Lamotrigine

Lamotrigine Brand Names

Lamictal | Lamictal CD | Lamictal ODT | Lamictal XR | Subvenite

What is Lamotrigine

Lamotrigine is an oral anticonvulsant agent developed based on the observation that some antiepileptic drugs possess antifolate activity. Although derived from agents which inhibit dihydrofolate reductase, lamotrigine has relatively little antifolate activity.

Due to life-threatening rashes (including Stevens-Johnson syndrome and toxic epidermal necrolysis), lamotrigine carries a boxed warning stating the drug should be discontinued if a rash appears at any time during treatment. Age is the only factor currently known to predict the occurrence or severity of a rash, with pediatric patients at increased risk.

Lamotrigine was found to be an effective anticonvulsant and is used as adjunctive treatment for refractory partial seizures with or without secondarily generalized tonic-clonic seizures.

In adults, it may be used for monotherapy of partial seizures in those currently on single-drug therapy with an enzyme-inducing antiepileptic drug. Improvements in quality of life, when compared to placebo, have been seen with lamotrigine; patients noted improvements in rating of seizure severity, mastery, and happiness.

Lamotrigine was originally approved by the FDA in December 1994. It is also effective for the adjunctive treatment of Lennox-Gastaut syndrome 

and was approved for this use in pediatric and adult patients in September 1998.

A chewable tablet was FDA-approved in August 1998. In January 2003, the FDA approved lamotrigine tablets as adjunctive therapy for partial seizures in children >= 2 years of age.

In January 2003, it was approved for monotherapy treatment for partial seizures in patients >= 16 years when converting from valproate therapy. FDA-approval for the long-term maintenance treatment of bipolar I disorder was granted in June 2003.

In September 2006, the FDA approved immediate-release lamotrigine for use as adjunct therapy in the treatment of primary generalized tonic-clonic seizures. In May 2009, an orally disintegrating tablet (ODT) formulation was approved by the FDA.

For patients 13 years of age and older, an extended-release formulation (Lamictal XR) was FDA approved as adjunctive therapy for partial onset seizures with or without secondary generalization in June 2009 and then as adjunctive therapy for primary generalized tonic-clonic seizures in February 2010.

Extended-release lamotrigine was FDA approved in April 2011 for conversion to monotherapy in patients 13 years of age and older with partial seizures who are receiving treatment with a single antiepileptic drug (AED).

It should be noted that safety and efficacy of extended-release lamotrigine have not been established as initial monotherapy or for simultaneous conversion to monotherapy from two or more concomitant AEDs.

Indications

1. absence seizures
2. bipolar disorder
3. Lennox-Gastaut syndrome
4. partial seizures
5. short-lasting unilateral neuralgiform headache with conjunctival injection and tearing
6. tonic-clonic seizures

NOTE: Medication errors have been reported with lamotrigine starter kits. Mild to severe side effects, including Stevens-Johnson Syndrome have occurred. There are 3 different starter kits with titration schedules dependent on concurrent medications. Patients must receive the correct kit to avoid over or under dosing.

