Lamotrigine Mylan 50 mg tablets – patient leaflet, side effects, dosage

1. What Lamotrigine Mylan is and what it is used for

Lamotrigine Mylan belongs to a group of medicines called anti-epileptics. It is used to treat two conditions – epilepsy and bipolar disorder.

Lamotrigine Mylan treats epilepsy

People with epilepsy are prone to having periods of uncontrolled electrical signals in the brain. These periods of uncontrolled electrical activity may lead to seizures.

Lamotrigine Mylan treats epilepsy by blocking the signals in the brain that trigger epileptic seizures (fits):

• For adults and children aged 13 years and over,

  Lamotrigine Mylan can be used on its own or with other medicines, to treat epilepsy. Lamotrigine Mylan can also be used with other medicines to treat the seizures that occur with a condition called Lennox-Gastaut syndrome.

• For children aged between 2 and 12 years,

  Lamotrigine Mylan can be used with other medicines, to treat those conditions. It can be used on its own to treat a type of epilepsy called typical absence seizures.

Lamotrigine Mylan also treats bipolar disorder

People with bipolar disorder (sometimes called manic depression) have extreme mood swings, with periods of mania (excitement or euphoria) alternating with periods of depression (deep sadness or despair). For adults aged 18 years and over, Lamotrigine Mylan can be used on its own or with other medicines, to prevent the periods of depression that occur in bipolar disorder. It is not yet known how Lamotrigine Mylan works in the brain to have this effect.

2. What you need to know before you take Lamotrigine Mylan

Do not take Lamotrigine Mylan:

• if you are allergic to lamotrigine or to any of the

  other ingredients of this medicine (listed in section 6). If this applies to you, tell your doctor and do not take Lamotrigine Mylan.

Warnings and precautions:

Talk to your doctor before taking Lamotrigine Mylan if any of the following applies to you, who may decide to lower your dose or that Lamotrigine Mylan is not suitable for you:

• if you have kidney problems

• if you have ever developed a rash after taking

  lamotrigine or other medicines for bipolar disorder or epilepsy, or if you experience a rash or sunburn after taking lamotrigine and having been exposed to sun or artificial light (e.g. solarium). Your doctor will check your treatment and may advise you to avoid sunlight or protect yourself against the sun (e.g. use of a sunscreen and/or to wear protective clothing).

• if you ever developed meningitis after taking

  lamotrigine (read the description of these symptoms in section 4 of this leaflet)

• if you are already taking medicine that contains

  lamotrigine.

• if you have a condition called Brugada syndrome

  or other heart problems. Brugada syndrome is a genetic disease that results in abnormal electrical activity within the heart. ECG abnormalities which may lead to arrhythmias (abnormal heart rhythm) can be triggered by lamotrigine. Talk to your doctor if you have this condition.

During treatment

Important information about potentially life-threatening reactions:

A small number of people taking Lamotrigine Mylan get an allergic reaction or potentially life-threatening skin reaction, which may develop into more serious problems if they are not treated. These can include Stevens–Johnson syndrome (SJS), toxic epidermal necrolysis (TEN) and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). You need to know the symptoms to look out for while you are taking Lamotrigine Mylan. These include skin rashes or redness, ulcers in the mouth or throat, sore mouth or throat, red or swollen eyes, fever, swelling around your face, swollen glands, unexpected bleeding or bruising. Read the description of these symptoms in section 4 of this leaflet under ‘Potentially life threatening reactions: get a doctor’s help straight away’.

The risk of serious skin reactions may be associated with a variant in genes called HLA-B*1502 in people from Asian origin (mainly Han Chinese and Thai). If you have been tested previously and know you are carrying this genetic variant discuss this with your doctor before taking Lamotrigine.

