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Home > Drug Category > Antiepileptic Medication > Lamictal and Equivalent

Lamictal (Lamotrigine) Information

Lamictal (lamotrigine) is a prescription medication classified as a phenyltriazine. It is approved as an antiepileptic drug (AED) and a mood stabilizer. For epilepsy, it is indicated for the treatment of Partial Seizures, Primary Generalized Tonic-Clonic Seizures, and generalized seizures of Lennox-Gastaut Syndrome in adults and children (usually 2 years old and older). In adults, it is also used for the maintenance treatment of Bipolar I Disorder to delay the time to the occurrence of mood episodes (depression, mania, hypomania, mixed episodes). Lamotrigine is generally well-absorbed after oral administration; however, its pharmacokinetics are significantly affected by the concurrent use of other medications. Its clearance is primarily achieved through hepatic metabolism by glucuronidation, mainly via the UGT1A4 enzyme, with its half-life varying widely (from approximately 13 to 15 hours when taken with enzyme-inducing antiepileptic drugs to over 48 to 59 hours when taken with valproate).

The drug is available in several oral formulations: immediate-release tablets, chewable/dispersible tablets, extended-release (XR) tablets, and orally disintegrating tablets (ODT). The precise and complete mechanism of action for lamotrigine is not entirely established; however, its main therapeutic effect is thought to be mediated by its action on voltage-sensitive sodium channels. By binding to and inhibiting these channels, lamotrigine stabilizes presynaptic neuronal membranes. This action helps to modulate the excessive release of excitatory amino acid neurotransmitters, such as glutamate and aspartate, thereby stabilizing electrical activity in the brain to control seizures and stabilize mood in bipolar disorder.

Lamictal Side Effects

While Lamictal is generally effective for its approved indications, it does come with a range of side effects, many of which involve the central nervous system and skin. The most common side effects reported, particularly during the dose titration phase, include dizziness, headache, diplopia (double vision), ataxia (lack of muscle coordination), nausea, blurred vision, and somnolence (drowsiness). Due to its effect on the nervous system, some patients may also experience insomnia, tremor, anxiety, irritability, and fatigue. Furthermore, a mild skin rash is a common occurrence. However, it must be carefully monitored due to the risk of progression to more serious dermatological conditions. Other common effects include rhinitis (runny nose) and pharyngitis (sore throat). However, more serious side effects can occur. If any of the following symptoms are experienced, a patient should seek immediate medical attention:

• Aseptic Meningitis: Symptoms may include headache, fever, nausea, vomiting, neck stiffness, and photophobia.

• Blood Dyscrasias: Decreased blood cell counts, which can manifest as easy bruising, unusual bleeding, or signs of infection (e.g., persistent fever, sore throat).

• Cardiac Rhythm and Conduction Abnormalities: Lamotrigine can affect heart rhythm, particularly in patients with pre-existing heart conditions.

• Hemophagocytic Lymphohistiocytosis (HLH): A potentially fatal systemic inflammatory reaction characterized by fever, rash, swollen lymph nodes, organ involvement (including liver failure), and blood dyscrasias.

• Severe Skin Rashes (Boxed Warning): Lamotrigine carries a Black Box Warning for a rare but potentially fatal risk of severe rashes, including Stevens-Johnson Syndrome (SJS), Toxic Epidermal Necrolysis (TEN), and Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS). This risk is higher with rapid dose escalation or co-administration with valproate.

• Suicidal Thoughts and Behaviour: Like all antiepileptic drugs, Lamictal may increase the risk of suicidal thoughts or behaviour; patients and caregivers must monitor for new or worsening depression and behavioural changes.

Lamictal Precautions

Before initiating treatment with Lamictal, a healthcare provider should obtain a thorough history, especially concerning prior rashes or allergic reactions to other AEDs, as the only absolute contraindication is known hypersensitivity to the drug. Lamotrigine must be started at a very low dose and titrated slowly according to a prescribed schedule to significantly minimize the risk of a severe rash; the recommended initial dose and dose-escalation should never be exceeded. Due to the high risk of withdrawal seizures, the medication should never be stopped abruptly; gradual discontinuation over at least two weeks is required unless a severe rash demands immediate cessation. Caution is necessary for patients with a history of heart problems, as lamotrigine has been linked to cardiac conduction abnormalities. Patients with renal or hepatic impairment may require dose adjustments due to altered clearance of the drug. Women of childbearing potential should be aware that estrogen-containing hormonal contraceptives can decrease Lamictal levels, potentially reducing its effectiveness and requiring a dose increase. At the same time, the drug is also known to pass into breast milk. Finally, patients should be advised to avoid operating complex machinery or driving until they know how the drug affects them, as it commonly causes dizziness and visual disturbances.

Do I need a prescription to order Lamictal?

Yes, a prescription is required from your physician to order Lamictal.