Lamotrigine


Generic Medicine Info
Administration
May be taken with or without food.
Contraindications
Hypersensitivity (e.g. acute urticaria, rash, extensive pruritus, angioedema, mucosal ulceration) to lamotrigine.
Special Precautions
Patient with a history of allergy or rash to other antiepileptic drugs; clinically important structural or functional heart disease (e.g. heart failure, MI, Brugada syndrome or other Na channelopathies, multiple risk factors for coronary heart disease; valvular, congenital or ischaemic heart disease, conduction system disease, ventricular arrhythmias); history of suicidal behaviours or thoughts, or exhibiting a significant degree of suicidal ideation before treatment initiation. Women taking estrogen-containing oral contraceptives. Not indicated for the treatment of acute manic or depressive episodes. Avoid abrupt withdrawal (unless serious reactions occur). Significant renal and moderate to severe hepatic impairment. Children. Pregnancy and lactation. Patient Counselling This drug may cause dizziness, drowsiness and double vision; if affected, do not drive or operate machinery. Avoid excessive exposure to sunlight or UV lights; use protective clothing and sunscreen when going outdoors. Monitoring Parameters Monitor the serum levels of concomitant anticonvulsants; lamotrigine plasma concentrations (as clinically indicated); LFTs and renal function; ECG before starting treatment in at-risk patients. Closely assess for signs and symptoms of hypersensitivity reactions (particularly skin rash), blood dyscrasias, and aseptic meningitis; clinical worsening (in bipolar disorder), depression, suicidal thoughts, and unusual mood or behavioural changes particularly during treatment initiation and dose changes.
Adverse Reactions
Significant: Suicidal ideation and behaviour, CNS depression, exacerbation of myoclonic seizures, aseptic meningitis, photosensitivity reactions, rash; may accumulate and cause toxicity in the eye and other melanin-rich tissues (long-term use). Rarely, blood dyscrasias (e.g. aplastic anaemia, pancytopenia, neutropenia, leucopenia, thrombocytopenia). Cardiac disorders: Chest pain. Eye disorders: Nystagmus, diplopia, blurred vision. Gastrointestinal disorders: Nausea, vomiting, diarrhoea, xerostomia, abdominal pain, constipation, dyspepsia. General disorders and administration site conditions: Fatigue, pain, fever, flu syndrome. Hepatobiliary disorders: Rarely, hepatic dysfunction. Infections and infestations: Infection. Investigations: Weight gain or loss. Rarely, increased LFTs. Metabolism and nutrition disorders: Anorexia. Musculoskeletal and connective tissue disorders: Arthralgia, back or neck pain. Nervous system disorders: Headache, dizziness, tremor, ataxia, incoordination, somnolence, exacerbation of Parkinson's disease. Psychiatric disorders: Aggression, irritability, insomnia, agitation. Reproductive system and breast disorders: Dysmenorrhoea, vaginitis. Respiratory, thoracic and mediastinal disorders: Rhinitis, pharyngitis, increased cough.
Potentially Fatal: May cause cardiac rhythm and conduction abnormalities (e.g. slow ventricular conduction [widen QRS], arrhythmia, typical Brugada ECG pattern) in patients with heart disease. Rarely, serious skin rashes (e.g. Stevens-Johnson syndrome, toxic epidermal necrolysis), haemophagocytic lymphohistiocytosis (HLH); multiorgan hypersensitivity reactions or drug reaction with eosinophilia and systemic symptoms (DRESS) causing hepatic or multiorgan failure, or disseminated intravascular coagulation.
Drug Interactions
Valproate significantly inhibits lamotrigine glucuronidation resulting in the increased serum concentrations and toxic effects of lamotrigine. Concomitant use with drugs that induce lamotrigine glucuronidation such as phenytoin, carbamazepine, primidone, phenobarbital, rifampicin, lopinavir/ritonavir, atazanavir/ritonavir, and estrogen-containing oral contraceptives (e.g. ethinylestradiol/levonorgestrel) leads to decreased plasma concentrations of lamotrigine. May cause CNS effects (e.g. blurred vision, diplopia, dizziness, ataxia) and nausea with carbamazepine. May increase the concentrations of topiramate. Risk of arrhythmias may be increased further with other Na channel blockers. May increase the plasma levels of certain organic cationic transporter 2 (OCT2) substrates.
CIMS Class
Anticonvulsants / Antipsychotics
ATC Classification
N03AX09 - lamotrigine ; Belongs to the class of other antiepileptics.
Disclaimer: This information is independently developed by CIMS based on lamotrigine from various references and is provided for your reference only. Therapeutic uses, prescribing information and product availability may vary between countries. Please refer to CIMS Product Monographs for specific and locally approved prescribing information. Although great effort has been made to ensure content accuracy, CIMS shall not be held responsible or liable for any claims or damages arising from the use or misuse of the information contained herein, its contents or omissions, or otherwise. Copyright © 2021 CIMS. All rights reserved. Powered by CIMSAsia.com
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