Lamotrigine, commonly known by its brand name Lamictal, is a medication primarily used as an anticonvulsant and mood stabilizer. It is approved by the FDA for treating epilepsy and for maintenance treatment of bipolar I disorder. While many medications used to treat these conditions are known to cause weight gain, Lamictal is generally considered weight-neutral. This article explores the relationship between Lamictal and weight changes, potential side effects, and important considerations for individuals taking this medication.
What is Lamictal?
Lamotrigine functions as an anticonvulsant, helping to control seizures, and as a mood stabilizer, extending the periods between extreme mood episodes in individuals with bipolar disorder. It is often prescribed for long-term management of bipolar I disorder, particularly in individuals aged 18 and older who have previously been treated with other medications for mood episodes. Lamictal is available in various forms, including oral tablets, chewable tablets, and orally disintegrating tablets, as well as an extended-release oral tablet (Lamictal XR).
Weight Gain and Lamictal: What the Research Says
Unlike many mood stabilizers that are known to cause weight gain, Lamictal is less likely to do so. Clinical trials indicate that less than 5% of individuals taking Lamictal experienced weight gain. In fact, studies have shown that lamotrigine is associated with stable body weight during treatment and is comparable to placebo in terms of mean weight change.
- Clinical Trial Evidence:
- One study showed that mean weight changes at week 52 were -1.2 kg with lamotrigine, +0.2 kg with placebo, and +2.2 kg with lithium.
- The percentage of patients with a ≥7% weight gain during randomized treatment was 10.9% for lamotrigine, 7.6% for placebo, and 11.8% for lithium.
- The percentage of patients with a ≥7% weight loss during randomized treatment was 12.1% for lamotrigine, 11.5% for placebo, and 5.1% for lithium.
These findings suggest that Lamictal is less likely to cause weight gain compared to other mood stabilizers like lithium.
Potential Reasons for Weight Gain While Taking Lamictal
If you experience weight gain while taking Lamictal, it is important to consider other potential factors:
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- Bipolar Disorder Itself: Bipolar disorder can influence appetite and metabolism, leading to weight gain.
- Lifestyle Changes: Mood changes associated with bipolar disorder can affect motivation to exercise and maintain a healthy diet.
- Other Medications: Concurrent use of other medications may contribute to weight gain.
If weight gain is a concern, consulting with a nutritionist and discussing alternative medications with your doctor can be beneficial.
Common and Serious Side Effects of Lamictal
While Lamictal is generally well-tolerated, it can cause side effects. It’s important to be aware of both common and serious side effects.
More Common Side Effects
- Nausea
- Sleeping troubles
- Sleepiness or extreme tiredness
- Back pain
- Rash
- Runny nose
- Stomach pain
- Dry mouth
These side effects are usually temporary and may subside as your body adjusts to the medication. If they persist or worsen, consult your doctor.
Serious Side Effects
- Serious Skin Rashes: Lamictal carries a boxed warning regarding the risk of serious skin rashes, which can be life-threatening and may require hospitalization. Symptoms include rash, blistering or peeling skin, hives, and painful sores in the mouth or around the eyes.
- Reactions Affecting Liver or Blood Cells: Symptoms include fever, frequent infections, severe muscle pain, swollen lymph glands, unusual bruising or bleeding, weakness or tiredness, yellowing of the skin or eyes, and swelling of the face, eyes, lips, or tongue.
- Suicidal Thoughts or Actions: Mood changes, increased anxiety, agitation, hopelessness, and thoughts of self-harm should be reported to your doctor immediately.
- Aseptic Meningitis: Symptoms include headache, fever, nausea, vomiting, stiff neck, rash, unusual sensitivity to light, muscle pain, chills, confusion, and drowsiness.
- Hemophagocytic Lymphohistiocytosis (HLH): A rare, life-threatening immune system reaction with symptoms like fever, swollen lymph nodes, and skin rash.
- Heart Rhythm Problems: Chest pain, fast, slow, or uneven heartbeat, lightheadedness, or trouble breathing.
If you experience any of these serious side effects, seek immediate medical attention.
Interactions and Other Considerations
Lamictal can interact with other drugs, potentially affecting its efficacy and increasing the risk of side effects.
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Drug Interactions
- Valproic Acid or Divalproex Sodium (Depakene, Depakote): Can double the amount of Lamictal in your body, increasing the risk of side effects.
- Carbamazepine (Tegretol), Phenytoin (Dilantin), Phenobarbital (Luminal), or Primidone (Mysoline): Can decrease Lamictal levels in your body by about 40%.
- Estrogen-Containing Birth Control Pills and Rifampin (Rifadin): Can decrease Lamictal levels by about 50%.
Other Conditions
- Liver or Kidney Damage: May require a lower starting dosage due to impaired processing of Lamictal.
- Pregnancy and Breastfeeding: Discuss with your doctor before taking Lamictal, as it is not known if it is safe to use during pregnancy and it can pass into breast milk.
Managing Weight While Taking Lamictal
Even though Lamictal is weight-neutral, maintaining a healthy lifestyle is important for overall well-being.
- Balanced Diet: Focus on whole, protein-rich foods, vegetables, healthy fats, and whole grains. Limit sugary snacks and processed foods.
- Regular Exercise: Combine cardiovascular activities with resistance training.
- Stress Reduction: High stress levels can lead to weight gain.
- Consistent Sleep Patterns: Aim for seven to nine hours of sleep each night.
- Consult a Healthcare Professional: Seek medical advice from your healthcare provider regarding any weight-related issues.
Alternatives to Lamictal
If weight gain is a significant concern, discuss alternative medications with your doctor. Some weight-neutral alternatives to Lamictal include carbamazepine or oxcarbazepine.
Important Precautions and Warnings
- Serious Skin Rash: Lamictal has a boxed warning for the risk of serious skin rash. Seek immediate medical attention if you develop symptoms such as blisters, peeling skin, or fever.
- Suicidal Thoughts and Behaviors: Lamictal may increase the risk of suicidal thoughts or behaviors. Report any mood changes or suicidal ideation to your doctor immediately.
- Aseptic Meningitis: Be vigilant for symptoms of aseptic meningitis, such as stiff neck, confusion, fever, and headache.
- Allergic Reactions: Seek immediate medical attention if you experience symptoms of an allergic reaction, such as skin rash, itching, swelling, or difficulty breathing.
- Alcohol Use: While there are no known interactions between Lamictal and alcohol, drinking alcohol during treatment may lead to alcohol intolerance.
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