Side Effects

1. abdominal pain
2. acne vulgaris
3. agitation
4. agranulocytosis
5. akathisia
6. alopecia
7. amblyopia
8. amenorrhea
9. amnesia
10. anemia
11. angioedema
12. anorexia
13. anxiety
14. aphasia
15. aplastic anemia
16. apnea
17. appetite stimulation
18. arthralgia
19. aseptic meningitis
20. asthenia
21. ataxia
22. atopic dermatitis
23. back pain
24. blurred vision
25. bronchospasm
26. chest pain (unspecified)
27. choreoathetosis
28. colitis
29. confusion
30. conjunctivitis
31. constipation
32. contact dermatitis
33. cough
34. cystitis
35. delirium
36. depression
37. diaphoresis
38. diarrhea
39. diplopia
40. disseminated intravascular coagulation (DIC)
41. dizziness
42. drowsiness
43. Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS)
44. dysarthria
45. dyskinesia
46. dysmenorrhea
47. dyspepsia
48. dysphagia
49. dysphoria
50. dyspnea
51. dystonic reaction
52. dysuria
53. ecchymosis
54. edema
55. ejaculation dysfunction
56. elevated hepatic enzymes
57. emotional lability
58. eosinophilia
59. epididymitis
60. epistaxis
61. eructation
62. erythema
63. erythema multiforme
64. esophagitis
65. euphoria
66. exfoliative dermatitis
67. fatigue
68. fever
69. flatulence
70. flushing
71. gastritis
72. gingivitis
73. glossitis
74. goiter
75. hallucinations
76. headache
77. hematemesis
78. hematuria
79. hemolytic anemia
80. hemophagocytic lymphohistiocytosis
81. hepatic failure
82. hepatitis
83. hiccups
84. hirsutism
85. hostility
86. hot flashes
87. hyperalgesia
88. hyperbilirubinemia
89. hyperesthesia
90. hyperglycemia
91. hyperkinesis
92. hyperreflexia
93. hypersalivation
94. hypertension
95. hypertonia
96. hyperventilation
97. hypoesthesia
98. hyponatremia
99. hyporeflexia
100. hypothyroidism
101. hypotonia
102. impotence (erectile dysfunction)
103. increased urinary frequency
104. infection
105. influenza
106. insomnia
107. irritability
108. leukocytosis
109. leukopenia
110. libido decrease
111. libido increase
112. lupus-like symptoms
113. lymphadenopathy
114. lymphocytosis
115. maculopapular rash
116. malaise
117. mania
118. melena
119. memory impairment
120. menorrhagia
121. migraine
122. myalgia
123. myasthenia
124. myocarditis
125. nasal congestion
126. nausea
127. neuritis
128. neutropenia
129. nocturia
130. nystagmus
131. orthostatic hypotension
132. palpitations
133. pancreatitis
134. pancytopenia
135. paranoia
136. paresthesias
137. parosmia
138. peptic ulcer
139. peripheral edema
140. peripheral vasodilation
141. petechiae
142. pharyngitis
143. photophobia
144. polyuria
145. pruritus
146. psychosis
147. ptosis
148. rash
149. red cell aplasia
150. renal failure (unspecified)
151. rhabdomyolysis
152. rhinitis
153. sinus tachycardia
154. sinusitis
155. skin discoloration
156. splenomegaly
157. Stevens-Johnson syndrome
158. stomatitis
159. suicidal ideation
160. syncope
161. thrombocytopenia
162. tinnitus
163. toxic epidermal necrolysis
164. tremor
165. urinary incontinence
166. urinary retention
167. urinary urgency
168. urticaria
169. uveitis
170. vaginitis
171. vasculitis
172. vertigo
173. visual impairment
174. vomiting
175. weight gain
176. weight loss
177. xerosis
178. xerostomia
179. yawning

Monitoring Parameters

• CBC

Contraindications

• abrupt discontinuation
• aplastic anemia
• aseptic meningitis
• breast-feeding
• children
• depression
• dialysis
• driving or operating machinery
• folate deficiency
• geriatric
• hemophagocytic lymphohistiocytosis
• hepatic disease
• history of angioedema
• infants
• leukopenia
• neonates
• neutropenia
• pregnancy
• red cell aplasia
• renal failure
• renal impairment
• serious rash
• suicidal ideation
• thrombocytopenia

