Lamotrigine

Indications
 Oral
Epilepsy
Adult: Initially, 25 mg once daily for 2 wk followed by 50 mg once daily for 2 wk; thereafter, increase the dose by a max of 50-100 mg every 1-2 wk to usual maintenance doses of 100-200 mg daily, as a single dose or in 2 divided doses. Some patients may require up to 500 mg daily.
Child: >12 yr: Initially, 25 mg once daily for 2 wk followed by 50 mg once daily for 2 wk; thereafter, increase the dose by a max of 50-100 mg every 1-2 wk to usual maintenance doses of 100 -200 mg daily, as a single dose or in 2 divided doses. Some patients may require up to 500 mg daily. <12 yr: Not recommended.
Max Dosage: Adult: 500 mg daily.
Hepatic impairment: Moderate impairment (Child-Pugh category B): Reduce dose by about 50%. Severe impairment (Child-Pugh category C): Reduce dose by about 75%.
Oral
Adjunct in epilepsy
Adult: With valproate: Initially, 25 mg on alternate days for 2 wk followed by 25 mg once daily for 2 wk; thereafter, increase by a max of 25-50 mg every 1-2 wk; usual maintenance doses: 100-200 mg daily in 1-2 divided doses. With enzyme-inducing antiepileptics but not with valproate: 50 mg once daily for 2 wk followed by 50 mg bid for 2 wk; thereafter, increase by a max of 100 mg every 1-2 wk; usual maintenance doses: 200-400 mg/day in 2 divided doses; up to 700 mg/day in some patients. With oxcarbazepine but no enzyme-inducing or -inhibiting antiepileptics: 25 mg once daily for 2 wk followed by 50 mg once daily for 2 wk; thereafter increase dose by a max of 50-100 mg every 1-2 wk; usual maintenance doses: 100-200 mg daily in 1-2 divided doses; up to 500 mg daily in some patients.
Child: With valproate: Initially, 0.15 mg/kg once daily for 2 wk followed by 0.3 mg/kg once daily for 2 wk; thereafter, increase by a max of 0.3 mg/kg every 1-2 wk to usual maintenance doses of 1-5 mg/kg once daily or in 2 divided doses.
Hepatic impairment: Moderate impairment (Child-Pugh category B): Reduce dose by about 50%. Severe impairment (Child-Pugh category C): Reduce dose by about 75%.
Oral
Bipolar disorder
Adult: Monotherapy: Initially, 25 mg once daily for 2 wk followed by 50 mg once daily for 2 wk; thereafter, double the daily dose at wkly intervals to usual maintenance dose of 200 mg daily. Max dose: 200 mg/day. With valproate: Initially, 25 mg every other day for 2 wk followed by 25 mg once daily for 2 wk; thereafter, double the daily dose at wkly intervals to usual maintenance dose of 100 mg daily. With enzyme-inducing antiepileptics but not with valproate: Initially, 50 mg once daily for 2 wk followed by 100 mg daily in 2 divided doses for 2 wk; thereafter, increase in 100-mg increments wkly to usual maintenance dose of 400 mg daily in 2 divided doses.
Hepatic impairment: Moderate impairment (Child-Pugh category B): Reduce dose by about 50%. Severe impairment (Child-Pugh category C): Reduce dose by about 75%.

Special Populations: Reduce dose by 50% in patients with moderate hepatic impairment and 75% in severe hepatic impairment.
Warnings / Precautions
 Hepatic or renal impairment. Closely monitor patient. Monitor children's body wt. Advise patient to report any hypersensitivity reaction. Avoid abrupt withdrawal unless severe skin reactions have developed. May impair ability to drive or operate machinery. Pregnancy and lactation.
Adverse Reactions
 Skin eruptions usually maculopapular in nature, nausea, headache, tiredness, dizziness, ataxia, irritability/aggression, tremor, agitation, confusion, hallucination, diplopia, blurred vision. Haematological abnormalities e.g. leucopenia and thrombocytopenia. Elevations of LFTs. Arthralgia, pain and back pain.
Potentially Fatal: Stevens-Johnson syndrome and toxic epidermal necrolysis.
Overdose Reactions
 Symptoms: Nystagmus and muscle hypertonicity, QRS interval prolongation, low-grade fever, erythema, and periorbital oedema, generalised tonic-clonic seizures, tremor, muscle weakness, ataxia, hypertonia. Management: Gastric lavage and activated charcoal.
Drug Interactions
 Metabolism enhanced by enzyme-inducing drugs e.g. phenytoin, carbamazepine, phenobarbitone, primidone, rifampicin, ethinyloestradiol/levonorgestrel combination. Metabolism reduced by sodium valproate.
See Below for More lamotrigine Drug Interactions
Mechanism of Actions
 Lamotrigine inhibits voltage-sensitive sodium channels, thereby stabilising neuronal membranes and consequently inhibiting pathological release of excitatory amino acids (e.g. glutamate and aspartate). These amino acids play a role in the generation and spread of epileptic seizures.
Absorption: Well absorbed from the GI tract (oral); peak plasma concentrations after 2.5 hr.
Distribution: Widely distributed; enters breast milk.
Metabolism: Extensively hepatic.
Excretion: Via urine (as glucuronide conjugate); 24 hr (elimination half-life at steady state).
Administration
 May be taken with or without food.
Storage Conditions
 Oral: Store below 30°C (86°F).
ATC Classification
 N03AX09 - lamotrigine ; Belongs to the class of other antiepileptics.
Storage
 Oral: Store below 30°C (86°F).
Available As
  • Lamotrigine 100 mg
  • Lamotrigine 200 mg
  • Lamotrigine 25 mg
  • Lamotrigine 5 mg
  • Lamotrigine 50 mg

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