( 5.8 , 16 , 17 ) 5.1 Serious Skin Rashes [see Boxed Warning] Pediatric Population The incidence of serious rash associated with hospitalization and discontinuation of LAMICTAL in a prospectively followed cohort of pediatric patients (aged 2 to 17 years) is approximately 0.3% to 0.8%. One rash-related death was reported in a prospectively followed cohort of 1,983 pediatric patients (aged 2 to 16 years) with epilepsy taking LAMICTAL as adjunctive therapy. Additionally, there have been rare cases of toxic epidermal necrolysis (TEN) with and without permanent sequelae and/or death in U.S. and foreign postmarketing experience. There is evidence that the inclusion of valproate in a multidrug regimen increases the risk of serious, potentially life-threatening rash in pediatric patients. In pediatric patients who used valproate concomitantly for epilepsy, 1.2% (6 of 482) experienced a serious rash compared with 0.6% (6 of 952) patients not taking valproate. Adult Population Serious rash associated with hospitalization and discontinuation of LAMICTAL occurred in 0.3% (11 of 3,348) of adult patients who received LAMICTAL in premarketing clinical trials of epilepsy. In the bipolar and other mood disorders clinical trials, the rate of serious rash was 0.08% (1 of 1,233) of adult patients who received LAMICTAL as initial monotherapy and 0.13% (2 of 1,538) of adult patients who received LAMICTAL as adjunctive therapy. No fatalities occurred among these individuals. However, in worldwide postmarketing experience, rare cases of rash-related death have been reported, but their numbers are too few to permit a precise estimate of the rate. Among the rashes leading to hospitalization were Stevens-Johnson syndrome, toxic epidermal necrolysis, angioedema, and those associated with multiorgan hypersensitivity [see Warnings and Precautions ( 5.3 )] . Risk Factors Concomitant Use of Valproate There is evidence that the inclusion of valproate in a multidrug regimen increases the risk of serious, potentially life-threatening rash in adults. Specifically, of 584 patients administered LAMICTAL with valproate in epilep …

Adverse Reactions

openFDA Drug Labeling

6 ADVERSE REACTIONS The following serious adverse reactions are described in more detail in the Warnings and Precautions section of the labeling: • Serious Skin Rashes [see Warnings and Precautions ( 5.1 )] • Hemophagocytic Lymphohistiocytosis [see Warnings and Precautions ( 5.2 )] • Multiorgan Hypersensitivity Reactions and Organ Failure [see Warnings and Precautions ( 5.3 )] • Cardiac Rhythm and Conduction Abnormalities [see Warnings and Precautions ( 5.4 )] • Blood Dyscrasias [see Warnings and Precautions ( 5.5 )] • Suicidal Behavior and Ideation [see Warnings and Precautions ( 5.6 )] • Aseptic Meningitis [see Warnings and Precautions ( 5.7 )] • Withdrawal Seizures [see Warnings and Precautions ( 5.10 )] • Status Epilepticus [see Warnings and Precautions ( 5.11 )] Epilepsy: Most common adverse reactions (incidence ≥10%) in adults were dizziness, headache, diplopia, ataxia, nausea, blurred vision, somnolence, rhinitis, pharyngitis, and rash. Additional adverse reactions (incidence ≥10%) reported in children included vomiting, infection, fever, accidental injury, diarrhea, abdominal pain, and tremor. ( 6.1 ) Bipolar disorder: Most common adverse reactions (incidence >5%) in adults were nausea, insomnia, somnolence, back pain, fatigue, rash, rhinitis, abdominal pain, and xerostomia. ( 6.1 ) To report SUSPECTED ADVERSE REACTIONS, contact GlaxoSmithKline at 1-888-825-5249 or FDA at 1-800-FDA-1088 or www.fda.gov/medwatch . 6.1 Clinical Trial Experience Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared with rates in the clinical trials of another drug and may not reflect the rates observed in practice. Epilepsy Most Common Adverse Reactions in All Clinical Trials: Adjunctive Therapy in Adults with Epilepsy: The most commonly observed (≥5% for LAMICTAL and more common on drug than placebo) adverse reactions seen in association with LAMICTAL during adjunctive therapy in adults and not seen at an equivalent frequency among placebo-treated patients were: dizziness, ataxia, somnolence, headache, diplopia, blurred vision, nausea, vomiting, and rash. Dizziness, diplopia, ataxia, blurred vision, nausea, and vomiting were dose related. Dizziness, diplopia, ataxia, and blurred vision occurred more commonly in patients receiving carbamazepine with LAMICTAL than in patients receiving other AEDs with LAMICTAL. Clinical data suggest a higher incidence of rash, including serious rash, in patients receiving concomitant valproate than in patients not receiving valproate [see Warnings and Precautions ( 5.1 )] . Approximately 11% of the 3,378 adult patients who received LAMICTAL as adjunctive therapy in premarketing clinical trials discontinued treatment because of an adverse reaction. The adverse reactions most commonly associated with discontinuation were rash (3.0%), dizziness (2.8%), and headache (2.5%). In a dose-response trial in adults, the rate of discontinuation of LAMICTAL for dizziness, ataxia, diplopia, blurred vision, nausea, and vomiting was dose related. Monotherapy in Adults with Epilepsy: The most commonly observed (≥5% for LAMICTAL and more common on drug than placebo) adverse reactions seen in association with the use of LAMICTAL during the monotherapy phase of the controlled trial in adults not seen at an equivalent rate in the control group were vomiting, coordination abnormality, dyspepsia, nausea, dizziness, rhinitis, anxiety, insomnia, infection, pain, weight decrease, chest pain, and dysmenorrhea. The most commonly observed (≥5% for LAMICTAL and more common on drug than placebo) adverse reactions associated with the use of LAMICTAL during the conversion to monotherapy (add-on) period, not seen at an equivalent frequency among low-dose valproate-treated patients, were dizziness, headache, nausea, asthenia, coordination abnormality, vomiting, rash, somnolence, diplopia, ataxia, accidental injury, tremor, blurred vi …

