Lamictal(lamotrigine) is a drug used for epilepsy and stabilizing mood in Bipolar Disorder. About 50 million people in the world are epileptic being the most common neurological disease worldwide, followed closely by Bipolar disorder that affects almost 45 million. Lamictal is one of the most popular drugs for these disorders, with almost 11 million prescriptions in 2018. If you are using it for bipolar disorder or epilepsy, you might want to know if you can drink alcohol while on Lamictal. Go ahead and read this article to get more information about it. 

Picture of a tray with cups, small bottle of alcohol and pills.

Lamotrigine is a 2nd generation anti-epileptic used for epilepsy and preventing depression in bipolar disorder. It is a first-line treatment used for focal seizures, 2nd-line treatment for generalized seizures, and a mood stabilizer for bipolar disorder. 

Indications for using Lamictal

Indications for using Lamictal are generalized seizures, partial seizures, tonic-clonic seizures, bipolar disorder, and Lennox- Gastaut syndrome. It is also used for panic disorder, binge eating disorder, and migraine. 

Mechanism of Action

The mechanism of action of Lamictal(lamotrigine) is not clearly understood, however, one of the most probable mechanisms of its action is: It selectively binds sodium channels, stabilizes presynaptic neuronal membranes, prevents glutamate release that is the main excitatory neurotransmitter in the brain. It has anti glutaminergic effects as well strong anti kindling actions, that protect against bipolar disorder and epileptic seizures. Thus, it will decrease brain excitability.

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Another proposed mechanism is that it inhibits voltage-gated calcium channels in neuronal membranes that are important in seizure propagation. Lamictal also increases the release of GABA, an inhibitory neurotransmitter, thus decreasing neuronal excitation to protect against excitotoxicity. It has also been shown to have effects on serotonin reuptake, which explains its anti-depressant effects. That is why it delays or prevents depressive episodes in bipolar disorder. 

Administration and Absorption of Lamictal

Lamictal is available in the form of tablets, chewable tablets, orally disintegrating tablets. It is absorbed rapidly and reaches peak concentrations in 3 hours after taking orally.

Most psychiatric drugs can cause dependency especially if used for a long time. Your body slowly starts developing dependence while you are using these drugs, which means you will experience unpleasant symptoms if you skip the drug. These are called Withdrawal symptoms. Lamictal is generally safe. Most experts are of the view that Lamictal is not addictive but it can have withdrawal symptoms if stopped abruptly. Patients have reported withdrawal seizures on stopping Lamictal and return of the symptoms of bipolar disorder. Other withdrawal symptoms of Lamictal: 

● Moodiness 

● Hostility 

● Lethargy 

● Loss of focus 

● Headaches 

● Body tingling 

● Suicidal Thoughts 

These symptoms vary depending on the body and duration of use. Many people may abuse these drugs including Lamictal to prevent unpleasant feelings and escape from reality. They may also abuse Lamictal to experience that pleasurable “high”. The abuse rate is not so high as other antipsychotics but still, it does carry abusive potential. Some people may abuse it by chewing the non-chewable tablets or they may snort, inject or smoke the resulting powder. 

Therefore, it is important to taper the dose of Lamictal instead of stopping it completely at once. Consult your doctor whenever you want to stop using it. Your doctor will slowly reduce the dose in a period of 2 to 3 weeks and then stop it. This will prevent you from having withdrawal symptoms of Lamictal. 

A black box warning is present on the medication box to warn people that Lamictal can cause severe life-threatening rashes in some people requiring hospitalization and discontinuation of the drug. It has a potential risk of causing systemic lupus erythematosus(SLE) that can be life-threatening. The risk of developing SLE in children is more than in adults. Rarely cases of Toxic epidermal necrolysis can also occur which is a rare and life-threatening reaction of the skin. These occur mostly in the first three to eight weeks of lamotrigine use. Incidence is especially higher in children who are already using other anticonvulsants, especially the older ones like valproic acid and phenytoin. 

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The National Alliance on mental illness has reported that drugs like lamotrigine may increase suicidal ideation and mood swings. Other behavioral disturbances like hostility, mania, irritability, impulsivity, aggression, agitation, and restlessness may also occur. 

Common side effects of Lamotrigine(Lamictal) are: 

● Blurred vision double vision 

● Nausea and vomiting

● Back pain 

● Stomach upset and loss of appetite 

● Weight loss 

● Insomnia, sleep disturbances, and abnormal dreams.

