Lamotrigine alternatives: What can I take instead of lamotrigine?

Compare lamotrigine alternatives | Lithium | Depakote | Tegretol | Seroquel | Keppra | Natural alternatives | How to switch meds

Anyone can feel reluctant to change medication for their bipolar disorder or seizures. Those two conditions are frightening to experience, and altering the treatment plan could make you susceptible to a relapse of seizures or mental health problems. Lamotrigine, the generic form of brand name Lamictal, has Food and Drug Administration (FDA) approval for maintenance treatment of both bipolar I disorder and prevention of seizures. Although many find Lamictal helpful, you may not and could rightfully be considering a switch to a different drug. Lamictal may simply be ineffective, prompting you to want something better, or it could be causing you unacceptable side effects. But even if your reason for looking into an alternative is justified, it is crucial to understand the options in detail and take your ideas to a healthcare provider before making any changes. Those details are exactly what we will cover.

What can I take in place of lamotrigine?

Lamotrigine is categorized as an anticonvulsant, a drug used to treat epilepsy. Anticonvulsants or antiepileptic drugs are a broad category with various mechanisms for blocking the repetitive firing of neurons (brain cells) that causes seizures. If Lamictal is not the right choice for you, there are a number of alternatives to look into. Most are not overly expensive, but a SingleCare discount card may still be advisable to help reduce the cost.

Treatment of bipolar disorder often incorporates a mood stabilizer as a core element. Certain anticonvulsants, including Lamictal, can function as mood stabilizers. Changing to a different anticonvulsant or a different type of mood stabilizer could be options for you. Aside from mood stabilizers, antipsychotic drugs are another category that is effective for bipolar disorder and may be a worthy substitute for Lamictal. Comparing your options will hopefully help you find the right one.

RELATED: Bipolar disorder statistics 2022

Other alternatives to lamotrigine

• Haloperidol
• Geodon (ziprasidone)
• Clozaril (clozapine)
• Fycompa (perampanel)
• Mysoline (primidone)
• Phenobarbital
• Klonopin (clonazepam)
• Onfi (clobazam)
• Felbatol (felbamate)
• Xcompri (cenobamate)
• Trileptal (oxcarbazepine)
• Valproic acid
• Valproate
• Neurontin (gabapentin)
• Dilantin (phenytoin)
• Keppra XR (levetiracetam extended release)
• Briviact (brivaracetam)

Top 5 lamotrigine alternatives

The following are some of the most common alternatives to lamotrigine.

1. Lithium

Lithium is a long-standing, well-studied mood stabilizer for bipolar disorder. How exactly it works remains a mystery, but its efficacy is undeniable. Clinical trials have shown that lithium and Lamictal are equally good at reducing the overall risk of relapse, although lithium seems a bit better at lowering risk of mania recurrence. If Lamictal is not working for you, lithium is certainly an alternative to be aware of. 

Unfortunately, lithium has a multitude of side effects which make it less tolerable than the effects of Lamictal in studies. Potential adverse effects of lithium on kidney, thyroid, and parathyroid function can be problematic, as can untoward symptoms like diarrhea, nausea, tremor, and weight gain. Toxic effects of lithium are experienced at drug levels not much higher than those required for effectiveness. Accordingly, lithium drug levels are monitored with bloodwork to help avoid toxicity. When done right, lithium therapy can be a good choice, but the prospect of serious side effects and drug monitoring may keep you looking for other options.

RELATED: Lithium side effects and how to avoid them

2. Depakote

Divalproex sodium is the generic form of Depakote and is chemically similar to valproate and valproic acid. Depakote shares both seizure and bipolar treatment indications with lamotrigine. They both are anticonvulsants that are effective in preventing seizures in epilepsy and mood stabilizers that are effective for preventing mood swings in bipolar disorder. Extended-release formulations are available for both, if the convenience of once-daily dosing is important. Depakote and Lamictal can each match lithium for efficacy and surpass it for tolerability. 

Given all the similarities, the reason to consider changing from Lamictal to Depakote is the difference in side effects and potential allergic reactions. Either can make you nauseous, dizzy, tremulous, or cause blurred vision, but there are serious toxicities that each is notorious for. Lamotrigine has a black box warning from the FDA for the potential to cause the life-threatening skin rash condition Stevens Johnson syndrome and others like it. It can also provoke substantial adverse effects on the heart. In comparison, the black box warning on Divalproex is regarding the potential for hepatotoxicity, including fatal liver failure, and pancreatitis, an attack of pancreas inflammation. It can trigger dangerous drops in blood cell counts as well. A pre-existing medical condition or bad initial experience with Lamictal could sway you toward Depakote.

RELATED: Depakote side effects and how to avoid them

3. Tegretol

Another anticonvulsant/mood stabilizer with a potential for life threatening rashes, blood cell count disturbances, and liver effects, Tegretol does not immediately distinguish itself from Lamictal and Depakote. Like them, it has a generic form and extended-release product too. Sometimes the reason to change may simply be to try to find something that works better. While carbamazepine, the generic form of Tegretol, is a common first-line option for epilepsy, it is not usually an early choice for bipolar disorder. A reason to hesitate regarding carbamazepine is the large list of meds that interact with it. The search for the right medication must take into account your list of prescription drugs and over-the-counter medications to evaluate for drug interactions.

4. Seroquel

Seroquel (quetiapine) is solely an alternative to Lamictal for those with bipolar mood disorder. It is not an anticonvulsant. Quetiapine is a second generation or atypical antipsychotic, but it is a popular mood stabilizer for those with bipolar. The popularity likely stems from its ability to treat both manic episodes and depressive symptoms of bipolar. Limitations that you should be aware of are its propensity to cause tiredness and weight gain.

RELATED: Seroquel side effects and how to avoid them

5. Keppra

If you are searching for an alternative to Lamictal for epilepsy control rather than bipolar, Keppra (levetiracetam) is worth a look. Levetiracetam’s efficacy and tolerability leads many who start it to stick with it. Other attractive features are the lack of a FDA black box warning and a relative paucity of contraindications and drug interactions compared to lamotrigine. Before choosing Keppra, you should review the common side effects, including sedation and mood disturbance. Caution when starting any of these drugs is advisable, because excessive tiredness could cause impairment with driving and other tasks.

Natural alternatives to lamotrigine

Facing warning labels, serious side effects, drug interactions, and contraindications could have you fearful of just about any medication. For that reason, many folks turn to natural alternatives. However, just because something is considered natural does not mean it is safe. Many supplements have not been adequately tested either. A review of supplements for bipolar depression reached the conclusion that there is not enough evidence to support any particular one, but it also pointed out that natural options can have potential, as evidenced by the mood stabilizer lithium being a natural mineral.

Cannabidiol (CBD) garners a lot of attention as a potential, natural remedy for bipolar and seizure disorders. Only weak evidence exists for use in bipolar treatment, according to a 2020 review. Likewise, a review indicated that the use of CBD for certain seizure disorders is backed by clinical trials, but numerous questions remain about its safety and effectiveness.

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How to switch to a lamotrigine alternative

The gravity of a decision about seizure or bipolar treatment can seem overwhelming. Hopefully, gathering information has helped to put you on the right track in the decision-making process. The next step is to discuss the matter with the prescribing healthcare professional. If the effects of lamotrigine have you considering discontinuation, be prepared to explain why you are dissatisfied and what you are looking for in a substitute, including any of the options noted above. Your pharmacist can be another great resource for medical advice. When a decision is made, your entire healthcare team should be on the same page.