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Lamotrigine
Definition
Lamotrigine is an anticonvulsant medication used in the treatment of epilepsy. Epilepsy is a neurological disorder in which excessive surges of electrical energy are emitted in the brain, causing seizures. Lamotrigine is usually reserved for difficult-to-control seizures that have not responded to other anticonvulsant medications. In psychiatry, lamotrigine is also indicated in the treatment of bipolar disorder (manic-depression).
Purpose
While lamotrigine controls seizures associated with epilepsy, there is no known cure for the disorder. Although the precise mechanism by which lamotrigine exerts its therapeutic effect is unknown, lamotrigine is thought to act at sodium channels in the neuron (nerve cell) to reduce the amount of excitatory neurotransmitters that the nerve cell releases. Neurotransmitters are chemicals that aid in the transfer of nerve impulses from one nerve junction to the next. With decreased levels of these neurotransmitters, the electrical activity in the brain that triggers seizures is reduced.
In the treatment of bipolar disorders, lamotrigine's effect upon neurochemicals stabilizes mood, preventing sudden, unpredictable, and severe episodes of mania and depression.
Description
For the treatment of epilepsy-related seizures, lamotrigine may be used alone or in combination with other anti-epileptic drugs (AEDs) or anticonvulsants. In the United States, lamotrigine is sold under the brand name Lamictal.
Recommended dosage
Lamotrigine is taken orally, in either tablet or chewable form. Chewable tablets may be dispersed into a liquid solution, according to the prescribing physician's instructions. Lamotrigine is prescribed by physicians in varying daily dosages, usually ranging 200–900 mg per day divided into two doses.
Beginning any course of treatment that includes lamotrigine requires a gradual dose-increasing regimen. The safety and effectiveness of lamotrigine in children under age 18 have not been proven; therefore, the drug is seldom used in children. Adults typically take an initial dose for the first two weeks that is slowly increased over time. It may take several weeks to realize the full benefits of lamotrigine, especially in those patients taking lamotrigine for the treatment of bipolar disorders.
A double dose of lamotrigine should not be taken. If a dose is missed, it should be taken as soon as possible. However, if it is within four hours of the next dose, then the missed dose should be skipped. When ending a course of treatment that includes lamotrigine, physicians typically direct patients to gradually taper down their daily dosages over a period of several weeks. Stopping the medicine suddenly may severely alter mood or cause seizures to occur, even in patients taking lamotrigine for the treatment of bipolar disorders.
Precautions
A physician should be consulted before taking lamotrigine with certain non-prescription medications. Patients should avoid alcohol and CNS depressants (medications that make one drowsy or tired, such as antihistimines, sleep medications, and some pain medications), while taking lamotrigine. Lamotrigine can exacerbate the side effects of alcohol and some other medications. Alcohol may also increase the risk or frequency of seizures.
Lamotrigine may not be suitable for persons with a history of liver or kidney disease, depressed renal functital illness, anemia, high blood pressure, angina (chest pain), or irregular heartbeats and other heart problems. Before beginning treatment with lamotrigine, patients should notify their physician if they consume a large amount of alcohol, have a history of drug use, are nursing, pregnant, or plan to become pregnant.
Lamotrigine's safety during pregnancy has not been established. Persons taking lamotrigine (and other AEDs or anticonvulsants) should be aware that many AEDs and anticonvulsants cause birth defects. Patients who become pregnant while taking any AED or anticonvulsants should contact their physician immediately.
Side effects
Lamotrigine is generally well tolerated. However, in some patients, lamotrigine may produce some of the traditionally mild side effects associated with anticonvulsants. Headache, nausea, and unusual tiredness and weakness are the most frequently reported side effects of anticonvulsants. Other possible side effects that do not usually require medical attention include:
mild coordination problems
mild dizziness
abdominal pain
sinus pain
sleepiness or sleeplessness
diarrhea or constipation
heartburn or indigestion
aching joints and muscles or chills
unpleasant taste in mouth or dry mouth
Many of these side effects disappear or occur less frequently during treatment as the body adjusts to the medication. However, if any symptoms persist or become too uncomfortable, the prescribing physician should be consulted.
