An anticonvulsant, Lamotrigine or Lamictal has no chemical relation to other mood regulators and anticonvulsants.
Approval And Uses of Lamotrigine
In the United States, this drug received marketing approval way back in December 1994 and it was only in 2003 that it received FDA approval because of the benefits derived from it when used on bipolar patients. Initially, Lamotrigine was approved as an anticonvulsant.
Generic Version of Lamotrigine
USA has generic Lamictal available and many manufacturers offer it. The effectiveness of generic Lamotrigine is generally good except the generic version manufactured by a company called TEVA. People who have taken this version because of pressure from their insurance provider have reported that it is not as effective.
Difference Between Lamotrigine and Other Mood Stabilizers
There are 2 major areas where Lamotrigine differs from other options –
- Effectiveness – Patients who do not respond to other mood stabilizing drugs and antidepressants have reacted positively to Lamotrigine.
- Side Effects – The side effects of Lamotrigine are relatively harmless as compared to other options.
Difference Between Lamotrigine and Carbamazepine/Valproate
Better Relief For Rapid Cycling – When it comes to bipolar states that are mixed and rapid cycling, Lamotrigine is a lot more effective than Carbamazepine/Valproate.
As compared to Carbamazepine/Valproate, Lamotrigine is a lot more effective as an antidepressant, especially for unipolar depression.
Better Relief PTSD and BPD
Ideal Candidates for Lamotrigine
As it is too early to pinpoint the specific disorders that Lamotrigine is most effective in treating in, here are some disorders where Lamotrigine has been beneficial –
Unipolar Depression of the acute kind
Depersonalization Disorder treatment
Schizoaffective Disorder treatment
Effectiveness of Lamotrigine for Preventing and Treating Depression/Mania
Initially, Lamotrigine was mainly used for treating people with acute depression, mania, and suffered from mixed states. These people were not responding to existing medicines, but did well on Lamotrigine. When they were put on this drug for long term, severe episodes were controlled and there is evidence in support of this that is steadily increasing.
Tests Before Lamotrigine Prescription
A thorough evaluation is conducted before Lamotrigine is prescribed to the patient. This includes urine tests and blood tests so that any medical conditions can be ruled out. For instance, thyroid disorders frequently lead to mood swings. So, by conducting a medical examination in advance and ensuring that nothing else is interfering with physiology, it can be ensured that a mood disorder is not being exacerbated by Lamotrigine.
Initiating Treatment with Lamotrigine
People who are not on Valproate/Carbamazepine are started off on 12.5 to 25 mg Lamotrigine dose per day. Every few weeks, the dose is increased by the same amount, if needed. For people who are specifically on Valproate, the starting dose is usually 12.5mg and every week to 10 days, the dose is increased by the same amount. Doses can be bigger in case of Carbamazepine. The increasing doses are also bigger in this case.
Problems with Lamotrigine Prescription For People Taking Carbamazepine/Valproate/Lithium
There are no reports on the interaction between Lithium and Lamotrigine.
With Tegretol (Carbamazepine), enzymes facilitating Lamotrigine metabolism are induced. This is why, people who take Carbamazepine have lower levels of Lamotrigine in their blood as compared to those who don’t take it.
With Depakote (Valproate), Lamotrigine plasma levels are doubled. Because of this reason, Valproate dose is initially kept around one-half of the initial dose.
Final Lamotrigine Dose
When Lamotrigine is used as a mood stabilizer or as an antidepressant for the treatment of depression, the last dose ranges between 100 to 200 mg per day. For some patients suffering from severe and acute depression, for a decent antidepressant effect, the dose has to be as high as 600 mg a day. Because of the effect of Valproate on the plasma levels in the body of patients and similar pharmacokinetic effects, the doses of Lamotrigine cannot be as high in patients taking Valproate as well. There are also certain dermatological effects associated with high doses.
Time Taken for Lamotrigine To Work
In certain cases, the antidepressant and antimanic benefits of Lamotrigine are noticed pretty early on in the treatment cycle. For some other patients, though, effects are seen after about a month of being on Lamotrigine treatment. It takes certain people longer to experience the positive effects of Lamotrigine as compared to others.
Normal Side Effects Associated With Lamotrigine
During clinical trials, certain side effects were noticed in patients in the initial few days of dose increase of
Lamotrigine as compared to those who were on Placebo but they faded soon
Dizziness was experienced by 38% patients as compared to 10% of those who were on placebo.
Dizziness was experienced by 38% patients as compared to 10% of those who were on placebo.
Headache was experienced by 29% patients as compared to 19% of those who were on placebo.
Double vision was experienced by 28% patients as compared to 7% of those who were on placebo.
Unsteadiness was experienced by 22% patients as compared to 6% of those who were on placebo.
Nausea was experienced by 19% patients as compared to 10% of those who were on placebo.
Blurred vision was experienced by 16% patients as compared to 5% of those who were on placebo.
Sleepiness was experienced by 14% patients as compared to 7% of those who were on placebo.
Rashes were experienced by 10% patients as compared to 5% of those who were on placebo.
Vomiting was experienced by 10% patients as compared to 4% of those who were on placebo.
Serious Side Effects of Lamotrigine Including Sexual Side Effects
Rashes are the only side effect serious enough for patients to stop taking Lamotrigine. They can be mild – looking like a sunburn, to severe similar to rashes caused due to poison ivy. All patients who are prescribed this drug must immediately report any rashes they see on their body, no matter how mild they may appear. 10% people develop a mild rash and 0.1% develop a severe rash. Those with mild rashes can easily continue treatment along with an antihistamine.
