Lamotrigine

Date: January 2020, Version 3

What is it?

Lamotrigine (Lamictal®) is used to treat epilepsy, sometimes in combination with other medicines. Lamotrigine is also used in the treatment of bipolar disorder.

Is it safe to take lamotrigine in pregnancy?

When deciding whether to use lamotrigine during pregnancy it is important to weigh up the potential benefits to your health and wellbeing against any possible risks to you or your baby, some of which may depend on how many weeks pregnant you are. Use of lamotrigine in pregnancy may sometimes be considered necessary to control epilepsy or bipolar disorder. Your doctor or specialist will help you make decisions about your treatment.

It is recommended that all women taking anti-epileptic medicines also take high dose folic acid (5mg/day) whilst trying to conceive and during the first trimester of pregnancy. High dose folic acid has to be prescribed by a doctor. For more information please see the folic acid bump leaflet.

What if I have already taken lamotrigine during pregnancy?

If you have taken or are taking any medicines it is always a good idea to let your doctor know that you are pregnant so that you can decide together whether you still need the medicines that you are on and to make sure that you are taking the lowest dose that works and only for as long as you need to.

It is very important that you do not suddenly stop taking lamotrigine as this could be dangerous. Do not make any changes to your medication without first talking to your doctor.

Because of the normal bodily changes associated with a progressing pregnancy, the dose of lamotrigine may need to be adjusted to ensure that symptoms remain well-controlled. Your doctor may offer ongoing monitoring to determine whether dose changes are required.

Can taking lamotrigine in pregnancy cause birth defects in the baby?

A baby’s body and most internal organs are formed during the first 12 weeks of pregnancy. It is mainly during this time that some medicines are known to cause birth defects.

The likelihood of birth defects has been studied in around 13,000 babies born to women who took lamotrigine during pregnancy. These babies do not appear to be any more likely to have a birth defect than babies born to women who didn’t take lamotrigine.

Can taking lamotrigine in pregnancy cause miscarriage or stillbirth?

There is currently no proof that lamotrigine use in pregnancy causes miscarriage or stillbirth. However, the number of women studied is quite small and ongoing research is therefore ideally required.

Can taking lamotrigine in pregnancy cause preterm birth or my baby to be small at birth (low birth weight)?

No links between taking lamotrigine in pregnancy and preterm birth or low birth weight in the baby were identified in studies, each of around 3,000 women.

Can taking lamotrigine in pregnancy cause other health problems in the child?

Withdrawal symptoms at birth (‘neonatal withdrawal’)
Withdrawal symptoms are thought to occur when a newborn baby’s body has to adapt to no longer getting certain types of medicines through the placenta.

Lamotrigine works in a similar way to other medicines that are known to cause neonatal withdrawal, therefore close monitoring of your baby for a few days after birth may be advised if you have taken lamotrigine regularly in the weeks before delivery. Monitoring of your baby may be particularly important if you have taken lamotrigine in combination with other antiepileptic medicines or medicines that act on the brain.

Learning and behavioural problems
A baby’s brain continues to develop right up until the end of pregnancy. It is therefore possible that taking certain medicines at any stage of pregnancy (particularly those that act upon the brain) could have a lasting effect on a child’s learning or behaviour.

Several studies have assessed the learning and behaviour of children exposed in the womb to lamotrigine. Although the results are generally reassuring, for some outcomes only small numbers of children at quite young ages have been studied. Ongoing research, including assessments of children as they get older, is therefore ideally required.

Will I or my baby need extra monitoring?

Most women will be offered a scan at around 20 weeks of pregnancy to look for birth defects as part of their routine antenatal care. Taking lamotrigine in pregnancy is not expected to cause problems that would require extra monitoring of your baby. However, women with epilepsy may be more closely monitored during pregnancy to ensure that they remain well throughout and that their baby is growing and developing as expected.

If you have taken lamotrigine around the time of delivery your baby may require extra monitoring after birth because of the risk of neonatal withdrawal.

Are there any risks to my baby if the father has taken lamotrigine?

We would not expect any increased risk to your baby if the father took lamotrigine before or around the time you became pregnant.

Who can I talk to if I have questions?

If you have any questions regarding the information in this leaflet please discuss them with your health care provider. They can access more detailed medical and scientific information from www.uktis.org

How can I help to improve drug safety information for pregnant women in the future?

Our online reporting system (MyBump Portal) allows women who are currently pregnant to create a secure record of their pregnancy, collected through a series of questionnaires. You will be asked to enter information about your health, whether or not you take any medicines, your pregnancy outcome and your child's development. You can update your details at any time during pregnancy or afterwards. This information will help us better understand how medicines affect the health of pregnant women and their babies. Please visit the MyBump Portal to register.

General information
Sadly, miscarriage and birth defects can occur in any pregnancy.

Miscarriage occurs in about 1 in every 5 pregnancies, and 1 in every 40 babies are born with a birth defect. This is called the ‘background risk’ and happens whether medication is taken or not.

Most medicines cross the placenta and reach the baby. For many medications this is not a problem. However, some medicines can affect a baby’s growth and development.

If you take regular medication and are planning to conceive, you should discuss whether your medicine is safe to continue with your doctor/health care team before becoming pregnant. If you have an unplanned pregnancy while taking a medicine, you should tell your doctor as soon as possible.

If a new medicine is suggested for you during pregnancy, please make sure that the person prescribing it knows that you are pregnant. If you have any concerns about a medicine, you can check with your doctor, midwife or pharmacist.

Our Bumps information leaflets provide information about the effects of medicines in pregnancy so that you can decide, together with your healthcare provider, what is best for you and your baby.