Lamotrigine
Commercial names and formulations:
Brand name: Lamictal
Formulations: Tablet, oral-disintegrating tablet, extended release tablet, chewable tablet
Years on the market:
Since 1994
How to store it?
Store at room temperature and protect from light and moisture.
What does the body do to the medication?
Can I take it with food?
Yes
How long does it take to get to the blood after I take it?
Approximately 1-3 hours
How long does it take to start having a steady effect?
5 days
Can this medication be started at a high dose or it has to be started gradually?
Very gradually
How long does it stay in the body?
About 1 day
How is it eliminated?
Liver
What does the medication do to the body?
Type of epilepsy that helps:
Partial and Generalized Epilepsy
FDA approved for:
Partial seizures, primary generalized tonic-clonic seizures, Lennox-Gastaut syndrome
Common side effects:
• Skin: rash, itching
• Bones: none
• Blood: decrease in white blood cells
• Liver: none
• Kidneys: none
• Stomach and intestines: nausea, vomiting, diarrhea, upset stomach, constipation, weight loss, abdominal pain
• Heart: none
• Brain: dizziness, difficulty with coordination, drowsiness, difficulty sleeping, tremor, convulsion, difficulty speaking, difficulty concentrating, headache
• Mood: depression, anxiety, irritability
• Others: flu like symptoms, fever, blurred vision, joint pain
Serious side effects:
Serious skin rash including Stevens-Johnson syndrome and toxic epidermal necrolysis
Risk of suicidal thoughts or behavior, severe headaches from aseptic meningitis
What happens if I get too much of it (intoxication)?
Symptoms of an overdose include difficulty with coordination, abnormal eye movements, increased seizure activity, and possibly loss of consciousness or coma.
What happens if I stop it suddenly (withdrawal)?
Lamictal should not be abruptly discontinued, as there is a possibility of increasing seizure frequency.
Who should not take this medication?
You should not take Lamictal if you know that you are allergic to any of the ingredients. Patients with severe myoclonic epilepsy should avoid this medication
What is the average dose and how many times a day should be given?
Children:
Initial 0.3 mg/kg/day (in divided doses); Maintenance 4.5-7.5 mg/kg/day (in divided doses). Titration will be different when patients are taking other seizure medication especially depakote
Adults:
Initial 25 mg/day; Maintenance 100-400 mg/day (in divided doses)
Titration will be different when patients are taking other seizure medication especially depakote
Does the body get used to the medication?
Yes
Medications to be careful with:
Other AEDs that can increase the blood level of lamotrigine:
Valproic Acid
Other AEDs that can decrease the blood level of lamotrigine:
Phenobarbital, Phenytoin, Primidone, Carbamazepine. Oxcarbaazepine and topiramate may also do this.
Other drug interactions:
Estrogen in birth control pills will lower lamotrigine levels
Blood work required?
How often?
At the discretion of the physician
Are medication levels in blood useful?
Yes
Normal range
1.5 to 14 mg/L
Women’s health
Affects contraceptives?
No, but some OTC will lower lamotrigine levels which can lead to breakthrough seizures.
Affect fertility?
No
Are safe in pregnancy?
Discuss this with your doctor. It may be safe for some women to take lamotrigine during pregnancy.
Category
Pregnancy Category C
Can breastfeed?
Discuss with your MD. The effect of lamotrigine on the breast-feeding infant remains unknown. These unknown risks have to be weighed against the multiple benefits of breast-feeding by the individual patient.
Affect bones (osteoporosis)?
No
Men’s health
Affects sexual performance?
No
Affects fertility?
No
Use other than epilepsy:
Bipolar Disorder