Lamotrigine
What is lamotrigine?
Lamotrigine is a so-called anti-epileptic, so it is used to treat epilepsy. It is used for treatment in adults and adolescents, but also in children.
Lamotrigine is also used as a medicine to treat bipolar disorder.
Lamotrigine can be used on its own, i.e. in monotherapy, or with other medicines to treat epilepsy and bipolar disorder.
Indications for lamotrigine
Lamotrigine works well in a variety of forms of epilepsy. It is used in the treatment of partial seizures but also in the case of grand mal seizures (generalized seizures).
Absence, a form of epilepsy typical in children, can also be treated with lamotrigine.
Lamotrigine is also used in the severe form of childhood epilepsy, Lennox-Gastaut syndrome.
In addition, lamotrigine prevents possible withdrawal cramps during alcohol withdrawal.
Another indication for lamotrigine is bipolar disorder, in which patients experience extreme mood swings with phases of mania and phases of depression. In the treatment of bipolar disorder, lamotrigine is particularly useful in preventing the depressive phase. It is also used in unipolar depression.
Lamotrigine is also used to treat neuropathic pain.
In migraine prophylaxis, lamotrigine seems to be particularly effective on the so-called migraine aura.
You can find more information about epilepsy here: Epilepsy, Symptoms of Epilepsy
Migraine prophylaxis
A migraine is sometimes difficult to control with drug therapy. In addition to acute therapy, in which so-called triptans are primarily used, drugs are also used to prevent migraine attacks.
Studies have shown that lamotrigine therapy is effective for the special form of migraine with aura. On the other hand, lamotrigine does not appear to be effective for migraines without aura. About a fifth of all those affected suffer from migraines with aura. This describes a mostly visual disturbance preceding the headache attack. This disturbance is temporary and, in addition to the visual system, can also affect olfactory perception, balance, language or sensitivity. Lamotrigine appears to be a possible therapy option for migraineurs with aura.
Do you suffer from migraines? Read more on the subject at: migraine
effect
Lamotrigine is a drug from the group of anti-epileptic drugs. It is used in long-term therapy to prevent seizures.
Lamotrigine works on nerve cells and reduces the release of so-called excitatory neurotransmitters. Lamotrigine amplifies inhibitory signals in the brain and increases the threshold for seizures.
Lamotrigine is considered a newer anticonvulsant, with widespread use and fewer side effects and interactions than classic antiepileptic drugs.
The active ingredient is also used to treat epilepsy in adolescents from the age of twelve, and even in children between the ages of two and twelve if indicated.
As a rule, lamotrigine is well tolerated, but like any drug it can also have side effects.
More information on anticonvulsant drugs can be found here: Medication for epilepsy
How quickly can an effect be expected?
In order to avoid sometimes serious side effects, lamotrigine must be crept in slowly. This means that a lower dose is generally started, which is increased over several weeks.
Several weeks can pass before the individual, optimal dose is achieved. The onset of action in combination therapy with other anti-epileptic drugs is usually faster, but monotherapy should still be started. Multiple drugs increase the risk of side effects and interactions.
Half-life of lamotrigine
The half-life for lamotrigine in monotherapy, i.e. as the sole drug in treatment, is around 24 hours. The half-life can be lengthened or shortened by the addition of other drugs, as they can affect the metabolism of lamotrigine. The dose at which the patient is optimally adjusted is very individual. Therefore, you should mainly follow the clinic (i.e. the frequency of seizures) and the lamotrigine level in the blood.
Side effects
Taking lamotrigine may cause side effects. In particular, increasing the dose too quickly can cause considerable side effects, which is why lamotrigine should always be crept in slowly.
If the dosage is increased too quickly, severe allergic reactions and skin reactions can occur. These show up as rashes or redness, can form blisters and are more pronounced around the mouth, nose, eyes and genital area. In addition, there may be fever and swelling of the face and glands. The most serious form of this side effect is Stevens-Johnson syndrome, a potentially fatal immune reaction.
The risk of the side effects described increases when increasing the dose quickly and when taking lamotrigine together with valproate, another anti-epileptic drug.
