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To avoid an increased risk of rashthe recommended initial dose and subsequent dose escalations of LAMICTAL should not be exceededsee BOXED WARNING

Lamotrigine may cause severe or life-threatening skin rashespecially in children and in people who take too high.

Because lamotrigine binds to melaninit could accumulate in melanin-rich tissues over timeThis raises the possibility that lamotrigine may cause toxicity in these tissues after extended useAlthough ophthalmological testing was performed in 1 controlled clinical trialthe testing was inadequate to exclude subtle effects or injury occurring after long-term exposureMoreoverthe capacity of available tests to detect potentially adverse consequencesif anyof lamotrigine’s binding to melanin is unknownsee CLINICAL PHARMACOLOGY

While atazanavir/ritonavir does reduce the lamotrigine plasma concentrationno adjustments to the recommended dose-escalation guidelines for LAMICTAL should be necessary solely based on the use of atazanavir/ritonavirDose escalation should follow the recommended guidelines for initiating adjunctive therapy with LAMICTAL based on concomitant AED or other concomitant medicationssee Tables 12and 5In patients already taking maintenance doses of LAMICTAL and not taking glucuronidation inducersthe dose of LAMICTAL may need to be increased if atazanavir/ritonavir is addedor decreased if atazanavir/ritonavir is discontinuedsee CLINICAL PHARMACOLOGY

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