Lamictal

Lamotrigine

Adjunctive or monotherapy in treatment of epilepsy for partial & generalized seizures, including tonic-clonic seizures & seizures associated w/ Lennox-Gastaut syndrome. Bipolar disorder: Prevention of mood episodes predominantly by preventing depressive episode.

Adult & adolescent >16 yr Epilepsy monotherapy Initially 25 mg once daily for 2 wk, followed by 50 mg once daily for 2 wk. May be increased to max: 50-100 mg every 1-2 wk. Maintenance: 100-200 mg once daily or as 2 divided doses. Adult & adolescent >12 yr Add-on therapy w/ valproate Initially 25 mg every alternate day for 2 wk, followed by 25 mg once daily for 2 wk. May be increased to max: 25-50 mg every 1-2 wk. Maintenance: 100-200 mg once daily or in 2 divided doses. Add-on therapy w/ antiepileptics or other medications inducing lamotrigine glucuronidation Initially 50 mg once daily for 2 wk, followed by 100 mg daily in 2 divided doses for 2 wk. May be increased to max: 100 mg every 1-2 wk. Maintenance: 200-400 mg daily in 2 divided doses. Add-on therapy w/ drugs 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. May be increased to max: 50-100 mg every 1-2 wk. 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 once daily for 2 wk, followed by 0.3 mg/kg once daily for 2 wk. May be increased to max: 0.3 mg/kg every 1-2 wk. Maintenance: 1-5 mg/kg once daily or in 2 divided doses. Max: 200 mg daily. Add-on therapy w/ antiepileptics or other medications inducing lamotrigine glucuronidation Initially 0.6 mg/kg daily in 2 divided doses for 2 wk, followed by 1.2 mg/kg daily in 2 divided doses for 2 wk. May be increased to max: 1.2 mg/kg every 1-2 wk. Maintenance: 5-15 mg/kg daily in 2 divided doses. Max: 400 mg daily. Add-on therapy w/ drugs that do not significantly inhibit or induce lamotrigine glucuronidation Initially 0.3 mg/kg once daily or in 2 divided doses for 2 wk, followed by 0.6 mg/kg once daily or in 2 divided doses for 2 wk. May be increased to max: 0.6 mg/kg every 1-2 wk. Maintenance: 1-10 mg/kg once daily or in 2 divided doses. Max: 200 mg daily. Adult ≥18 yr Bipolar disorder adjunct therapy w/ valproate Initially 25 mg every alternate day for 2 wk, followed by 25 mg once daily for 2 wk. May be increased to 50 mg once daily or in 2 divided doses for 1 wk. Usual target dose: 100 mg once daily or in 2 divided doses, may be increased to max: 200 mg daily. Adjunct therapy w/ phenytoin, carbamazepine, phenobarb, primidone & other drugs inducing lamotrigine glucuronidation Initially 50 mg once daily for 2 wk, followed by 100 mg daily in 2 divided doses for 2 wk. May be increased to 200 mg daily as 2 divided doses for 1 wk, then further increased to 300 mg daily for 1 wk. Usual target dose: 400 mg daily in 2 divided doses for 1 wk. Monotherapy or adjunct therapy w/ drugs that do not significantly induce or inhibit lamotrigine glucuronidation Initially 25 mg once daily for 2 wk, followed by 50 mg once daily or in 2 divided doses for 2 wk. May be increased to 100 mg daily for 1 wk. Usual target dose: 200 mg once daily or as 2 divided doses.

May be taken with or without food: Tab: Swallow whole, do not chew/crush. Dispersible tab: May be chewed/dispersed in a small vol of water or swallowed whole w/ a little water.

Hypersensitivity.

History of allergy or rash to other antiepileptic drugs. Not to be restarted in patients who have discontinued due to rash or aseptic meningitis associated w/ prior treatment. Haemophagocytic lymphohistiocytosis; heart failure, valvular heart disease, congenital heart disease, conduction system disease, ventricular arrhythmias, cardiac channelopathies eg, Brugada syndrome. Monitor for clinical worsening, suicidal ideation/behaviour, thoughts or unusual changes in behaviour. Avoid abrupt w/drawal. Long-term use. Not recommended in co-administration w/ OCT2 substrates eg, dofetilide. Not to be administered in patients currently being treated w/ other lamotrigine-containing prep. Concomitant use w/ hormonal contraceptives. May affect ability to drive & use machines. Renal failure. Hepatic impairment. Pregnancy & lactation. Not to be used for bipolar disorder in childn & adolescents <18 yr. Major depressive & other psychiatric disorders in childn & adolescents <18 yr. Childn <2 yr w/ epilepsy.

Skin rash; headache. Aggression, irritability; somnolence, insomnia, dizziness, tremor, agitation; nausea, vomiting, diarrhoea; arthralgia; tiredness, pain, back pain.

Inhibited glucuronidation by valproate. Induced glucuronidation by carbamazepine, phenytoin, primidone, phenobarb, rifampicin, lopinavir/ritonavir/atazanavir, ethinylestradiol/levonorgestrel combination. Increased topiramate conc. Reduced AUC & C_max w/ OCs. Reduced plasma AUC & C_min w/ paracetamol. False +ve reading for phencyclidine.

Anticonvulsants

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

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