Drug Interactions

openFDA Drug Labeling

7 DRUG INTERACTIONS Significant drug interactions with LAMICTAL are summarized in this section. Uridine 5 ́-diphospho-glucuronyl transferases (UGT) have been identified as the enzymes responsible for metabolism of lamotrigine. Drugs that induce or inhibit glucuronidation may, therefore, affect the apparent clearance of lamotrigine. Strong or moderate inducers of the cytochrome P450 3A4 (CYP3A4) enzyme, which are also known to induce UGT, may also enhance the metabolism of lamotrigine. Those drugs that have been demonstrated to have a clinically significant impact on lamotrigine metabolism are outlined in Table 13 . Specific dosing guidance for these drugs is provided in the Dosage and Administration section, and, for women taking estrogen‐containing products, including oral contraceptives, in the Warnings and Precautions section [see Dosage and Administration ( 2.1 ), Warnings and Precautions ( 5.9 )] . Additional details of these drug interaction studies are provided in the Clinical Pharmacology section [see Clinical Pharmacology ( 12.3 )] . Table 13. Established and Other Potentially Significant Drug Interactions ↓ = Decreased (induces lamotrigine glucuronidation). ↑ = Increased (inhibits lamotrigine glucuronidation). ? = Conflicting data. Concomitant Drug Effect on Concentration of Lamotrigine or Concomitant Drug Clinical Comment Estrogen-containing oral contraceptive preparations containing 30 mcg ethinylestradiol and 150 mcg levonorgestrel ↓ lamotrigine ↓ levonorgestrel Decreased lamotrigine concentrations approximately 50%. Decrease in levonorgestrel component by 19%. Carbamazepine and carbamazepine epoxide ↓ lamotrigine ? carbamazepine epoxide Addition of carbamazepine decreases lamotrigine concentration approximately 40%. May increase carbamazepine epoxide levels. Lopinavir/ritonavir ↓ lamotrigine Decreased lamotrigine concentration approximately 50%. Atazanavir/ritonavir ↓ lamotrigine Decreased lamotrigine AUC approximately 32%. Phenobarbital/primidone ↓ lamotrigine Decreased lamotrigine concentration approximately 40%. Phenytoin ↓ lamotrigine Decreased lamotrigine concentration approximately 40%. Rifampin ↓ lamotrigine Decreased lamotrigine AUC approximately 40%. Valproate ↑ lamotrigine ? valproate Increased lamotrigine concentrations slightly more than 2-fold. There are conflicting study results regarding effect of lamotrigine on valproate concentrations: 1) a mean 25% decrease in valproate concentrations in healthy volunteers, 2) no change in valproate concentrations in controlled clinical trials in patients with epilepsy. Effect of LAMICTAL on Organic Cationic Transporter 2 Substrates Lamotrigine is an inhibitor of renal tubular secretion via organic cationic transporter 2 (OCT2) proteins [see Clinical Pharmacology ( 12.3 )] . This may result in increased plasma levels of certain drugs that are substantially excreted via this route. Coadministration of LAMICTAL with OCT2 substrates with a narrow therapeutic index (e.g., dofetilide) is not recommended. • Valproate increases lamotrigine concentrations more than 2-fold. ( 7 , 12.3 ) • Carbamazepine, phenytoin, phenobarbital, primidone, and rifampin decrease lamotrigine concentrations by approximately 40%. ( 7 , 12.3 ) • Estrogen-containing oral contraceptives decrease lamotrigine concentrations by approximately 50%. ( 7 , 12.3 ) • Protease inhibitors lopinavir/ritonavir and atazanavir/lopinavir decrease lamotrigine exposure by approximately 50% and 32%, respectively. ( 7 , 12.3 ) • Coadministration with organic cationic transporter 2 substrates with narrow therapeutic index is not recommended ( 7 , 12.3 )

