Lamotrigine

Anti-epileptic · Triazine

Indications

Monotherapy for partial, primary and secondarily generalized tonic-clonic seizures. Add-on therapy for partial and secondary generalized tonic-clonic seizures. Prevention of depressive episodes associated with bipolar disorder.

Dosage

Adults: Dose titration should be repeated if restarting after an interval of more than 5 days. Monotherapy of seizures: Initially 25 mg once daily for 14 days, increased to 50 mg once daily for further 14 days, then increased by max 100 mg every 7-14 days; usual maintenance 100-200 mg/day in 1-2 divided doses (up to 500 mg/day). Adjunctive therapy of seizures with valproate: Initially 25 mg on alternate days for 14 days then 25 mg once daily for further 14 days, thereafter increased by max 50 mg every 7-14 days; usual maintenance, 100-200 mg/day in 1-2 divided doses. Adjunctive therapy of seizures with enzyme inducing drugs and without valproate: Initially 50 mg once daily for 14 days then 50 mg twice daily for further 14 days, thereafter increased by max 100 mg every 7-14 days; usual maintenance 200-400 mg/day in 2 divided doses (up to 700 mg/day). Adjunctive therapy of seizures…

Adverse Effects

Tiredness, insomnia, GI disturbances, rash, including angioedema and Stevens-Johnson syndrome, diplopia, blurred vision, dizziness, ataxia, tremor, agitation, confusion, irritability, aggression, headache, somnolence, fatigue, dry mouth, pain. Toxic epidermal necrolysis and drug reaction with eosinophilia and systemic symptoms (DRESS).

Risk Factor (Pregnancy/Lactation)

Pregnancy: Risk cannot be ruled out. Lactation: Contraindicated or not recommended. Contraindications: Significant hepatic impairment. Precautions: Monitor hepatic, renal & clotting parameters in patients who develop rash, fever, flu, drowsiness or worsening of seizure control. Withdraw gradually over 2 weeks. Monitor patients for clinical worsening and suicidality.

Interactions

Phenytoin, carbamazepine, phenobarbital, primidone, sodium valproate, rifampicin, oral contraceptives, protease inhibitors, OCT2 substrates (e.g., metformin, gabapentin, varenicline), St John's wort.

Advice to Patient

Take with or without meals. Do not chew or crush tablets, swallow whole. Do not stop taking medication abruptly, gradually lower the dose and then stop. Contact prescriber if there is change in mental status, change in memory, constipation, vomiting, stomach cramps, loss of appetite, skin rash, change in vision, unusual bruising or bleeding, blood in mouth/urine/stool, swelling of lips/face/tongue, loss of control on seizure or if there is worsening of condition. Avoid alcohol during therapy. Take sufficient amount of fluids (2-3 litres per day) to maintain hydration, unless restricted by the prescriber. Carry identification card mentioning you have epilepsy and names of all medications you take. On start of therapy or change of dosage, patient must be watched for suicidal tendency by caretaker.

Pharmacokinetics

Absorption: Immediate release: Rapid and complete, 97.6% absorbed. Bioavailability: Immediate release: 98%. Half-life elimination: Paediatric patients: No concomitant enzyme-inducing AEDs (i.e., phenytoin, phenobarbital, carbamazepine, primidone): Infants and Children 10 mths-5 yrs: 19 hrs. Concomitant valproate derivative therapy: Infants and Children 10 mths-5 yrs: 45 hrs. Children 5-11 yrs: 66 hrs. Concomitant enzyme-inducing AEDs (i.e., phenytoin, phenobarbital, carbamazepine, primidone): Infants and Children 10 mths-5 yrs: 7.7 hrs. Children 5-11 yrs: 7 hrs. Concomitant enzyme-inducing AEDs plus valproate derivative therapy: Children 5-11 yrs: 19 hrs. Adults: Immediate release: 25-33 hrs, Elderly: 25-43 hrs; Extended release: Similar to immediate release. Concomitant valproic acid therapy: 48-70 hrs. Concomitant phenytoin, phenobarbital, primidone, or carbamazepine therapy: 13-14…

Brands with this active ingredient

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