What Meds

Psychiatric Medications


Lamotrigine
Brand Name: Lamictal

Overview
Lamictal is the brand name for lamotrigine (also known as LTG), an anticonvulsant and mood stabilizer. It is chemically unrelated to other anticonvulsant medications. This drug blocks specific sodium channels, inhibiting the release of glutamate and aspartate.

Lamictal’s side effects are generally few and relatively benign. Lamictal is known as a drug that is effective in people who were not helped by other, more traditional medications, when used as an anticonvulsant or as a mood stabilizer.

Lamictal is not a cure for epilepsy, but this medication can help to control epileptic seizures, and it is often used along with other medications for this same purpose. Prescribing information for children as young as 2 years old is available.

Lamictal is FDA approved for used as a mood stabilizer as a maintenance therapy, to prevent manic and depressive episodes. It seems to be effective in a large proportion of patients who were not helped with other mood stabilizing drugs, and is especially effective in bipolar depression.

Why is this drug prescribed?
Lamictal FDA-labeled in adults for the prevention of mood episodes associated with bipolar 1 disorder, Lennox-Gastaut syndrome, partial seizures, and tonic-clonic seizures. It is also FDA-labeled in children 2 years and older for Lennox-Gastaut syndrome, partial seizures, and tonic-clonic seizures.

Lamictal is also used to treat mood disordes that do not respond to other medication, such as:

How much of this drug is typically used?
Tablet: 25 mg, 100 mg, 150 mg, 200 mg
Tablet, combination package [each unit-dose starter kit contains]:
  Lamictal (blue kit; for patients taking valproic aid):
    Tablet: Lamotrigine 25 mg (35s)
  Lamictal (green kit; for patients taking carbamazepine, phenytoin, phenobarbital, primidone, or rifampin and not taking valproic acid):
    Tablet: Lamotrigine 25 mg (84s)
    Tablet: Lamotrigine 100 mg (14s)
  Lamictal (orange kit; for patients not taking carbamazepine, phenytoin, phenobarbital, primidone, rifampin, or valproic acid):
    Tablet: Lamotrigine 25 mg (42s)
    Tablet: Lamotrigine 100 mg (7s)
Tablet, dispersible/chewable: 2 mg, 5 mg, 25 mg

Warnings and Precautions
Children: Lamictal is used in children primarily for Lennox-Gastaut syndrome. The risk of the side effect of a skin rash is higher in children under 16 than in adults. Sometimes the rashes caused by Lamictal could be very serious or even fatal. This risk must be weighed against the benefits of Lamictal and any rashes should be discussed with a pediatrician. The risk of rash is usually only significant during the first six months of beginning Lamictal therapy.

Rash is the most significant side-effect of Lamictal because in rare instances, it has caused serious harm or, very rarely, death. Factors that increase the risk of a serious rash include a high initial dosage of Lamictal, and use of valproic acid at the same time. In the past the rash incidence, leading to Stevens-Johnson Syndrome, was high because of high initial doses and failure to adjust the dose when given with valproate. Newer data suggest that the incidence of a dangerous rash is much lower with current dosing guidelines.

Patients taking Lamictal should not try new shampoos, soaps, or detergents and should avoid sun exposure so as not to increase the chance of an allergic reaction or development of a rash which is not due to Lamictal, but would necessitate stopping the medication in order to investigate the source of the rash. The appearance of any rash in a patient taking Lamictal should be immediately reported to a doctor.

Dosage: adjustments to the dosage must be made by considering all medications that the patient will be taking. The medications valproic acid, carbamazepine, phenobarbital, primidone, and phenytoin must especially be taken into account and may be adjusted for Lamictal.

Whenever possible, Lamictal should not be discontinued abruptly, but dosage should be graudally tapered to minimize the risk of increased frequency of seizures.

Because Lamictal can cause dizziness, drowsiness, and vision problems, patients should not engage in activities, such as driving or operating machinery, until they are certain that Lamictal’s effects do not present a danger to themselves or others.

For Pregnant or Nursing Mothers: Lamictal’s effects have not been studied in pregnant women, but studies on animals indicate that it can harm the fetus or cause miscarriage, even in doses less than the equivalent of an overdose in humans. Pregnant women taking Lamictal may be asked to take a folic acid supplement. Lamictal passes into breast milk, but its effects on the infant are not well understood so breastfeeding is not recommended.

Contraindications
Lamictal should Not be used for people with an allergy or hypersensitivity to Lamictal.

Precautions
Lamictal may be used with caution in people with the following conditions:

Adverse Reactions
Lamictal may cause the following reactions:

Rarely:

Interactions with Drugs and Other Substances
Drugs or substances that may interact with Lamictal include:

Research Studies and Use in Child Psychiatry
Lamotrigine is used to prevent mood episodes (mania or depression) from occurring in patients with bipolar disorder.  This medication has shown some evidence that favors the usage for bipolar disorder depressed phase, refractory epilepsy, migraines, obesity, trigeminal neuralgia, and adjunctive use of treatment resistant depression in adults.

Safety and efficacy in pediatric patients with acute mood disorders has not been established. In an 8-week open-label study of lamotrigine in adolescents ages 12 to 17 years with bipolar disorder experiencing a depressive episode, lamotrigine was effective, whether as adjunctive or monotherapy, in decreasing depression, mania, and aggression. (Chang et al, 2006).  Larger, placebo-controlled studies are currently underway for lamotrigine in children and adolescents with bipolar disorder. Carbamazepine, phenytoin, primidone, and valproic acid may change blood levels of lamictal; dosage adjustments are needed for one or both medications.

Sources

Stanford Medicine Resources:

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