Use in Specific Populations

openFDA Drug Labeling

8 USE IN SPECIFIC POPULATIONS • Pregnancy: Based on animal data may cause fetal harm. ( 8.1 ) • Hepatic impairment: Dosage adjustments required in patients with moderate and severe liver impairment. ( 2.1 , 8.6 ) • Renal impairment: Reduced maintenance doses may be effective for patients with significant renal impairment. ( 2.1 , 8.7 ) 8.1 Pregnancy Pregnancy Exposure Registry There is a pregnancy exposure registry that monitors pregnancy outcomes in women exposed to AEDs, including LAMICTAL, during pregnancy. Encourage women who are taking LAMICTAL during pregnancy to enroll in the North American Antiepileptic Drug (NAAED) Pregnancy Registry by calling 1-888-233-2334 or visiting http://www.aedpregnancyregistry.org/. Risk Summary Data from several prospective pregnancy exposure registries and epidemiological studies of pregnant women have not detected an increased frequency of major congenital malformations or a consistent pattern of malformations among women exposed to lamotrigine compared with the general population (see Data) . The majority of LAMICTAL pregnancy exposure data are from women with epilepsy. In animal studies, administration of lamotrigine during pregnancy resulted in developmental toxicity (increased mortality, decreased body weight, increased structural variation, neurobehavioral abnormalities) at doses lower than those administered clinically. Lamotrigine decreased fetal folate concentrations in rats, an effect known to be associated with adverse pregnancy outcomes in animals and humans (see Data) . In the U.S. general population, the estimated background risk of major birth defects and miscarriage in clinically recognized pregnancies is 2% to 4% and 15% to 20%, respectively. Clinical Considerations Disease-associated Maternal and/or Embryofetal Risk Epilepsy, with or without exposure to antiepileptic drugs, has been associated with several adverse outcomes during pregnancy, including preeclampsia, preterm labor, antepartum and postpartum hemorrhage, placental abruption, poor fetal growth, prematurity, fetal death, and maternal mortality. The risk of maternal or fetal injury may be greatest for patients with untreated or poorly controlled convulsive seizures. Women with epilepsy who become pregnant should not abruptly discontinue antiepileptic drugs, including LAMICTAL, due to the risk of status epilepticus or severe seizures, which may be life-threatening [see Warnings and Precautions ( 5.10 )]. Dose Adjustments During Pregnancy and the Postpartum Period As with other AEDs, physiological changes during pregnancy may affect lamotrigine concentrations and/or therapeutic effect. There have been reports of decreased lamotrigine concentrations during pregnancy and restoration of pre-pregnancy concentrations after delivery. Dose adjustments may be necessary to maintain clinical response. Data Human Data: Data from several international pregnancy registries have not shown an increased risk for malformations overall. The International Lamotrigine Pregnancy Registry reported major congenital malformations in 2.2% (95% CI: 1.6%, 3.1%) of 1,558 infants exposed to lamotrigine monotherapy in the first trimester of pregnancy. The NAAED Pregnancy Registry reported major congenital malformations among 2.0% of 1,562 infants exposed to lamotrigine monotherapy in the first trimester. EURAP, a large international pregnancy registry focused outside of North America, reported major birth defects in 2.9% (95% CI: 2.3%, 3.7%) of 2,514 exposures to lamotrigine monotherapy in the first trimester. The frequency of major congenital malformations was similar to estimates from the general population. The NAAED Pregnancy Registry observed an increased risk of isolated oral clefts: among 2,200 infants exposed to lamotrigine early in pregnancy, the risk of oral clefts was 3.2 per 1,000 (95% CI: 1.4, 6.3), a 3-fold increased risk versus unexposed healthy controls. This finding has not been observed in other large international pregnancy re …

