Mood Stabilizers as Medications lamotrigine, Lamictal

Mood stabilizer: lamotrigine, Lamictal

Generic Name: lamotrigine
Brand Name(s): Lamictal
Common Use: Mood stabilizer

Lamotrigine is a drug of the phenyltriazine class chemically unrelated to existing antiepileptic drugs (AEDs).

As adjunctive therapy for the management of patients with epilepsy who are not satisfactorily controlled by conventional therapy. Also indicated for use as monotherapy following withdrawal of concomitant antiepileptic drugs.

Contraindications
Patients with known hypersensitivity to lamotrigine or to any components of the formulation.

Adverse Side Effects

Rarely, serious skin rashes, including Stevens-Johnson syndrome and toxic epidermal necrolysis (Lyell's syndrome) have been reported. The latter condition carries a high mortality. Adverse experiences in patients receiving lamotrigine were generally mild, occurred within the first 2 weeks of therapy, and resolved without discontinuation of the drug.

Commonly Observed:
The most commonly observed adverse experiences associated with the use of adjunctive therapy with lamotrigine (incidence of at least 10%) were dizziness, headache, diplopia, somnolence, ataxia, nausea and asthenia.

Dizziness, diplopia, ataxia and blurred vision were dose-related and occurred more commonly in patients receiving carbamazepine in combination with lamotrigine than in patients receiving other enzyme inducing AEDs with lamotrigine. Reduction of the daily dose and/or alteration of the timing of doses of concomitant antiepileptic drugs and/or lamotrigine may reduce or eliminate these symptoms. Clinical data suggest a higher incidence of rash in patients who are receiving concomitant valproic acid, or non-inducing AEDs.

Adverse Events Associated with Discontinuation of Treatment:
Across all studies, the most common adverse experiences associated with discontinuation of lamotrigine were rash, dizziness, headache, ataxia, nausea, diplopia, somnolence, seizure exacerbation, asthenia and blurred vision. In controlled clinical teals, 6.9% of the 711 patients receiving lamotrigine discontinued therapy due to an adverse experience, versus 2.9% of the 419 patients receiving placebo. Of 3,501 patients and volunteers who received lamotrigine in premarketing clinical studies, 358 (10.2%) discontinued therapy due to an adverse experience.

Serious Adverse Events Associated with Discontinuation of Treatment:
Discontinuation due to an adverse experience classified as serious occurred in 2.3% of patients and volunteers who received lamotrigine in the premarketing studies. Rash accounted for almost half of the discontinuations due to serious adverse experiences. More rapid initial titration dosing of lamotrigine and concomitant use of valproic acid were associated with higher incidences of rash-related withdrawal in clinical studies.

Overdose

There are no specific antidotes for lamotrigine. Following a suspected overdose, hospitalization of the patient is advised. General supportive care is indicated, including frequent monitoring of vital signs and close observation of the patient. If indicated, emesis should be induced or gastric lavage should be performed.

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