 Joint pain 

● Tremors 

● Dysmenorrhea 

● Skin irritation 

● Stiff neck 

● Dry mouth 

● Difficulty in balancing the body. 

● Euphoria 

● Apathy 

● Taste problems 

● Panic attacks 

● Depression 

● Twitching 

● Leg cramps 

● Uncontrollable eye movements 

● Irregular breathing 

● Irregular heartbeat 

Less common side effects are: 

● Anxiety 

● Confusion 

● Increase in seizures 

● Chest pain 

● Depression 

● Irritability 

Rare side effects of Lamotrigine are: 

● Skin rash 

● Blistering 

● `Jerky movements 

● Slurred speech 

● High fever 

● Shuffling gait 

● Pale skin 

● Bluish discoloration of lips 

● Nose Bleeds.

These potential side effects can increase in severity if the lamotrigine is abused or used for recreation. Overdose of Lamictal as much as 16g has been reported to cause fatalities from seizures, coma, and other complications. There are no specific antidotes for Lamictal, so overdosage requires immediate hospitalization and treatment of the poisoned person. 

The answer is NO. Alcohol can increase the side effects of lamotrigine. even mixing small amounts of Lamictal with alcohol is not recommended. If someone takes Lamictal and alcohol together, he will experience synergistic effects of both substances. This also depends upon the amount and ratios in which these two are mixed. 

Alcohol exaggerates the side effects of Lamictal highly increasing the amounts of GABA that is the inhibitory neurotransmitter leading the brain and spinal cord to a more depressed state that will eventually lead to drowsiness, lethargy, sedation as well as reduced motor reflexes, coma, and respiratory depression from consuming both lamotrigine and alcohol. That is the reason mixing Lamictal and Alcohol is not something you should do. 

Alcohol interacts with most of the medications. Drinking while on lamotrigine is not recommended because alcohol can increase the side effects of lamotrigine. Alcohol Potentiates the CNS pharmacologic side effects of lamotrigine like dizziness, drowsiness, lack of concentration, lethargy, impaired judgment, impaired balancing, and psychomotor skills, and lack of attention.

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These interactions can be dangerous especially if a person drinks too much alcohol while on lamotrigine as this can lead to severe depression of the CNS leading to severe respiratory depression, life-threatening skin rash, and death in very severe cases. This is the reason it is advisable to limit or not drink alcohol at all when on lamotrigine. It is also advisable to avoid doing hazardous, attention-requiring work until you know how it affects you. 

You can develop tolerance while on lamotrigine, that is your body will start to need more of it. Lamotrigine can also cause dependence i.e. you will experience symptoms if you stop taking it. Some of these withdrawal symptoms can be severe. 

● Mood swings 

● Anxiety and irritability may seem very similar to the symptoms of bipolar disorder.

● Dizziness 

● Headache 

● gastrointestinal problems 

● Nausea and diarrhea 

● Cough and cold 

● liver problems 

● Difficulty in sleeping

● withdrawal seizures especially in patients with bipolar disorder and epilepsy

● Rebound worsening of bipolar symptoms 

● Anhedonia( inability to feel pleasure even in pleasurable things) 

● Increased risk for psychosis 

● Frightening vivid nightmares 

● Dysphoria ( intense feelings of discontent) 

● Weight gain 

● Muscle spasms 

● Abnormal menstruation 

● sensory problems 

● Eye problems 

● Pancreatitis 

● Fatigue 

● Anxiety 

● Difficulty with learning and impaired judgment 

In people with seizure disorders, the sudden withdrawal of lamotrigine is associated with very high-intensity seizures. 

Lamictal should always be tapered slowly instead of abruptly stopping it except in the cases of SLE or other life-threatening conditions. Slow tapering of the drug especially anticonvulsants is the general recommendation of the doctors. This is important to prevent a sudden shock to the body which can lead to severe complications and leave the patient in a worse situation than he was in before the prescription.

Because Lamictal blocks the release of excitatory neurotransmitters like aspartate and glutamate, during the withdrawal period these excitatory neurotransmitters will start to flood into the system leading to increased excitability. That is why this process must be slow. It is also advised to limit the foods that contain aspartic acid and glutamic acid during the withdrawal period.