Mechanism of Action

openFDA Drug Labeling

12.1 Mechanism of Action The precise mechanism(s) by which lamotrigine exerts its anticonvulsant action are unknown. In animal models designed to detect anticonvulsant activity, lamotrigine was effective in preventing seizure spread in the maximum electroshock (MES) and pentylenetetrazol (scMet) tests, and prevented seizures in the visually and electrically evoked after-discharge (EEAD) tests for antiepileptic activity. Lamotrigine also displayed inhibitory properties in the kindling model in rats both during kindling development and in the fully kindled state. The relevance of these models to human epilepsy, however, is not known. One proposed mechanism of action of lamotrigine, the relevance of which remains to be established in humans, involves an effect on sodium channels. In vitro pharmacological studies suggest that lamotrigine inhibits voltage-sensitive sodium channels, thereby stabilizing neuronal membranes and consequently modulating presynaptic transmitter release of excitatory amino acids (e.g., glutamate and aspartate). Effect of Lamotrigine on N-Methyl d-Aspartate-Receptor–Mediated Activity Lamotrigine did not inhibit N-methyl d-aspartate (NMDA)-induced depolarizations in rat cortical slices or NMDA-induced cyclic GMP formation in immature rat cerebellum, nor did lamotrigine displace compounds that are either competitive or noncompetitive ligands at this glutamate receptor complex (CNQX, CGS, TCHP). The IC 50 for lamotrigine effects on NMDA-induced currents (in the presence of 3 μM of glycine) in cultured hippocampal neurons exceeded 100 μM. The mechanisms by which lamotrigine exerts its therapeutic action in bipolar disorder have not been established.

Description

openFDA Drug Labeling

11 DESCRIPTION LAMICTAL (lamotrigine), an AED of the phenyltriazine class, is chemically unrelated to existing AEDs. Lamotrigine’s chemical name is 3,5-diamino-6-(2,3-dichlorophenyl)- as -triazine, its molecular formula is C 9 H 7 N 5 Cl 2 , and its molecular weight is 256.09. Lamotrigine is a white to pale cream-colored powder and has a pK a of 5.7. Lamotrigine is very slightly soluble in water (0.17 mg/mL at 25°C) and slightly soluble in 0.1 M HCl (4.1 mg/mL at 25°C). The structural formula is: LAMICTAL tablets are supplied for oral administration as 25-mg (white), 100-mg (peach), 150-mg (cream), and 200-mg (blue) tablets. Each tablet contains the labeled amount of lamotrigine and the following inactive ingredients: lactose; magnesium stearate; microcrystalline cellulose; povidone; sodium starch glycolate; FD&C Yellow No. 6 Lake (100-mg tablet only); ferric oxide, yellow (150-mg tablet only); and FD&C Blue No. 2 Lake (200-mg tablet only). LAMICTAL tablets for oral suspension are supplied for oral administration. The tablets contain 2 mg (white), 5 mg (white), or 25 mg (white) of lamotrigine and the following inactive ingredients: blackcurrant flavor, calcium carbonate, low-substituted hydroxypropylcellulose, magnesium aluminum silicate, magnesium stearate, povidone, saccharin sodium, and sodium starch glycolate. The tablets for oral suspension meet Organic Impurities Procedure 2 as published in the current USP monograph for Lamotrigine Tablets for Oral Suspension. LAMICTAL ODT orally disintegrating tablets are supplied for oral administration. The tablets contain 25 mg (white to off-white), 50 mg (white to off-white), 100 mg (white to off-white), or 200 mg (white to off-white) of lamotrigine and the following inactive ingredients: artificial cherry flavor, crospovidone, ethylcellulose, magnesium stearate, mannitol, polyethylene, and sucralose. LAMICTAL ODT orally disintegrating tablets are formulated using technologies (Microcaps and AdvaTab) designed to mask the bitter taste of lamotrigine and achieve a rapid dissolution profile. Tablet characteristics including flavor, mouth-feel, after-taste, and ease of use were rated as favorable in a study in 108 healthy volunteers. lamotrigine chemical structure

