What is your experience with lamotrigine

The most important thing about lamotrigine

Summary:

Lamotrigine is a new generation drug for epilepsy, and a first-line drug for all epilepsy.

In 40-60% of new hires, it leads to permanent freedom from seizures.

Lamotrigine is generally well tolerated. A well-known side effect is a skin rash, which occurs especially when the dose is increased rapidly; therefore, with lamotrigine, it is necessary to slowly reach the target dose.

Lamotrigine is therefore not an emergency medication

Lamotrigine is one of the anti-epilepsy drugs that doesn't make you tired.

Lamotrigine can be combined with any other anti-epilepsy medication if necessary.

Lamotrigine can be influenced in its effectiveness by other drugs. If you are treated with carbamazepine, phenytoin and phenobarbital at the same time, more (about twice as much) lamotrigine must be prescribed. In the case of simultaneous treatment with valproic acid, less lamotrigine has to be prescribed (about half as much) and the dosage is slower.

Lamotrigine is a drug that only needs to be given twice a day; In some cases, one intake per day is enough.

A disadvantage of lamotrigine is that it can only be dosed very slowly (approx. 8-12 weeks until the maintenance dose is reached). This is especially true for childhood.

Until recently, it was believed that lamotrigine did not weaken the effect of birth control pills, meaning that no other method of contraception was necessary either in addition to or instead. Meanwhile, more research has shown that lamotrigine can lower levels of the hormones used in some birth control products. Whether this has an influence on the effectiveness of the "pill" has not yet been fully clarified. Therefore, at the present time it cannot be said with certainty that the effect of the "pill" will not be affected; therefore, additional contraceptive measures may have to be considered.

An increased rate of malformations has not yet been proven for lamotrigine during pregnancy. So far there is not enough data available to prove or exclude a connection. However, caution should be exercised when combined with valproic acid.

Under what name is lamotrigine commercially available?

Lamotrigine is available as Lamictal® and Lamotriax® in Germany, Switzerland and Austria.

How does lamotrigine work?

Lamotrigine is a drug that inhibits the conduction of nerve cells.

The nerve cells are excited at the cell membrane. There are channels through which blood salts pass. Examples are sodium, potassium, calcium, and chloride. By blocking certain channels, the pathological conduction typical of epilepsy is inhibited.

In addition, Lamotrig reduces the transmission of impulses from one nerve cell to the other by inhibiting the transmitter substance glutamate.

What types of seizures / epilepsy can lamotrigine treat?

Lamotrigine is a drug that has shown good results in the treatment of both focal and generalized epilepsy. It

can be given as a single drug (monotherapy) or in combination with other drugs. Overall, lamotrigine is a drug with broad effectiveness against epilepsy, so it can be used in almost all patients.

Who is lamotrigine approved for?

Lamotrigine is the only drug (monotherapy) approved for patients aged 12 years and over with generalized seizures, focal and secondary generalized seizures, as well as for mixed epilepsy or as an additional drug. It can be given as an additional medication for children aged 2-11. Lamotrigine can be combined well with many other drugs for epilepsy.

Who should not be treated with lamotrigine?

Lamotrigine should only not be given if you are hypersensitive (allergic) to lamotrigine or one of the excipients in the tablet. In addition, it should not be given to children under 2 years of age.

How well does lamotrigine work?

Lamotrigine has been available for the treatment of epilepsy for more than 10 years. It can be said that lamotrigine has had similar successes as valproic acid in the treatment of generalized forms of epilepsy in monotherapy; the results in focal epilepsies are similar to those with carbamazepine. In combination therapy, it is comparable to other drugs. In sufficient doses, depending on the type of attack, 40-60% of patients will be free of attacks in a first monotherapy, i.e. when treated with lamotrigine as the only drug. The effectiveness is good in idiopathic-generalized epilepsy (wake-up grand males, absenteeism, juvenile myoclonic epilepsy) and in herd epilepsy (focal epilepsy).

Lamotrigine is only available as tablets, so that a rapid increase in the dose as an infusion is not possible in emergencies, e.g. in status epilepticus or during a series of seizures.

What are the main side effects of lamotrigine?

Lamotrigine is generally very well tolerated.

An important side effect is the development of allergic skin reactions. Usually these are harmless and go away quickly after you stop taking the drug. However, there have also been reports of more severe skin reactions up to and including peeling of the skin with fatal courses. This risk has now become significantly lower since it was recognized that this happens especially when the dose is increased too quickly.

Nevertheless, the manufacturer assumes a 0.3-1% probability of skin reactions to be treated in the hospital. The risk seems to be slightly higher in children than in adults.

Rare side effects are dizziness, double vision, behavioral disorders (especially aggressiveness) and sleep disorders.

It is important that, in contrast to many other anti-epilepsy drugs, lamotrigine does not make you tired and the ability to concentrate is maintained, so that lamotrigine is a drug that is often given to schoolchildren or students, for example.

How is lamotrigine added?

Lamotrigine must be added very slowly so that no allergic reactions occur.

Normally, monotherapy, in which lamotrigine is the only substance, is started in adults of normal weight with 25 mg / day for the first 2 weeks. Then increase to 50 mg / day for a further 2 weeks, and then increase by 25-50 mg every 2 weeks.

