Lamotrigine (LaMICtal®)

Last Update: 18 Nov 2024

Medication

Table of content

1. What Is Lamotrigine? 2. Lamotrigine During Pregnancy 3. Risks 4. Benefits 5. Breastfeeding 6. Key Takeaways 7. Limits of Research

Welcome to our Fact Sheet on lamotrigine (LaMICtal®), during pregnancy and breastfeeding. The information given is based on current research and may be updated with new scientific knowledge. This information does not replace personalized advice from healthcare professionals.

1. What Is Lamotrigine?

Lamotrigine, also known by its brand name Lamictal®, is an anti-seizure medication (ASMs) used to treat several conditions, including the following:

Epilepsy as it helps manage seizures
Bipolar disorder as it helps stabilize mood as well as depersonalization disorder and obsessive-compulsive disorder (OCD)
Certain types of neuropathic pain, like trigeminal neuralgia (intense nerve pain in the face).

Lamotrigine primarily works by calming the brain’s electrical activity. This medication functions like a traffic controller, calming the overly active neurons in the brain and preventing them from sending too many signals. This helps prevent the sudden bursts of electrical activity that can cause seizures.

In our brain, we have sodium channels that act like traffic lights on a busy road. When the light is green, these channels allow particles called sodium (salt) to pass through, which helps send electrical signals. These signals tell our body what to do, like move our arms or feel emotions. When there’s a problem, such as a seizure, there are too many signals happening at the same time. Lamotrigine stabilizes these sodium channels to prevent surges of electrical activity that can cause seizures. It acts like a traffic controller, making sure the traffic flows smoothly without spikes or blockages.

Additionally, lamotrigine may also calm the brain’s electrical activity in another way. It reduces the amount of a neurotransmitter tooltip called glutamate, which excites nerve cells. So, with lamotrigine, the cars (signals) slow down instead of speeding up.

How can I prepare a pregnancy with epilepsy?

Learn more

2. Can I Take Lamotrigine During Pregnancy?

If you’re pregnant and taking lamotrigine, it’s important to continue your treatment until you can talk to your healthcare professional. Suddenly stopping lamotrigine can cause seizures, which can be dangerous for both you and your baby.

Studies shows that continuing lamotrigine during pregnancy does not greatly increase the risk of serious congenital malformations (birth defects).

If you need to start lamotrigine while you’re pregnant, your healthcare provider will carefully consider the advantages and risks of the treatment and medical conditions. They may adjust your dosage to find the best option for you and your baby throughout your pregnancy.

It’s important to have regular check-ups on lamotrigine levels during pregnancy because the way your body absorbs the medication can change throughout the trimesters. Sometimes, pregnancy can make the medication less effective, which may increase the risk of seizures.

Always consult your healthcare provider before making any changes to your medication during pregnancy to ensure the best care for both of you.

Note: Its important to inform your healthcare professional that you gave birth right away, since medications adjustments may be necessary early on to avoid side effects from dose changes made during pregnancy.

3. What Are the Risks of Lamotrigine Associated with Pregnancy?

As with any medication, it’s important to talk to your healthcare team to evaluate the advantages and potential risks so that you and your baby can get the best care.

Miscarriages, congenital malformations tooltip, premature births and other complications can occur in any pregnancy for many different reasons. This is known as the background risk. Here, we compare this background risk with the risks associated with taking the medication.

Lamotrigine is generally considered one of the preferred anti-seizure medication to use during pregnancy, but like all medications, it carries some risks.

The main potential risk is congenital malformation, but studies show that this risk is lower compared to other epilepsy medications. The risk of congenital malformations with lamotrigine is generally considered similar to the background risk, particularly when used as monotherapy (a single drug) at the lowest effective dose.

At this time, it’s unclear whether lamotrigine increases the risk of miscarriage, birth complications, prematurity (birth before 37 weeks), or health issues for the baby or child later in life. The available information is based on a small number of pregnancies. More scientific research is needed to better understand these risks.

Regular monitoring of lamotrigine levels during pregnancy is important because the drug’s metabolism can increase, potentially lowering its effectiveness and increasing the risk of seizures.

Here’s what you should know about the potential risks based on current research. These risks are relatives, your personal risk can vary based on your genetic, lifestyle, medical conditions, and other factors.

Table 1. Risks associated with lamotrigine during pregnancy.