Haemophagocytic lymphohistiocytosis (HLH)

There have been reports of a rare but very serious immune system reaction, in patients taking lamotrigine. Contact your doctor or pharmacist immediately if you experience any of the following symptoms while taking lamotrigine: fever, rash, neurological symptoms (e.g. shaking or tremor, confusional state, disturbances of brain function). The highest risk for occurrence of serious skin reactions is within the first weeks of treatment. If you have developed Stevens-Johnson syndrome or toxic epidermal necrolysis with the use of lamotrigine, you must not be re-started on lamotrigine at any time.

If you develop a rash or these skin symptoms, seek immediate advice from a doctor and tell him that you are taking this medicine.

Thoughts of harming yourself or suicide

Anti-epileptic medicines are used to treat several conditions, including epilepsy and bipolar disorder. People with bipolar disorder can sometimes have thoughts of harming themselves or committing suicide. If you have bipolar disorder, you may be more likely to think like this:

• when you first start treatment

• if you have previously had thoughts about harming

  yourself or about suicide

• if you are under 25 years old.

If you have distressing thoughts or experiences, or if you notice that you feel worse or develop new symptoms while you are taking lamotrigine, see a doctor as soon as possible or go to the nearest

hospital for help.

You may find it helpful to tell a family member, caregiver or close friend that you can become depressed or have significant changes in mood,

and ask them to read this leaflet. You might ask them to tell you if they are worried about your depression or other changes in your behaviour.

A small number of people being treated with anti-epileptics such as lamotrigine have had thoughts of harming or killing themselves. If at any time you have these thoughts, immediately contact your doctor. If you are taking Lamotrigine Mylan for epilepsy

The seizures in some types of epilepsy may occasionally become worse or happen more often while you are taking lamotrigine. Some patients may experience severe seizures, which may cause serious health problems. If your seizures happen more often, or if you experience a severe seizure while you’re taking lamotrigine see a doctor as soon as possible. Children and adolescents under 18 years Lamotrigine Mylan should not be given to people aged under 18 years to treat bipolar disorder. Medicines to treat depression and other mental health problems increase the risk of suicidal thoughts and behaviour in children and adolescents aged under 18 years.

Other medicines and Lamotrigine Mylan

Tell your doctor or pharmacist if you are taking, have recently taken or might take any other medicines including herbal medicines or other medicines you bought without a prescription. It is important to tell your doctor or pharmacist if you are taking any other medicines for epilepsy at the same time as lamotrigine if you are pregnant, think you may be pregnant, or are planning to have a baby (see also the information in section 2 on pregnancy and breast-feeding) Your doctor needs to know if you are taking other medicines to treat epilepsy or mental health problems to make sure you are taking the correct dose of lamotrigine. These medicines include:

• oxcarbazepine, felbamate, gabapentin,

  levetiracetam, pregabalin, topiramate or zonisamide, used to treat epilepsy

• lithium, olanzapine or aripiprazole, used to treat mental health problems
• bupropion, used to treat mental health problems or to stop smoking
• paracetamol, used to treat pain and fever Tell your doctor if you are taking any of these. Some medicines interact with lamotrigine or make it more likely that you will have side effects. These include:
• valproate, used to treat epilepsy and mental health problems
• carbamazepine, used to treat epilepsy and mental health problems
• phenytoin, primidone or phenobarbitone, used to treat epilepsy
• risperidone, used to treat mental health problems
• rifampicin, which is an antibiotic

• medicines used to treat Human Immunodeficiency

  Virus (HIV) infection (a combination of lopinavir and ritonavir or atazanavir and ritonavir)

• oestrogen containing products, including hormonal contraceptives, such as ‘the Pill’ (see below) and Hormone Replacement Therapy (HRT), used to treat the symptoms of menopause (see below). Tell your doctor if you are taking any of these or if you start or stop taking any.

Hormonal contraceptives (such as ‘the Pill’) can affect the way lamotrigine works.

Your doctor may recommend that you use a particular type of hormonal contraceptive, or another method of contraception, such as condoms, a cap or a coil. If you are using a hormonal contraceptive like ‘the Pill’, your doctor may take samples of your blood to check the level of Lamotrigine Mylan. If you are using or plan to start using a hormonal contraceptive, talk to your doctor, who will discuss suitable methods of contraception with you.