Interactions

• Acetaminophen
• Acetaminophen; Aspirin, ASA; Caffeine
• Acetaminophen; Butalbital
• Acetaminophen; Butalbital; Caffeine
• Acetaminophen; Butalbital; Caffeine; Codeine
• Acetaminophen; Caffeine
• Acetaminophen; Caffeine; Dihydrocodeine
• Acetaminophen; Caffeine; Magnesium Salicylate; Phenyltoloxamine
• Acetaminophen; Caffeine; Phenyltoloxamine; Salicylamide
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Phenylephrine
• Acetaminophen; Chlorpheniramine; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Chlorpheniramine; Phenylephrine; Phenyltoloxamine
• Acetaminophen; Codeine
• Acetaminophen; Dextromethorphan
• Acetaminophen; Dextromethorphan; Doxylamine
• Acetaminophen; Dextromethorphan; Guaifenesin; Phenylephrine
• Acetaminophen; Dextromethorphan; Phenylephrine
• Acetaminophen; Dextromethorphan; Pseudoephedrine
• Acetaminophen; Dichloralphenazone; Isometheptene
• Acetaminophen; Diphenhydramine
• Acetaminophen; Guaifenesin; Phenylephrine
• Acetaminophen; Hydrocodone
• Acetaminophen; Oxycodone
• Acetaminophen; Pentazocine
• Acetaminophen; Propoxyphene
• Acetaminophen; Pseudoephedrine
• Acetaminophen; Tramadol
• Aldesleukin, IL-2
• Alogliptin; Metformin
• Alprazolam
• Amphetamines
• Apalutamide
• Aripiprazole
• Atazanavir
• Atazanavir; Cobicistat
• Atropine; Hyoscyamine; Phenobarbital; Scopolamine
• Belladonna Alkaloids; Ergotamine; Phenobarbital
• Benzhydrocodone; Acetaminophen
• Bupropion
• Bupropion; Naltrexone
• Canagliflozin; Metformin
• Cannabidiol
• Carbamazepine
• Cenobamate
• Chlorpromazine
• Cimetidine
• Clozapine
• Codeine; Phenylephrine; Promethazine
• Codeine; Promethazine
• Colesevelam
• Dapagliflozin; Metformin
• Dasabuvir; Ombitasvir; Paritaprevir; Ritonavir
• Desmopressin
• Dextromethorphan; Promethazine
• Dienogest; Estradiol valerate
• Dofetilide
• Drospirenone
• Drospirenone; Estradiol
• Drospirenone; Ethinyl Estradiol
• Drospirenone; Ethinyl Estradiol; Levomefolate
• Elagolix; Estradiol; Norethindrone acetate
• Empagliflozin; Linagliptin; Metformin
• Empagliflozin; Metformin
• Ertugliflozin; Metformin
• Estradiol; Levonorgestrel
• Estradiol; Norethindrone
• Estradiol; Norgestimate
• Ethinyl Estradiol
• Ethinyl Estradiol; Desogestrel
• Ethinyl Estradiol; Ethynodiol Diacetate
• Ethinyl Estradiol; Etonogestrel
• Ethinyl Estradiol; Levonorgestrel
• Ethinyl Estradiol; Levonorgestrel; Ferrous bisglycinate
• Ethinyl Estradiol; Levonorgestrel; Folic Acid; Levomefolate
• Ethinyl Estradiol; Norelgestromin
• Ethinyl Estradiol; Norethindrone
• Ethinyl Estradiol; Norethindrone Acetate
• Ethinyl Estradiol; Norethindrone Acetate; Ferrous fumarate
• Ethinyl Estradiol; Norethindrone; Ferrous fumarate
• Ethinyl Estradiol; Norgestimate
• Ethinyl Estradiol; Norgestrel
• Etonogestrel
• Fluorouracil, 5-FU
• Fluphenazine
• Fosphenytoin
• Glipizide; Metformin
• Glyburide; Metformin
• Hydroxychloroquine
• Isocarboxazid
• Isoniazid, INH; Pyrazinamide, PZA; Rifampin
• Isoniazid, INH; Rifampin
• Ketoconazole
• Lacosamide
• Leuprolide; Norethindrone
• Levomefolate
• Levonorgestrel
• Linagliptin; Metformin
• Lopinavir; Ritonavir
• Maprotiline
• Mefloquine
• Meperidine; Promethazine
• Mephobarbital
• Mesoridazine
• Mestranol; Norethindrone
• Metformin
• Metformin; Pioglitazone
• Metformin; Repaglinide
• Metformin; Rosiglitazone
• Metformin; Saxagliptin
• Metformin; Sitagliptin
• Methotrexate
• Methsuximide
• Molindone
• Monoamine oxidase inhibitors
• Norethindrone
• Norgestrel
• Ombitasvir; Paritaprevir; Ritonavir
• Oral Contraceptives
• Pemoline
• Perphenazine
• Perphenazine; Amitriptyline
• Phenelzine
• Phenobarbital
• Phenothiazines
• Phentermine; Topiramate
• Phenylephrine; Promethazine
• Phenytoin
• Primidone
• Prochlorperazine
• Promethazine
• Pyrimethamine
• Pyrimethamine; Sulfadoxine
• Rifampin
• Ritonavir
• Rufinamide
• Segesterone Acetate; Ethinyl Estradiol
• Selegiline
• Sulfamethoxazole; Trimethoprim, SMX-TMP, Cotrimoxazole
• Thiethylperazine
• Thioridazine
• Topiramate
• Tranylcypromine
• Tricyclic antidepressants
• Trifluoperazine
• Trimethoprim
• Valproic Acid, Divalproex Sodium
• Varenicline