10 OVERDOSAGE 10.1 Human Overdose Experience Overdoses involving quantities up to 15 g have been reported for LAMICTAL, some of which have been fatal. Overdose has resulted in ataxia, nystagmus, seizures (including tonic-clonic seizures), decreased level of consciousness, coma, and intraventricular conduction delay. 10.2 Management of Overdose There are no specific antidotes for lamotrigine. Following a suspected overdose, hospitalization of the patient is advised. General supportive care is indicated, including frequent monitoring of vital signs and close observation of the patient. If indicated, emesis should be induced; usual precautions should be taken to protect the airway. It should be kept in mind that immediate-release lamotrigine is rapidly absorbed [see Clinical Pharmacology ( 12.3 )] . It is uncertain whether hemodialysis is an effective means of removing lamotrigine from the blood. In 6 renal failure patients, about 20% of the amount of lamotrigine in the body was removed by hemodialysis during a 4-hour session. A Poison Control Center should be contacted for information on the management of overdosage of LAMICTAL.

How Supplied / Storage and Handling

openFDA Drug Labeling

16 HOW SUPPLIED/STORAGE AND HANDLING LAMICTAL (lamotrigine) tablets 25-mg, white, scored, shield-shaped tablets debossed with “LAMICTAL” and “25”, bottles of 100 (NDC 0173-0633-02). Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F) [see USP Controlled Room Temperature] in a dry place. 100-mg, peach, scored, shield-shaped tablets debossed with “LAMICTAL” and “100”, bottles of 100 (NDC 0173-0642-55). 150-mg, cream, scored, shield-shaped tablets debossed with “LAMICTAL” and “150”, bottles of 60 (NDC 0173-0643-60). 200-mg, blue, scored, shield-shaped tablets debossed with “LAMICTAL” and “200”, bottles of 60 (NDC 0173-0644-60). Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F) [see USP Controlled Room Temperature] in a dry place and protect from light. LAMICTAL (lamotrigine) Starter Kit for Patients Taking Valproate (Blue Kit) 25-mg, white, scored, shield-shaped tablets debossed with “LAMICTAL” and “25”, blister pack of 35 tablets (NDC 0173-0633-10). Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F) [see USP Controlled Room Temperature] in a dry place. LAMICTAL (lamotrigine) Starter Kit for Patients Taking Carbamazepine, Phenytoin, Phenobarbital, or Primidone and Not Taking Valproate (Green Kit) 25-mg, white, scored, shield-shaped tablets debossed with “LAMICTAL” and “25” and 100 mg, peach, scored, shield-shaped tablets debossed with “LAMICTAL” and “100”, blister pack of 98 tablets (84/25-mg tablets and 14/100-mg tablets) (NDC 0173-0817-28). Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F) [see USP Controlled Room Temperature] in a dry place and protect from light. LAMICTAL (lamotrigine) Starter Kit for Patients Not Taking Carbamazepine, Phenytoin, Phenobarbital, Primidone, or Valproate (Orange Kit) 25-mg, white, scored, shield-shaped tablets debossed with “LAMICTAL” and “25” and 100 mg, peach, scored, shield-shaped tablets debossed with “LAMICTAL” and “100”, blister pack of 49 tablets (42/25-mg tablets and 7/100-mg tablets) (NDC 0173-0594-02). Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F) [see USP Controlled Room Temperature] in a dry place and protect from light. LAMICTAL (lamotrigine) tablets for oral suspension 2-mg, white to off-white, round tablets debossed with “LTG” over “2”, bottles of 30 (NDC 0173-0699-00). ORDER DIRECTLY FROM GlaxoSmithKline 1-800-334-4153. 5-mg, white to off-white, caplet-shaped tablets debossed with “GX CL2”, bottles of 100 (NDC 0173-0526-00). 25-mg, white, super elliptical-shaped tablets debossed with “GX CL5”, bottles of 100 (NDC 0173-0527-00). Store at 25°C (77°F); excursions permitted to 15°C to 30°C (59°F to 86°F) [see USP Controlled Room Temperature] in a dry place. LAMICTAL ODT (lamotrigine) orally disintegrating tablets 25-mg, white to off-white, round, flat-faced, radius-edged tablets debossed with “LMT” on one side and “25” on the other, Maintenance Packs of 30 (NDC 0173-0772-02). 50-mg, white to off-white, round, flat-faced, radius-edged tablets debossed with “LMT” on one side and “50” on the other, Maintenance Packs of 30 (NDC 0173-0774-02). 100-mg, white to off-white, round, flat-faced, radius-edged tablets debossed with “LAMICTAL” on one side and “100” on the other, Maintenance Packs of 30 (NDC 0173-0776-02). 200-mg, white to off-white, round, flat-faced, radius-edged tablets debossed with “LAMICTAL” on one side and “200” on the other, Maintenance Packs of 30 (NDC 0173-0777-02). Store between 20°C and 25°C (68°F and 77°F); with excursions permitted between 15°C and 30°C (59°F and 86°F). LAMICTAL ODT (lamotrigine) Patient Titration Kit for Patients Taking Valproate (Blue ODT Kit) 25-mg, white to off-white, round, flat-faced, radius-edged tablets debossed with “LMT” on one side and “25” on the other, and 50 mg, white to off-white, round, flat-faced, radius-edged tablets debossed with “LMT” on one side and “50” on the other, blister pack of 28 tablets (21/25-mg tablets …