Common side effects of lamotrigine include:
- a headache
- dizziness
- sleepiness
- Incoordination
- Nausea or vomiting
- visual disturbances, such as double vision or blurred vision
- Nystagmus (a quick eye twitch)
- Difficulty sleeping or feeling tired
Rare, sometimes life-threatening side effects:
- Aggression or irritability
- Skin reaction
- Changes in liver function
- Change in blood count
- serious bleeding disorders
Very rare side effects:
- Hallucinations and confusion
- uncontrollable body movements
- Worsening of existing Parkinson's disease
In the event of side effects, especially skin reactions, a doctor should be consulted immediately. In some patients taking lamotrigine for bipolar disorder; thoughts of suicide or self-harm can arise. Even in patients; taking lamotrigine to treat epilepsy, these thoughts may arise. A doctor or the nearest hospital should also be visited here.
Read more about the side effects under: Lamotrigine side effects
Influence on liver values
Very rarely, the use of lamotrigine leads to increased liver values, liver dysfunction or liver failure. These symptoms can appear in isolation or as a sign of an overreaction of the immune system. The liver values should be checked regularly; if the values are slightly elevated, the patient should be monitored. If there are signs of hyperreactivity of the immune system, such as rashes, fever, swollen lymph nodes or water retention, a doctor should be consulted immediately.
Weight gain
There is usually no weight gain when taking lamotrigine. Other anti-epileptic drugs, such as valproate or carbamazepine, however, may lead to weight gain. In combination therapy with lamotrigine, they may be responsible for an increase in body weight. Gabapentin and vigabatrin from the group of the newer anticonvulsants also have a minimal effect on body weight. Topiramate, on the other hand, can even lead to weight loss.
fatigue
Fatigue is a side effect of the majority of anti-epileptic drugs. In the case of lamotrigine, it is also listed in the package insert under possible side effects. Together with felbamate, however, lamotrigine belongs to the group of anti-epileptic drugs that, unlike other drugs in their group, hardly cause tiredness. The use of lamotrigine is also not an absolute contraindication for e.g. driving a car, although this must be discussed in detail with a doctor.
forgetfulness
Forgetfulness is not known to be a side effect of lamotrigine. It cannot therefore be ruled out that it can occur in individual patients. Drowsiness, drowsiness and tiredness can reduce the ability to concentrate and thus lead to supposed forgetfulness. If the side effects have a significant effect on everyday life, the attending physician must be consulted.
Interactions
Interactions are understood as the interaction of a drug with other drugs when taken at the same time.
Lamotrigine sometimes interacts with other anti-epileptic drugs, which increases the likelihood of side effects. These include valproate, carbamazepine, phenytoin or phenobarbital, for example.
The administration of risperidone, which is used for mental illnesses, can also lead to interactions.
Some antibiotics or drugs used to treat viral diseases can also interact with lamotrigine.
Contraception should also be discussed with the doctor, as the effectiveness of the contraceptive protection can change through interactions. The effectiveness of the anti-epileptic drug can also be influenced by the use of hormonal contraceptives, which may require a dose adjustment.
Lamotrigine and alcohol - are they compatible?
Patients on medication for epilepsy can be very sensitive to alcohol. As a rule, responsible, moderate consumption of alcohol is not associated with an increased risk of seizures. Nevertheless, the effect of alcohol can influence the effect of the anticonvulsants, which can be accompanied by an increase in side effects such as double vision, impaired balance and others. Consumption of large amounts of alcohol can encourage the occurrence of epileptic seizures, especially if it leads to a lack of sleep or irregular medication intake. Alcohol consumption in epilepsy patients should always be done responsibly and in a controlled manner.
Effectiveness of the pill
Taking the pill can affect the way lamotrigine works. The patient should inform her doctor about the use of hormonal contraceptives and discuss alternatives to contraception with them.
Lamotrigine can also affect the effectiveness of the pill, a decrease in effectiveness seems unlikely to date. Nevertheless, patients who observe changes in their menstrual periods, intermenstrual bleeding or spotting should consult their doctor and use additional contraceptive measures.
For further interactions of the pill read below: Which drugs affect the effect of the pill?
When should lamotrigine not be given?
An allergy, as a possible trigger of a life-threatening anaphylactic reaction, is always a contraindication to taking a drug.
Extreme caution is also required in the case of skin abnormalities after taking lamotrigine or other drugs for epilepsy. Caution is advised when taking lamotrigine if you have kidney problems.
Patients who are already taking anti-seizure medication; should inform their doctor about it.