In combination therapy with an enzyme-inducing drug (carbamazepine, phenytoin, phenobarbital), double doses can be given; from 200 mg / day can be increased in 100 mg steps.

If valproic acid is given at the same time, it must be slowed down. Here you give 12.5 mg / day in the first 2 weeks, then 25 mg / day for 2 weeks. It can then be increased by 25 mg every 2 weeks until 100 mg are reached; after that it can be increased by 25-50 mg / day every 2 weeks.

The following recommendations apply to children:

In monotherapy, 0.5 mg / kilogram of body weight (kgKG) is given per day. Every 2 weeks can be increased by 1 mg / kg body weight per day. In the case of concomitant medication with carbamazepine, phenytoin or phenobarbital, initially 2 mg / kg body weight is given per day and then increased every 2 weeks by 2-3 mg / kg body weight per day. With concomitant medication with valproic acid, start with 0.2 mg / kg body weight per day for the first 2 weeks, then 0.5 mg / kg body weight for 2 weeks and then increase every 2 weeks by 0.5-1 mg / kg body weight.

Which daily doses are useful?

As with most anticonvulsants, lamotrigine is first dosed to a medium dose range.

The following dose ranges are aimed for:

In adults in monotherapy 100-300 mg / day, in therapy with an enzyme inducer 200-700 mg / day, with valproic acid 100-300 mg / day. In monotherapy, children receive 0.5-5 mg / kg body weight per day, with an enzyme inducer 5-10 mg / kg body weight, maximum 400 mg per day, with valproic acid 1-5 mg / kg body weight per day, maximum 200 mg / day.

In individual cases, this general guideline must be modified according to the effect and side effect. In principle, all anticonvulsants are dosed until they are free from seizures or up to a dose at which side effects occur. If the latter happens, the dose is reduced to the last level tolerated. If more seizures then occur, the drug is not fully effective, so that another anti-epilepsy agent can or must be given instead or in addition.

Are there any interactions or incompatibilities with other drugs (mainly other anti-epilepsy drugs)?

Lamotrigine itself is affected by other drugs. Drugs that accelerate the breakdown of other substances in the liver, e.g. the anti-epilepsy drugs carbamazepine, phenytoin or phenobarbital, reduce the time lamotrigine stays in the body, so the dose of lamotrigine has to be increased (roughly doubled). In contrast, valproic acid reduces the breakdown of lamotrigine, so that the dose is reduced (roughly halved) and a slower dose increase is necessary.

Does it make sense to check blood levels?

This can actually be useful at times. In the dosage phase, it is possible to check which blood levels are reached with a certain dose. If side effects occur, it is possible to estimate the dose or level up to which the drug was tolerated without problems. This is also important when it comes to considering a drug as ineffective for a patient and, if necessary, switching to another. Furthermore, mirror checks make sense if the doctor wants to check whether the patient is also taking the drug regularly, because there are some patients who are careless here and for whom a drug would be quite effective if it were taken regularly. In this case, the drug must not be accused of being ineffective.

A level determination is also useful to check the interaction with other drugs.

However, there are no such clearly defined limits for lamotrigine as e.g. for valproic acid or carbamazepine, so that the levels are more interesting in the personal course than for the general classification of the levels, which can be very variable.

Is there anything to consider during pregnancy?

Pregnancies in epilepsy patients are generally high-risk pregnancies, as the child can be at risk from certain medications.

Lamotrigine is a drug that is currently considered to be of little problem in pregnancy. It must be said, however, that the data situation cannot yet be conclusively assessed, as not enough pregnancy courses have been investigated to be able to make definitive statements. The previous data from animal experiments and a pregnancy registry on lamotrigine suggest, however, that there is at least no accumulation of malformations. At 3-4%, the malformation rate in monotherapy tends to be somewhat higher than that of the normal population at 1-2%.

In this respect, there is currently no general recommendation to use lamotrigine over other drugs during pregnancy, but there is also no reason to switch to another anti-epilepsy drug.

It is unclear whether the intake of folic acid (2.5-5 mg / day) offers additional protection against deformities and should therefore be taken when trying to have children and during pregnancy. Since the folic acid level in the body can theoretically drop, taking it may make sense and is currently recommended.

If possible, you should avoid taking several drugs for epilepsy at the same time, as this leads to a significant increase in the risk.

Do you have to pay attention to anything else?

Lamotrigine can rarely reduce the ability to react. Therefore, when driving a vehicle (as far as this is permitted!) Or operating machines, it must be taken into account that dangerous situations can arise and appropriate caution must be exercised or the activity cannot be carried out if there are corresponding side effects.

Note:

Medicine as a science and thus also epileptology are subject to constant change due to the constant gain in research results. The data mentioned are therefore only valid at the time this patient information sheet is published. At irregular intervals or when essential changes are made, this patient information is revised and made available as a new version. Please understand that we can therefore only recommend the current version. Any liability for the information published here is rejected.

The information presented here has been researched to the best of our knowledge. Nevertheless, errors can occur, e.g. resulting from writing or transmission errors. Therefore, every user is requested to obtain additional literature and to check information if in doubt.

Specialized information for doctors can be found under

Anticonvulsant lamotrigine

Additional information can be found in the package insert for the medication. You can also ask your doctor or pharmacist.

Editor: Prof. Dr. A. Hufnagel