For who?	What?	What does research say?
For the pregnant person	Ability to get pregnant	Not enough research to tell if affects fertility tooltip. Long-term use of seizure medications may cause irregular periods, which can make it harder to get pregnant.
For the pregnant person	Miscarriages	Some studies show a slightly higher risk compared to the background risk, but only a small number of pregnancies have been studied tooltip. More research is needed to evaluate this risk.
For the unborn child	Congenital Malformations	Several studies have not found a higher risk compared to the background risk (3 out of 100 pregnancies) tooltip.
	Growth	Some studies showed a slightly higher risk of having a baby with low birth weight (5 pounds 8 ounces [2,500 grammes]) tooltip. More research is needed to fully understand this risk.
	Premature Birth	More research is needed to evaluate this risk.
	Neonatal Health complications	Some studies show a slight risk of needing medical care after birth, but only a small number of pregnancies have been studied tooltip. More research is needed.
For future child/adult	Brain Development	Some research shows a slightly higher risk of developmental delays or attention disorders (ADHD), but more studies are needed. More research is needed.

* The risks that increased when compared to the background chance in the population are in bold.

4. Aside from the risks, what are the benefits of Lamotrigine?

While there are risks associated with using lamotrigine during pregnancy, the benefits of controlling seizures often outweigh the potential risks. Maintaining good seizure control is essential for both the mother and the baby, as uncontrolled seizures can lead to complications such as injury (sometimes leading to placental abruption), preterm labor, and even miscarriage.

Here are some potential benefits of lamotrigine during pregnancy:

Flexibility in dose adjustment: Lamotrigine can be safely adjusted during pregnancy to maintain effective seizure control as its metabolism increases, helping protect both mother and baby.
Effective Seizure Control: Lamotrigine is highly effective for treating various types of seizures related to epilepsy, which is important to reduce potential risks to you and your baby.
Preferred Option for Focal-Onset Seizures: For focal-onset seizures, lamotrigine is considered one of the most effective treatments available, outperforming many other options. This effectiveness ensures better management of seizures in women who experience this type of epilepsy.
Reducing Risks Associated with Seizures: Effective seizure management with lamotrigine helps prevent complications such as injury or stress, which can affect both the mother and the developing fetus.

In summary, lamotrigine offers a strong balance between effective seizure management and a lower risk of harm to the baby, making it a valuable option for pregnant women with epilepsy. Always discuss with your healthcare provider to evaluate the benefits and risks specific to your situation.

5. Will I Be Able to Breastfeed?

If you are taking lamotrigine and wish to breastfeed, be aware that the medication passes into breast milk. The levels of lamotrigine in the baby’s blood can reach up to half of the mother’s levels.

There have been cases where breastfed babies experienced side effects such as rashes, drowsiness, or slow weight gain, but it’s unclear if these issues were directly caused by lamotrigine. If you observe symptoms consult your baby’s healthcare provider.

No research is available on the effect of lamotrigine on milk production.

To ensure the safety of your baby, discuss your situation with your healthcare provider. They can help you weigh the benefits of breastfeeding against potential risks and decide on the best approach for both your health and your baby’s well-being.

Key Takeaways

Lamotrigine (Lamictal®) helps control seizures related to epilepsy and mood swings associated with bipolar disorder, and is sometimes used for other conditions.
Lamotrigine is often used during pregnancy when the benefits outweigh the risks.
During pregnancy, lamotrigine may slightly increase the risk of low birth weight, premature birth, and developmental delays. The baby might need extra medical care at birth.
Lamotrigine passes into breast milk. If you want to breastfeed, talk to your healthcare professional to see if it’s safe to breastfeed while taking this medication.
In general, if you are taking this medication to control seizures, the risks from seizures are greater than the risks from the medication for the baby.

7. Research Is Great, But It Is Not Perfect

Making informed health decisions also means understanding the current state of scientific knowledge, which has some limitations. Here’s an overview of the conclusions from our expert committee on the quantity and quality of studies conducted so far on the use of lamotrigine during pregnancy:

Limited Long-Term Studies: Most studies on lamotrigine during pregnancy focus on short-term outcomes. There is a lack of studies on the long-term effects on children’s development and health.
Small Studies: Many studies involve a small number of participants, so the results may not apply to everyone. This means the findings may not be relevant to all pregnant women or all types of seizures.
Inconsistent Data: The results sometimes vary, with different reports on the risks of birth defects, making it difficult to reach definitive conclusions about the safety of lamotrigine during pregnancy.
Confounding Factors: Other factors, such as other medications taken, the medical condition being treated, and the mother’s overall health, can influence research outcomes.
Limited Research on Breastfeeding: There is little information on the effects of lamotrigine during breastfeeding, on milk production, or on the impact on babies.

Overall, while lamotrigine is considered as a good option during pregnancy based on available research, these limitations highlight the need for ongoing studies and careful consideration by healthcare providers when prescribing it to pregnant women.

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