lamotrigine (Lamictal, Lamictal ODT, Lamictal XR)

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Introduction

Tradename: Lamictal.

Indications

Contraindications

Caution:

  • use cautiously in patients with significant renal or hepatic dysfunction
  • do not discontinue use abruptly

pregnancy category = c

safety in lactation = -

Dosage

* for use in connection with valproic acid[4]

  • start 25 mg QOD for 2 weeks, then
  • 25 mg QD for 2 weeks
  • maintenance 50-75 mg BID

Tabs: 25, 100, 150, 200 mg; Lamictal XR (extended-release) for partial seizures

Oral disintegrating tabs: Lamical ODT

Pharmacokinetics

elimination via liver

elimination via kidney

1/2life = 25 hours

1/2life = 12 hours with phenytoin, carbamazepine, phenobarbital, primidone

1/2life = 60-70 hours with valproic acid

protein binding = 55 %

Monitor

Adverse effects

Toxicity:

Drug interactions

More general terms

Additional terms

Component of

References

  1. The Pharmacological Basis of Therapeutics, 9th ed. Gilman et al, eds. Permagon Press/McGraw Hill, 1996
  2. Harrison's Principles of Internal Medicine, 13th ed. Companion Handbook. Isselbacher et al (eds), McGraw-Hill Inc. NY, 1995, pg 702
  3. 3.00 3.01 3.02 3.03 3.04 3.05 3.06 3.07 3.08 3.09 3.10 3.11 Medical Knowledge Self Assessment Program (MKSAP) 11, 15, 16, 17, 18, 19. American College of Physicians, Philadelphia 1998, 2009, 2012, 2015, 2018, 2021
  4. 4.0 4.1 Kaiser Permanente Northern California Regional Drug Formulary, 1998
  5. 5.0 5.1 5.2 Journal Watch 25(15):118-19, 2005 Rowan AJ, Ramsay RE, Collins JF, Pryor F, Boardman KD, Uthman BM, Spitz M, Frederick T, Towne A, Carter GS, Marks W, Felicetta J, Tomyanovich ML; VA Cooperative Study 428 Group. New onset geriatric epilepsy: a randomized study of gabapentin, lamotrigine, and carbamazepine. Neurology. 2005 Jun 14;64(11):1868-73. PMID: https://www.ncbi.nlm.nih.gov/pubmed/15955935
  6. Department of Veterans Affairs, VA National Formulary
  7. 7.0 7.1 Biton V et al, Double-bind, placebo-controlled study of lamotrigine in primary generalized tonic-clonic seizures. Neurololgy 2005, 65:1737 PMID: https://www.ncbi.nlm.nih.gov/pubmed/16344515
  8. 8.0 8.1 The Washington Manual of Medical Therapeutics, 33rd edition Foster C et al (eds) Lippincott, Williams & Wilkins, Philadelphia, 2010, pg 951
  9. FDA MedWatch http://www.fda.gov/medwatch/safety/2006/safety06.htm#Lamictal
    Prescriber's Letter 13(11): 2006 Increased Risk of Oral Clefts with use of Lamotrigine (Lamictal) During Pregnancy Detail-Document#: http://prescribersletter.com/(5bhgn1a4ni4cyp2tvybwfh55)/pl/ArticleDD.aspx?li=1&st=1&cs=&s=PRL&pt=3&fpt=25&dd=221111&pb=PRL (subscription needed) http://www.prescribersletter.com
  10. 10.0 10.1 Lamictal (lamotrigine): Label Change - Risk of Aseptic Meningitis http://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm222269.htm
  11. Greiner-Sosanko E et al Drug monitoring: simultaneous analysis of lamotrigine, oxcarbazepine, 10-hydroxycarbazepine, and zonisamide by HPLC-UV and a rapid GC method using a nitrogen-phosphorus detector for levetiracetam J Chromatogr Sci. 2007 October; 45(9): 616-622 http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2231334/
  12. 12.0 12.1 Inaba T, Sogawa R, Mizoguchi Y et al Lamotrigine Rechallenge in Treatment-Resistant Bipolar Disorder. Prim Care Companion CNS Disord. 2018 Mar 29;20(2):17m02231. PMID: https://www.ncbi.nlm.nih.gov/pubmed/29659202 Free article.
    Oya K, Sakuma K, Esumi S et al Efficacy and safety of lithium and lamotrigine for the maintenance treatment of clinically stable patients with bipolar disorder: A systematic review and meta-analysis of double-blind, randomized, placebo-controlled trials with an enrichment design. Neuropsychopharmacol Rep. 2019 Sep;39(3):241-246 PMID: https://www.ncbi.nlm.nih.gov/pubmed/31026388 Free article.
  13. 13.0 13.1 Wiffen PJ, Derry S, Moore RA. Lamotrigine for chronic neuropathic pain and fibromyalgia in adults. Cochrane Database Syst Rev. 2013 Dec 3;12:CD006044. Review. PMID: https://www.ncbi.nlm.nih.gov/pubmed/24297457
  14. 14.0 14.1 Tomson T, Battino D, Bonizzoni E, et al Comparative risk of major congenital malformations with eight different antiepileptic drugs: a prospective cohort study of the EURAP registry. Lancet Neurology. April 18, 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29680205 <Internet> http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(18)30107-8/fulltext
    Pennell PB Prescribing antiepileptic drugs to women of reproductive age. Lancet Neurology. April 18, 2018 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/29680207 <Internet> http://www.thelancet.com/journals/laneur/article/PIIS1474-4422(18)30154-6/fulltext
  15. 15.0 15.1 FDA Safety Watch. April 25 2018 Lamictal (lamotrigine): Drug Safety Communication - Serious Immune System Reaction. https://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm605628.htm
  16. 16.0 16.1 FDA Safety Watch. March 31, 2021 Lamictal (lamotrigine): Drug Safety Communication - Studies Show Increased Risk of Heart Rhythm Problems in Patients with Heart Disease. https://www.fda.gov/safety/medical-product-safety-information/lamictal-lamotrigine-drug-safety-communication-studies-show-increased-risk-heart-rhythm-problems
    Hurley D Epileptologists Push Back on FDA's New Cardiac Warning for Lamotrigin. NeurologyToday. April 1, 2021 https://journals.lww.com/neurotodayonline/Fulltext/2021/04010/Epileptologists_Push_Back_on_FDA_s_New_Cardiac.6.aspx
  17. 17.0 17.1 Bunschoten JW, Husein N, Devinsky O et al Sudden Death and Cardiac Arrythmia With Lamotrigine: A Rapid Systematic Review. Neurology. 2022. March 8 PMID: https://www.ncbi.nlm.nih.gov/pubmed/35260442 https://n.neurology.org/content/early/2022/03/08/WNL.0000000000200164
  18. 18.0 18.1 Swift Yasgur B Lamotrigine Linked to Lowest Mortality Risk in Poststroke Epilepsy. Medscape. Jan 7, 2022 https://www.medscape.com/viewarticle/966285
  19. 19.0 19.1 Kneisel K Epilepsy Drugs May Up Risk of Parkinson's. Strongest association seen for sodium valproate. MedPage Today December 27, 2022 https://www.medpagetoday.com/neurology/seizures/102398
    Belete D, Jacobs BM, Simonet C et al Association Between Antiepileptic Drugs and Incident Parkinson Disease in the UK Biobank. JAMA Neurol. Published online December 27, 2022. PMID: https://www.ncbi.nlm.nih.gov/pubmed/36574240 https://jamanetwork.com/journals/jamaneurology/fullarticle/2799620

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