Packaging and NDCs

Source: NDC Directory
Every National Drug Code package associated with this medication. The NDC is the identifier used for dispensing, billing and pharmacovigilance in the United States.
Package NDC Product NDC Labeler Description Marketing start
0173-0594-02 0173-0594 GlaxoSmithKline LLC 1 BLISTER PACK in 1 PACKAGE, COMBINATION (0173-0594-02) / 1 KIT in 1 BLISTER PACK September 29, 2003
0173-0758-00 0173-0758 GlaxoSmithKline LLC 1 BLISTER PACK in 1 PACKAGE, COMBINATION (0173-0758-00) / 1 KIT in 1 BLISTER PACK July 6, 2009
0173-0759-00 0173-0759 GlaxoSmithKline LLC 1 BLISTER PACK in 1 PACKAGE, COMBINATION (0173-0759-00) / 1 KIT in 1 BLISTER PACK July 6, 2009
0173-0760-00 0173-0760 GlaxoSmithKline LLC 1 BLISTER PACK in 1 PACKAGE, COMBINATION (0173-0760-00) / 1 KIT in 1 BLISTER PACK July 6, 2009
0173-0778-00 0173-0778 GlaxoSmithKline LLC 1 BLISTER PACK in 1 PACKAGE, COMBINATION (0173-0778-00) / 1 KIT in 1 BLISTER PACK June 5, 2009
0173-0779-00 0173-0779 GlaxoSmithKline LLC 1 BLISTER PACK in 1 PACKAGE, COMBINATION (0173-0779-00) / 1 KIT in 1 BLISTER PACK June 5, 2009
0173-0780-00 0173-0780 GlaxoSmithKline LLC 1 BLISTER PACK in 1 PACKAGE, COMBINATION (0173-0780-00) / 1 KIT in 1 BLISTER PACK June 5, 2009
0173-0817-28 0173-0817 GlaxoSmithKline LLC 1 BLISTER PACK in 1 PACKAGE, COMBINATION (0173-0817-28) / 1 KIT in 1 BLISTER PACK September 29, 2003
0173-0594 0173-0594 GlaxoSmithKline LLC — September 29, 2003
0173-0758 0173-0758 GlaxoSmithKline LLC — July 6, 2009
0173-0759 0173-0759 GlaxoSmithKline LLC — July 6, 2009
0173-0760 0173-0760 GlaxoSmithKline LLC — July 6, 2009
0173-0778 0173-0778 GlaxoSmithKline LLC — June 5, 2009
0173-0779 0173-0779 GlaxoSmithKline LLC — June 5, 2009
0173-0780 0173-0780 GlaxoSmithKline LLC — June 5, 2009
0173-0817 0173-0817 GlaxoSmithKline LLC — September 29, 2003

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Orange Book FDA Therapeutic equivalence codes, reference drug flags, patents, exclusivity
Drug Labeling FDA / NLM Prescribing information reproduced above

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