Lamotrigine Mylan can also affect the way hormonal contraceptives work, although it’s unlikely to make them less effective. If you are using a hormonal contraceptive and you notice any changes in your menstrual pattern, such as breakthrough bleeding or spotting between periods, tell your doctor. These may be signs that lamotrigine is affecting the way your contraceptive is working.

Hormone Replacement Therapy (HRT) can affect the way lamotrigine works

HRT can affect the way lamotrigine works and could increase the frequency of seizures.

Pregnancy and breast-feeding

Pregnancy:

• If you are pregnant, or think you may be pregnant, you must tell your doctor straight away and discuss possible risks the epilepsy medicine you are taking might pose to your unborn baby.
• If you are planning to become pregnant, you should discuss your epilepsy treatment with your doctor as early as possible before you become pregnant.
• You should not stop treatment without discussing this with your doctor. This is particularly important if you have epilepsy.
• Pregnancy may also alter the effectiveness of lamotrigine, so you may need blood tests and your dose of lamotrigine may be adjusted.
• Studies of women who took lamotrigine at usual doses while they were pregnant have not shown an increased risk of physical birth abnormalities.
• The risk of physical birth abnormalities may increase when higher doses of epilepsy medicines are taken or more than one epilepsy medicine is used at the same time. Where possible, your doctor will consider using one epilepsy medicine at the lowest effective dose to control your epilepsy.
• Your doctor may advise you to take extra folic acid supplements if you are planning to become pregnant and while you are pregnant. There may be an increased risk of birth defects in babies whose mothers took lamotrigine during pregnancy. These defects include cleft lip or cleft palate.

Breast-feeding

If you are breast-feeding or planning to breast-feed ask your doctor or pharmacist for advice before taking this medicine. The active ingredient of Lamotrigine passes into breast milk and may affect your baby. Your doctor will discuss the risks and benefits of breast-feeding while you’re taking Lamotrigine, and will check your baby from time to time, whether drowsiness, rash or poor weight gain occurs, if you decide to breast-feed. Inform your doctor if you observe any of these symptoms in your baby. Driving and using machines

Lamotrigine Mylan can cause dizziness and double vision.

Do not drive or use machines unless you are sure you are not affected.

If you have epilepsy, talk to your doctor about driving and using machines.

Lamotrigine Mylan contains lactose and sodium

If you have been told by your doctor that you have an intolerance to some sugars, contact your doctor before taking this medicinal product.

This medicine contains less than 1 mmol sodium (23 mg) per tablet, that is to say essentially ‘sodium-free’.

3. How to take Lamotrigine Mylan

Always take this medicine exactly as your doctor or pharmacist has told you. Check with your doctor or pharmacist if you are not sure.

How much Lamotrigine Mylan to take

It may take a while to find the best dose of Lamotrigine Mylan for you. The dose you take will depend on:

• your age
• whether you are taking Lamotrigine Mylan with other medicines
• whether you have problems with your kidneys or liver. Your doctor will start you on a low dose, and gradually increase the dose over a few weeks until you reach a dose that works for you (called the effective dose). Never take more Lamotrigine Mylan than your doctor tells you to.

The usual effective dose of Lamotrigine Mylan for adults and children aged 13 years or over is between 100 mg and 400 mg each day.

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Use in children

For children aged 2 to 12 years, the effective dose depends on their body weight. Usually, its between between 1 mg and 15 mg for each kilogram of the child’s weight, up to a maximum maintenance dose of 200 mg daily. Your doctor may increase the dose of Lamotrigine Mylan if given in combination with certain other medicines.

Where a child’s dose cannot be achieved using these tablets, other forms of this medicine may be available. Speak to your doctor or pharmacist.

Lamotrigine Mylan is not recommended for children aged under 2 years.

