Lamotrigine is a sodium-channel-modulating, antiepileptic drug (AED), which was approved in the USA in 1994 for use in partial-onset seizures. It was ultimately approved for monotherapy in 1998. Lamotrigine has gained widespread use in the USA as both an immediate and an extended-release agent. Lamotrigine is effective against a broad spectrum of seizure types and has a favorable metabolic profile, with few but significant drug interactions. Pregnancy registries in several countries have demonstrated that AED use in women with epilepsy is associated with an increased risk of fetal malformations, if the infant is exposed during the period of organogenesis. In addition, new evidence demonstrates that AEDs may affect the intellectual development of a child, as measured up until the age of 3 years. This information has made the choice of an anticonvulsant for a woman who might become pregnant significantly more important. Pregnancy registries have consistently demonstrated lamotrigine to be among the safest medications for a developing fetus, both in terms of fetal malformations and postpartum cognitive development. These findings make lamotrigine probably the first choice of AED for women wishing to become pregnant and for whom the medication is appropriate.