Lamotrigine in pregnancy
Before a planned pregnancy or an existing pregnancy, the attending physician must be informed about the therapy with lamotrigine. Here, a dosage of the drug must be found that is free from seizures and the child is exposed to the lowest possible risk. A monotherapy at low dose should be aimed for.
Mothers who take lamotrigine during pregnancy may have an increased risk of developing birth defects. This includes cleft lip and palate. So far there is no indication of the influence on intellectual development, but there are only a few studies. During breastfeeding, the active ingredient can pass into the child through breast milk. In studies, however, these children were inconspicuous. The child should be examined regularly, and the benefits and risks of breastfeeding should be discussed in detail with the doctor.
Which drugs are allowed and which are not allowed during pregnancy? For detailed information, see: Medication during pregnancy
dosage
Lamotrigine should always be taken as recommended by a doctor. With the drug, the dose to be taken is very individual and varies with various influencing factors. The doctor will first prescribe a low dose and gradually increase it over a period of weeks, because lamotrigine has to be crept in slowly.
There are fixed schedules for increasing the dose of lamotrigine; the dose is usually increased by a maximum of 50 mg within two weeks. Otherwise there is a high risk of sometimes serious side effects.
Usually adults and adolescents over 13 years of age take between 100 mg to 400 mg of lamotrigine, in children the dose depends on body weight. The dose also depends on whether you are taking other anti-epileptic drugs.
The prescribed dose is taken once or twice a day with or without meals; the tablets must be swallowed whole.
An overdose can lead to side effects, in the worst case to loss of consciousness and coma. The patient should never stop treatment with lamotrigine without consulting their doctor; the dose must be reduced gradually over a few weeks. If the patient is stopped suddenly, seizures and worsening of epilepsy may occur.
What is lamotrigine level?
How much lamotrigine to take depends on various individual factors:
- Age of the patient
- Taking other anti-epileptic drugs
- Kidney and liver metabolic performance
The lamotrigine level in the blood can be determined in the laboratory after a blood test. The guide values are between 3 mg and 14 mg per liter. The decrease takes place on an empty stomach, i.e. before the intake of any food.
Regular use by the patient can be checked via the lamotrigine level, and it is also determined whether the level is in the so-called "therapeutic range".
With an overdose and high blood levels, the risk of side effects increases.
Underdosing can lead to therapy-resistant seizures.
The value can be increased due to impairment of the liver and kidney function; possible interactions with other drugs can also increase or decrease the value. Seizures can still occur even with optimal levels. Here, the intake should be increased in consultation with the doctor or the therapy should be combined with another anti-epileptic.
What should be considered when stopping lamotrigine?
Discontinuing lamotrigine should be discussed in detail with the doctor. As a rule, epilepsy requires long-term medication, and most patients receive lifelong therapy. Lamotrigine, like other anti-epileptic drugs, should not be stopped suddenly. This can lead to new seizures.
Lamotrigine should be tapered off as slowly as possible, but at least over a period of two weeks. The dose is reduced gradually.
If discontinuation is necessary due to severe side effects such as skin reactions, the intake can also be stopped abruptly.
Patients taking lamotrigine for bipolar disorder do not necessarily need to taper off the drug. Here too, a doctor should be consulted beforehand. In clinical studies there have been isolated cases of seizures in bipolar patients, which, however, are not unequivocally attributable to the discontinuation of lamotrigine.
price
As a rule, the treatment of epilepsy is long-term therapy. The cost of therapy depends on the total amount taken and the period of time. Depending on the provider, the prices for packs of 50 lamotrigine 100 mg vary between € 15 and € 18.
Alternatives to lamotrigine
Lamotrigine is one of the newer anti-epileptic drugs and can be used alone, i.e. in monotherapy, or together with other drugs in the treatment of epilepsy. Other new anticonvulsants are gabapentin, tiagabine, vigabatrin and others that also act on the inhibitory neurotransmitter system.
The classic antiepileptic drugs for monotherapy include phenytoin, phenobarbital and primidone. Carbamazepine and valproate in particular are short-listed for long-term therapy. Ethosuximide is also used for so-called absences, which occur mainly in childhood. The choice of medication depends on the type of seizure, age and tolerance of the patient.
For more information about the drugs for epilepsy, see the following page: Medication for epilepsy