How to take your dose of Lamotrigine Mylan

Take your dose of Lamotrigine Mylan once or twice a day, as your doctor advises. You can take it with or without food.

Your doctor may also advise you to start or stop taking other medicines, depending on what condition you are being treated for and the way you respond to treatment:

• swallow your tablets whole with water. Don’t break,

  chew or crush them.

• always take the full dose that your doctor has

  prescribed. Never take only part of a tablet. If you take more Lamotrigine Mylan than you should Contact a doctor or nearest hospital emergency

department immediately. If possible, show them the carton or bottle your medicine came in. If you take too much lamotrigine you may be more

likely to have serious side effects which may be

fatal. Someone who has taken too much lamotrigine may have any of these symptoms:

• rapid, uncontrollable eye movements (nystagmus)
• heart rhythm changes (detected usually on ECG)

• clumsiness and lack of co-ordination, affecting their

  balance (ataxia)

• loss of consciousness, fits (convulsions) or coma. If you forget to take Lamotrigine Mylan Do not take extra tablets or a double dose to make up for a forgotten dose. Just take your next dose at the usual time.

If you have missed taking a dose of Lamotrigine Mylan, ask your doctor for advice on how to start taking it again. It is important that you do this. If you stop taking Lamotrigine Mylan

Do not stop taking Lamotrigine Mylan without

advice.

Lamotrigine Mylan must be taken for as long as your doctor recommends. Do not stop unless your doctor advises you to.

If you are taking Lamotrigine Mylan for epilepsy: it is important that your dose is reduced gradually, over about 2 weeks. If you suddenly stop taking lamotrigine your epilepsy may come back or get worse. If you are taking Lamotrigine Mylan for bipolar

disorder: Lamotrigine Mylan may take some time to work, so you are unlikely to feel better straight away. If you stop taking Lamotrigine Mylan your dose will not need to be reduced gradually, but you should still talk to your doctor first if you want to stop taking Lamotrigine Mylan.

If you have further questions on the use of this medicine, ask your doctor or pharmacist.

4. Possible side effects

Like all medicines, this medicine can cause side effects, although not everyone gets them. If you experience any of the following potentially

life-threatening reactions, get a doctor’s help straight away or go to the nearest hospital emergency department.

A small number of people taking lamotrigine get an allergic reaction or potentially life-threatening skin reaction, which may develop into more serious problems if they are not treated.

These symptoms are more likely to happen during the first few months of treatment with lamotrigine, especially if the starting dose is too high or if the dose is increased too quickly, or if lamotrigine is taken with another medicine called valproate. Some of the symptoms are more common in children, so parents should be especially careful to watch out for them. Symptoms of these reactions include:

• skin rashes or redness, which may develop

  into serious or sometimes life-threatening skin reactions including rash with target lesions (Erythema multiforme), widespread rash with blisters and peeling skin, particularly occurring around the mouth, nose, eyes and genitals (Stevens-Johnson syndrome), extensive peeling of the skin (more than 30% of the body surface - toxic epidermal necrolysis) or extended rashes with liver, blood and other body organs involvement, such as in Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)

• ulcers in the mouth, throat, nose or genitals
• a sore mouth or red or swollen eyes (conjunctivitis)

• a high temperature (fever), flu-like symptoms or

  drowsiness

• swelling around your face, or swollen glands in

  your neck, armpit or groin

• unexpected bleeding or bruising, or your fingers

  turning blue

• a sore throat, or more infections (such as colds)

  than usual

• increased levels of liver enzymes seen in blood tests
• an increase in a type of white blood cell (eosinophils)
• enlarged lymph nodes

• involvement of the organs of the body including

  liver and kidneys

• a group of symptoms together including fever,

  nausea, vomiting, headache, stiff neck and

  extreme sensitivity to bright light. This may be caused by an inflammation of the membranes that cover the brain and spinal cord (meningitis). These symptoms usually disappear once treatment is stopped

• haemophagocytic lymphohistiocytosis (HLH) (see

  section 2 What you need to know before you take Lamotrigine).

