Initiation & Dosing

Give your patients a head start—initiate LAMICTAL now as maintenance

therapy in patients treated with acute therapy.

Initiating LAMICTAL is similar in currently or recently manic patients.

LAMICTAL can be titrated to an effective maintenance dose while patient is taking standard acute therapy

The effectiveness of LAMICTAL in the acute treatment of mood episodes has not been established

The physician who elects to prescribe LAMICTAL for periods extending beyond 16 weeks should periodically re-evaluate the long-term usefulness of the drug for the individual patient

LAMICTAL and LAMICTAL ODT are easy to initiate with kits available by prescription.

Initiating LAMICTAL and LAMICTAL ODT in adult patients with bipolar I disorder:

NOT TAKING carbamazepine, phenytoin, phenobarbital, primidone, rifampin^†, or valproate^‡

Weeks 1 & 2	Weeks 3 & 4	Week 5	Week 6
25 mg/day	50 mg/day	100 mg/day	Target Dose 200 mg/day

TAKING valproate^‡

Weeks 1 & 2	Weeks 3 & 4	Week 5	Week 6
25 mg/every other day	25 mg/day	50 mg/day	Target Dose 100 mg/day

TAKING carbamazepine, phenytoin, phenobarbital, primidone, or rifampin^†
and NOT TAKING valproate^‡

Weeks 1 & 2	Weeks 3 & 4	Week 5	Week 6	Week 7
50 mg/day	100 mg/day in divided doses	200 mg/day in divided doses	300 mg/day in divided doses	Target Dose Up to 400 mg/day in divided doses

If valproate, carbamazepine, phenytoin, phenobarbital, primidone, or rifampin are subsequently added, the dose of LAMICTAL in most cases will need to be adjusted.

Doses above target dose are not recommended.

†Carbamazepine, phenytoin, phenobarbital, primidone, and rifampin have been shown to increase the apparent
clearance of lamotrigine.

‡Valproate has been shown to decrease the apparent clearance of lamotrigine. Includes valproic acid and
divalproex sodium.

Adjusting LAMICTAL and LAMICTAL ODT in adult patients with bipolar I disorder:

After discontinuation of psychotropic drugs excluding carbamazepine, phenytoin, phenobarbital, primidone, rifampin,^† or valproate^‡

Maintain current dose of LAMICTAL.

After discontinuation of valproate^‡

Current dose of LAMICTAL	Week 1	Week 2	Week 3 onward
100 mg/day	150 mg/day	200 mg/day	200 mg/day

After discontinuation of carbamazepine, phenytoin, phenobarbital, primidone, or rifampin^†

Current dose of LAMICTAL	Week 1	Week 2	Week 3 onward
400 mg/day	400 mg/day	300 mg/day	200 mg/day

†Carbamazepine, phenytoin, phenobarbital, primidone, and rifampin have been shown to increase the apparent
clearance of lamotrigine.

‡Valproate has been shown to decrease the apparent clearance of lamotrigine. Includes valproic acid and
divalproex sodium.

Important dosing considerations

For women starting estrogen-containing oral contraceptives and not taking carbamazepine, phenytoin, phenobarbital, primidone, or rifampin, the maintenance dose of LAMICTAL or LAMICTAL ODT will in most cases need to be increased, by as much as twofold over the recommended target maintenance dose, in order to maintain a consistent lamotrigine plasma level.
Conversely, the maintenance dose of LAMICTAL or LAMICTAL ODT will in most cases need to be decreased by as much as 50% if estrogen-containing oral contraceptives are stopped in these patients.
Adverse events consistent with elevated levels of lamotrigine (such as dizziness, ataxia, and diplopia) may occur during the week of inactive hormone preparation (pill-free week). (See Dosage and Administration and Use in Specific Populations sections of the Prescribing Information for additional recommendations).
Adjustments to maintenance doses may also be necessary during pregnancy and following delivery.
Please consult complete Prescribing Information for guidelines on titrating LAMICTAL or LAMICTAL ODT, adjusting the dose if psychotropic medications are added or withdrawn during treatment, and for dosing in special populations.
Dose adjustments are recommended for patients with hepatic or renal functional impairment.

Formulations of LAMICTAL

There are three different formulations of LAMICTAL. See below for pictures of the actual tablets.

Starter Kits, Patient Titration Kits, and Maintenance Packs

If you want to start a new patient on LAMICTAL or LAMICTAL ODT, use the Patient Titration Kits for LAMICTAL ODT and Patient Starter Kits for LAMICTAL for a convenient way to get started.

Ask your GlaxoSmithKline representative about free 5-week Patient Titration Kits for LAMICTAL ODT and Patient Starter Kits for LAMICTAL for new patients and 14-day conversion kits for patients switching to LAMICTAL ODT from LAMICTAL.

The Patient Titration Kits for LAMICTAL ODT and Patient Starter Kits for LAMICTAL provide 5 weeks of therapy of LAMICTAL or LAMICTAL ODT and come in different packages depending on other medications the patient is taking:

LAMICTAL TABLETS

LAMICTAL ODT

Click to enlarge	For patients who are taking valproate^§	Click to enlarge
Click to enlarge	For patients who are TAKING carbamazepine, phenytoin, phenobarbital, primidone, or rifampin and are NOT TAKING valproate^§	Click to enlarge
Click to enlarge	For patients who are NOT TAKING carbamazepine, phenytoin, phenobarbital, primidone, rifampin, or valproate^§	Click to enlarge

§Includes valproic acid and divalproex sodium.

The kits contain LAMICTAL or LAMICTAL ODT in the proper dosages that are clearly marked day by day for each week.

Use easy 1:1 conversion to switch patients already taking a maintenance dose of LAMICTAL Tablets to LAMICTAL ODT

Use the Maintenance Packs of LAMICTAL ODT available by prescription to help patients stay on track with their daily dose.

There are four different Maintenance Packs for LAMICTAL ODT, each with a different tablet strength of LAMICTAL ODT—25 mg, 50 mg, 100 mg, and 200 mg. Each pack holds 30 tablets.

Each daily dose clearly marked in unique blister pack.

The Maintenance Packs use convenient packaging to help make it easy for patients to keep track of taking their tablets. The kits are clearly labeled with dosing instructions.

LAMICTAL ODT: Patient Instructions

All kits for LAMICTAL ODT are clearly labeled with dosing instructions and have
easy-to-read directions for use.

		FOLLOW THESE 4 STEPS
		1. PRESS Press and hold tab at bottom. 2. PULL Pull out table sleeve.
		3. PEEL Peel printed backing away with dry hand to expose tablet.
		4. PLACE Gently place tablet into dry hand. Then put immediately on tongue and move around in mouth to dissolve. Can be swallowed with or without water.