Rashes are more common when the drug comes in contact with Valproate or when the initial dose is quite high.
There are no sexual side effects associated with Lamotrigine.
Psychiatric Side Effects of Lamotrigine
Some psychiatric side effects of Lamotrigine that are rare include mania, irritability, emotional upheaval, depression, confusion, confusion, concentration issues, anxiety, and agitation. Lamotrigine induced mania is usually treated with Topiramate or lithium.
Interaction of Lamotrigine With Prescription or OTC Meds
Here are a few known interactions between Lamotrigine and other medications –
Carbamazepine – Lamotrigine concentration is lowered by Carbamazepine in the blood. Lamotrigine has been shows to increase Carbamazepine plasma level.
Lamotrigine plasma levels are doubled by Valproate which is why the dose of Valproate is reduced by 25% in those patients who are also taking Lamotrigine.
Primidone and Phenobarbital
By both these medications, Lamotrigine plasma levels are lowered by as much as 40%.
Lamotrigine plasma levels can be reduced by 50% in people who are on oral contraceptives.
Alcohol and Lamotrigine
The severity of Lamotrigine’s side effects can be exacerbated by alcohol.
Pregnancy/Nursing and Lamotrigine
When it comes to pregnancy, FDA has placed Lamotrigine in Category C which means that
fetus is adversely affected in animal studies but the human studies are still not adequate. It goes on to mention that the benefits of Lamotrigine are acceptable in women who are pregnant despite the potential risks.
Women who are sufferers of epilepsy continue with Lamotrigine throughout the entirety of their pregnancy, and their number is steadily growing. Effect of the drug on children is still continuing.
Safety of Lamotrigine for Young Adults and Children
In other nations, Lamotrigine has been used on both young adults and children. In the United States, however, the risk of side effects are severe and fatal in young people because of which the drug can only be used when the patient is over 16 years old.
Safety of Lamotrigine for Senior People
The handling of Lamotrigine in the elderly patients is quite similar to those with children. As such, the experience of Lamotrigine on psychiatric problems in elderly patients is still not enough to form reasonable conclusions about the efficacy of the drug.
Discontinuation of Lamotrigine
It is not recommended to abruptly discontinue Lamotrigine unless the side effects are quite severe. However, no symptoms are specifically developed when the drug is discontinued suddenly apart from seizures which is true for almost any anticonvulsant.
There is very little data available on what happens when a patient overdoses on Lamotrigine. There are only two reported cases in which an overdose has occurred. In those cases, the quantity taken by the patients was around 4,000 mg but the patients survived and did not suffer from any long term effects.
MAO Inhibitors and Lamotrigine
MAO Inhibitors have been combined with Lamotrigine and no specific problems have been faced by patients.
Cost of Lamotrigine
One tablet of Lamotrigine (Lamictal) costs the following, as of April 2011, and when ordered in lots of 100 tablets –
$4.83 for 25 mg tablet
$5.43 for 100 mg tablet
$5.93 for 150 mg tablet
$6.67 for 200 mg tablet
In case of generic Lamotrigine, the cost is as follows –
$0.3 for 25 mg tablet
$0.3 for 100 mg tablet
$0.53 for 150 mg tablet
$0.53 for 2000 mg tablet
Effectiveness of Lamotrigine On Patients Who Do Not Respond To Other Psychopharmacologic Drugs
Lamotrigine is most effective on those patients whose depression and symptoms are not being controlled by any other medication in the market. This is the number one use of Lamotrigine.
Advantages of Lamotrigine
Here are some major advantages of Lamotrigine
Effective in 2/3rds of Patients of Bipolar – Almost 2/3rds of patients who are suffering from bipolar mood disorders have responded excellently to Lamotrigine.
Ideal for Mixed States – People who, due to mania switches on intense cycling, have not been able to rely on other antidepressants have responded well to Lamotrigine when it is given in therapeutic doses.
Good for Patients Who Respond to Nothing Else – Patients who fail to respond to any other mood stabilizers and lithium have shown good results when they have been treated using Lamotrigine.
Minimal Side Effects – The side effects of Lamotrigine are quite minimal and usually fade away after some time which is a major advantage for every patient.
Effective for Unipolar Depression
For people who are suffering from acute unipolar depression, Lamotrigine has been quite effective in keeping the symptoms under check and offering some relief.
Disadvantages of Lamotrigine
Here are some disadvantages of Lamotrigine –
No Knowledge on Long-Term Efficacy – Because the drug is relatively new, there is no knowledge of how effective it would be when taken for long term by patients.
No Information on Long-Term Side Effects – Because the drug was approved fairly recently, there is no information on any long term side effects which may be experienced by patients who are on Lamotrigine.
Manic or Hypomanic Symptoms – Certain hypomanic and manic symptoms are noticed when the quantities are large but lithium/topiramate can be used for controlling them.
Rashes – Rashes can be fatal, but are mostly seen in people over 16 years of age. However, the chance of a severe rash occurring is 0.1% – that is 1 in thousand people suffer from it.
Why Choose Lamotrigine Over Older Mood Regulators
The reason why physicians prescribe Lamotrigine and patients take Lamotrigine, despite there being various other mood regulating agents available, is because sometimes, the better known drugs that are older fail to provide the desired benefits to patients. They also come with certain side effects which might be unacceptable to the physicians and/or patients.
Availability of Lamotrigine
Lamotrigine is available in the USA and 60 other countries in the world.