In many cases, these symptoms will be signs of less serious side effects. But you must be aware that they are potentially life-threatening and can develop into more serious problems, such as organ failure, if they are not treated. Contact a doctor as soon as possible. Your doctor may decide to carry out tests on your liver, kidneys or blood, and may tell you to stop taking Lamotrigine Mylan. In case you have developed Stevens-Johnson syndrome or toxic epidermal necrolysis your doctor will tell you that you must never use lamotrigine again:

• reduced numbers of different blood cells, which

  may cause pale skin, feeling tired and breathless and having dark urine (reduced number of red blood cells), frequent infections with fever, chills, sore throat or mouth ulcers (reduced number of white blood cells), bleeding or bruising for longer than normal or unexpectedly (reduced number of platelets). These changes may happen all at once (pancytopenia) or as a disorder of the bone marrow called aplastic anaemia

• lower immunity because of lower levels of

  antibodies called immunoglobulins in the blood which help protect against infection.

• a serious disorder of blood clotting, which

  can cause unexpected bleeding or bruising (disseminated intravascular coagulation)

• lupus-like reaction (symptoms may include: back or

  joint pain which sometimes may be accompanied by fever and/or general ill health)

• yellowing of the whites of the eyes or skin,

  abdominal pain, dark urine, pale bowel movements and itching, which may be signs of liver failure. Other possible side effects

Very common (may affect more than 1 in 10 people):

• headache
• skin rash.

Common (may affect up to 1 in 10 people):

• aggression or irritability
• shaking or tremors
• feeling dizzy

• feeling sleepy, drowsy or tired

  • difficulty in sleeping (insomnia)
  • feeling agitated
  • feeling sick (nausea) or being sick (vomiting)
  • diarrhoea
  • dry mouth
  • pain in your back or joints, or elsewhere. Uncommon (may affect up to 1 in 100 people):
  • clumsiness and lack of co-ordination (ataxia)
  • double or blurred vision
  • unusual hair loss or thinning (alopecia)
  • skin rash or sunburn after exposure to sun or artificial light (photosensitivity)

Rare (may affect up to 1 in 1000 people):

• rapid, uncontrollable eye movements (nystagmus)

• itchy eyes, with discharge and crusty eyelids

  (conjunctivitis)

• skin reaction that causes red spots or patches on the skin, that may look like a target or “bulls-eye” with a dark red centre surrounded by paler red rings (erythema multiforme)
• a life-threatening skin reaction (Stevens-Johnson syndrome) (see information at the beginning of section 4)
• a group of symptoms together including fever, nausea, vomiting, headache, stiff neck and extreme sensitivity to bright light. This may be caused by an inflammation of the membranes that cover the brain and spinal cord (meningitis). These symptoms usually disappear once treatment is stopped. If the symptoms continue or get worse contact your doctor. Very rare (may affect up to 1 in 10 000 people):
• hallucinations (‘seeing’ or ‘hearing’ things that aren’t really there)
• confusion
• feeling ‘wobbly’ or unsteady when you move about
• uncontrollable repeated body movements and/or sounds or words (tics), uncontrollable muscle spasms affecting the eyes, head and torso (choreoathetosis), or other unusual body movements such as jerking, shaking or stiffness
• in people who already have epilepsy, seizures happening more often
• changes in liver function, which will show up in blood tests, or liver failure: (see also the information at the beginning of section 4)
• in people who already have Parkinson’s disease, worsening of the symptoms.
• a life-threatening skin reaction (toxic epidermal necrolysis); (see also the information at the beginning of section 4)

• Drug Reaction with Eosinophilia and Systemic

  Symptoms (DRESS); (see also the information at the beginning of section 4)

• a high temperature (fever); (see also the information at the beginning of section 4)
• swelling around the face (oedema) or swollen glands in the neck, armpit or groin (lymphadenopathy); (see also the information at the beginning of section 4)
• a serious disorder of blood clotting, which can cause unexpected bleeding or bruising (disseminated intravascular coagulation); (see also the information at the beginning of section 4)