Other, uncommon side effects of lamotrigine can be serious and may indicate an allergic reaction. Severe and potentially life-threatening rashes have occurred during treatment with lamotrigine, occurring approximately once in every 1,000 persons who take the drug. In the unusual event that this rash develops, it normally occurs within the first eight weeks of treatment. A patient taking lamotrigine who experiences any of the following symptoms should contact a physician immediately:
rash or bluish patches on the skin
sores in the mouth or around the eyes
depression or suicidal thoughts
mood or mental changes, including excessive fear, anxiety, hostility
general loss of motor skills
persistent lack of appetite
altered vision
difficulty breathing
chest pain or irregular heartbeat
faintness or loss of consciousness
persistent, severe headaches
persistent fever or pain
Interactions
Lamotrigine may have negative interactions with some antacids, antihistamines, antidepressants, antibiotics, and monoamine oxidase inhibitors (MAOIs). Other medications such as HIV protease inhibitors (indinavir), ritonavir (Norvir), ipratropium (Atrovent), isoniazid, phenobarbital (Luminal, Solfoton), nefazodone, metronidazole, acetazolamide (Diamox), propranolol (Inderal), rifampin (Rifadin, Rimactane), and warfarin may also adversely react with lamotrigine. Oral contraceptives (birth control pills) may decrease the amount of lamotrigine absorbed by the body.
Lamotrigine may be used with other seizure prevention medications, if advised by a physician.
Resources
BOOKS
Devinsky, Orrin, M. D., Epilepsy: Patient and Family Guide, 2nd ed. Philadelphia: F. A. Davis Co., 2001.
Weaver, Donald F. Epilepsy and Seizures: Everything You Need to Know. Toronto: Firefly Books, 2001.
OTHER
"Lamotrigine." Medline Plus. National Library of Medicine. May 6, 2004 (June 1, 2004). http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202786.html.
"Lamotrigine." Yale New Haven Health Service Drug Guide. May 6, 2004 (June 1, 2004). http://yalenewhavenhealth.org/library/healthguide/enus/drugguide/topic.asp?hwid=multumd03809a1.
ORGANIZATIONS
Epilepsy Foundation. 4351 Garden City Drive, Landover, MD 20785-7223. (800) 332-1000. http://www.epilepsyfoundation.org.
American Epilepsy Society. 342 North Main Street, West Hartford, CT 06117-2507. http://www.aesnet.org.
Generic Name: lamotrigine
Drug Class And Mechanism: Lamotrigine is an oral drug that is used for treating seizures. It is chemically unrelated to other anti-seizure drugs. The precise mechanism by which lamotrigine exerts its anti-seizure action is not known.
Prescription: yes
Generic Available: no
Storage: Tablets should be stored at room temperature, between 15 and 30°C (59-86°F).
Prescribed For: Lamotrigine is used in combination with other anti-seizure drugs in the treatment of some types of seizures. It also is used alone for treating partial seizures in patients 16 years and older when converting from the anti-epileptic drug valproate.
Dosing: The initial dose of lamotrigine in patients not taking valproicacid (Depakote) is 50 mg once daily for two weeks, followed by 100 mg daily given in two divided doses for two weeks. Thereafter, the usual maintenance dose is 300 to 500 mg daily given in two divided doses. In patients taking valproic acid, the initial dose of lamotrigine is 25 mg every other day for two weeks, then 25 mg once daily for two weeks, slowly increasing the dose (by 25 to 50 mg per day) every one to two weeks) until a dose of 100 to 150 mg daily is reached. Standard doses of lamotrigine are given twice daily.
Drug Interactions: Lamotrigine can interact with valproic acid. When lamotrigine is begun in patients already receiving valproic acid, the blood concentrations of valproic acid can decrease over a 3-week period. This may result in loss of seizure control. The risk of severe skin rash may be increased by combining lamotrigine with valproic acid.
There may be a higher incidence of dizziness, double vision, and blurred vision in patients receiving carbamazepine together with lamotrigine. The mechanism of this interaction is unclear.
Pregnancy: Damage to the fetus has been shown in some but not all pregnant animal species given lamotrigine. There have been no good studies in pregnant women. Physicians may choose to prescribe lamotrigine to pregnant women if they feel the benefit outweighs the potential risk.
Nursing Mothers: Lamotrigine is secreted into human breast milk. Because the effects on the infant are unknown, breast-feeding while taking lamotrigine is not recommended.
Side Effects: Severe, life-threatening rashes have occurred with lamotrigine. The risk in children (for whom lamotrigine is not approved) is as high as 1 in 50 to 1 in 100 patients. Rash is rare in adults, but the risk is increased if the dose is increased faster than recommended or if patients also are taking valproic acid. Nearly all reported rashes have occurred within 2 to 8 weeks of starting therapy. Patients taking lamotrigine should report any rash to a physician immediately.
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