Lamotrix

Lamotrigine

Adjunctive or monotherapy (for adult >12 yr only) in the treatment of epilepsy, partial & generalised seizures including tonic-clonic seizures & seizures associated w/ Lennox-Gastaut syndrome. Prevention of depressive episodes in patients w/ bipolar disorder (adult ≥18 yr).

Epilepsy Adult >12 yr Monotherapy Initially 25 mg once daily for 2 wk followed by 50 mg once daily for 2 wk; increase by a max of 50-100 mg every 1-2 wk until optimal response is achieved. Maintenance: 100-200 mg/day once daily or in 2 divided doses; may be given up to 500 mg/day. Add-on therapy: W/ valproate Initially 25 mg every alternate day for 2 wk, followed by 25 mg once daily for 2 wk; increase by a max of 25-50 mg every 1-2 wk until optimal response is achieved. Maintenance: 100-200 mg once daily or in 2 divided doses. W/o valproate Initially 50 mg once daily for 2 wk, followed by 100 mg/day in 2 divided doses for 2 wk; increase by a max of 100 mg every 1-2 wk until optimal response is achieved. Maintenance: 200-400 mg/day in 2 divided doses; may be given up to 700 mg/day. Patient taking other medications that do not significantly inhibit or induce lamotrigine glucuronidation Initially 25 mg once daily for 2 wk, followed by 50 mg once daily for 2 wk; increase by a max of 50-100 mg every 1-2 wk until the optimal response is achieved. Maintenance: 100-200 mg once daily or as 2 divided doses. Childn 2-12 yr Add-on therapy: W/ valproate Initially 0.15 mg/kg/day given once daily for 2 wk, followed by 0.3 mg/kg/day given once daily for 2 wk; increase by a max of 0.3 mg/kg every 1-2 wk until optimum response is achieved. Maintenance: 1-5 mg/kg once daily or in 2 divided doses. Max: 200 mg/day. W/o valproate Initially 0.6 mg/kg/day in 2 divided doses for 2 wk, followed by 1.2 mg/kg/day in 2 divided doses for 2 wk; increase by a max of 1.2 mg/kg every 1-2 wk until optimum response is achieved. Maintenance: 5-15 mg/kg once daily or in 2 divided doses. Max: 400 mg/day. Bipolar disorder Adult ≥18 yr Adjunct therapy w/ enzyme inhibitors eg, valproate Initially 25 mg every alternate day for 2 wk, followed by 25 mg once daily for 2 wk; increase to 50 mg once daily or in 2 divided doses in wk 5. Usual target dose: 100 mg once daily or in 2 divided doses. Max: 200 mg once daily. Adjunct therapy w/ enzyme inducers (w/o co-administration w/ enzyme inhibitors) Initially 50 mg once daily for 2 wk, followed by 100 mg/day given in 2 divided doses for 2 wk; increase to 200 mg/day in 2 divided doses in wk 5 & may be increased in wk 6 to 300 mg/day. Usual target dose: 400 mg/day in 2 divided doses which may be given in wk 7. Monotherapy or adjunct therapy in patients taking other medications that do not inhibit/induce lamotrigine glucuronidation Initially 25 mg once daily for 2 wk, followed by 50 mg once daily or in 2 divided doses for 2 wk; increase to 100 mg/day in wk 5. Usual target dose: 200 mg once daily or in 2 divided doses.

May be taken with or without food.

Hypersensitivity.

Discontinue use at 1st sign of rash. History of allergy or rash to other antiepileptic drugs. Haemophagocytic lymphohistiocytosis. Increased risk of aseptic meningitis, suicidality. Monitor clinical worsening of bipolar disorder. Concomitant use w/ hormonal contraceptives. Not recommended to be co-administered w/ organic cationic transporter 2 substrates w/ narrow therapeutic index eg, dofetilide. Acute multi-organ failure. Possible long-term ophthalmologic effects. Do not administer in patients taking other lamotrigine-containing prep. Patients w/ Brugada-type syndrome. Women starting/stopping hormonal contraceptives. Hepatic impairment. Renal failure. May impair ability to drive or operate machinery. Pregnancy & lactation. Epilepsy: Not recommended as initial monotherapy for newly diagnosed ped patients. Abrupt w/drawal may provoke rebound seizures (gradually decrease over a period of 2 wk). Childn <2 yr. Bipolar disorder: Increased risk of suicidal thinking & behaviour in childn & adolescents <18 yr w/ major depressive disorder & other psychiatric disorders.

Skin rash, headache; somnolence, dizziness. Aggression, irritability, insomnia, tremor, nausea, vomiting, diarrhoea, tiredness. Agitation, arthralgia, pain, back pain. Potentially, Stevens Johnson syndrome & toxic epidermal necrolysis (Lyell's syndome).

Inhibited glucuronidation w/ valproate. Significantly induced glucuronidation w/ carbamazepine, phenytoin, primidone, phenobarb, rifampicin, lopinavir/ritonavir & ethinyloestradiol/levonorgestrel combination. False positive test, particularly for phencyclidine, in rapid urine drug screens.

Anticonvulsants

N03AX09 - lamotrigine ; Belongs to the class of other antiepileptics.

POM