• haemophagocytic lymphohistiocytosis (HLH);

  (see section 2, what you need to know before you take lamotrigine)

• changes which may show up in blood tests — including reduced numbers of red blood cells (anaemia), reduced numbers of white blood cells (leucopenia, neutropenia, agranulocytosis), reduced numbers of platelets (thrombocytopenia), reduced numbers of all these types of cell (pancytopenia), and a disorder of the bone marrow called aplastic anaemia
• lupus-like reaction (symptoms may include; back or joint pain which sometimes may be accompanies by fever and/or general ill-health).

Not known (frequency cannot be estimated from the available data):

• there have been reports of bone disorders including osteopenia and osteoporosis (thinning of the bone) and fractures. Check with your doctor or pharmacist if you are on long-term antiepileptic medication, have a history of osteoporosis, or take steroids.
• Nightmares.
• Inflammation of the kidney (tubulointerstitial nephritis), or inflammation of both the kidney and the eye (tubulointerstitial nephritis and uveitis syndrome)
• lower immunity because of lower levels of antibodies called immunoglobulins in the blood which help protect against infection

• red nodules or patches on the skin

  (pseudolymphoma).

Reporting side effects

If you get any side effects, talk to your doctor, pharmacist or nurse. This includes any possible side effects not listed in this leaflet. You can also report side effects directly via the Yellow Card Scheme at: www.mhra.gov.uk/yellowcard or search for MHRA Yellow Card in the Google Play or Apple App Store. By reporting side effects you can help provide more information on the safety of this medicine.

5. How to store Lamotrigine Mylan

Keep this medicine out of the sight and reach of children.

Do not use this medicine after the expiry date which is stated on the carton and the blister after EXP. The expiry date refers to the last day of that month. This medicine does not require any special storage conditions.

Do not throw away any medicines via wastewater or household waste. Ask your pharmacist how to throw away medicines you no longer use. These measures will help protect the environment.

6. Content of the pack and other information

What Lamotrigine Mylan contains

The active substance is lamotrigine.

Lamotrigine Mylan 25 mg tablets

Each tablet contains 25 mg lamotrigine. Lamotrigine Mylan 50 mg tablets

Each tablet contains 50 mg lamotrigine. Lamotrigine Mylan 100 mg tablets

Each tablet contains 100 mg lamotrigine. Lamotrigine Mylan 200 mg tablets

Each tablet contains 200 mg lamotrigine. The other ingredients are lactose anhydrous (see section 2, “Lamotrigine Mylan contains lactose and sodium”), magnesium stearate (E572), microcrystalline cellulose (E460), sodium starch glycolate, povidone and iron oxide yellow (E172). What Lamotrigine Mylan looks like and contents of the pack

Lamotrigine Mylan are yellow round tablets. The 25 mg tablets are marked with “LG” over “25” on one side and “G” on the other side.

The 50 mg tablets are marked with “LG” over “50” on one side and “G” on the other side.

The 100 mg tablets are marked with “LG” over “100” on one side and “G” on the other side.

The 200 mg tablets are marked with “LG” over “200” on one side and “G” on the other side.

The tablets are available in bottles and blisters in pack sizes of: 14, 21, 28, 30, 42 (25 mg only), 46, 56, 60, 90, 100 and 200 (25 mg, 50 mg and 100 mg only) tablets. Not all pack sizes may be marketed.

Marketing Authorisation Holder

Mylan, Potters Bar, Hertfordshire, EN6 1TL, United Kingdom

Manufacturer

Generics [UK] Ltd, Potters Bar, Hertfordshire, EN6 1TL, United Kingdom

Gerard Laboratories, 35/36 Baldoyle Industrial Estate, Grange Road, Dublin 13, Ireland

Mylan Hungary Kft, Mylan utca 1, Komarom 2900, Hungary

This leaflet was last revised in:

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