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(December 2008)LamotrigineSystematic (IUPAC) name6-(2,3-dichlorophenyl)-1,2,4-triazine-3,5-diamineIdentifiersCAS number84057-84-1ATC codeN03AX09PubChem3878DrugBankAPRD00570ChemSpider3741Chemical dataFormulaC9H7Cl2N5 Mol. mass256.091 g/molSMILESeMolecules & PubChemPharmacokinetic dataBioavailability98%Protein binding55%MetabolismHepatic (mostly UGT1A4-mediated)Half life24–34 hours (healthy adults)ExcretionRenalTherapeutic considerationsPregnancy cat.C(US)Legal statusPOM(UK) ℞-only(US)RoutesOralLamotrigine (marketed as Lamictal (IPA: /ləˈmɪktəl/) by GlaxoSmithKline, called Lamictin in South Africa, למוג'ין (Lamogine) in Israel, and 라믹탈 in South Korea and also Lamitor) is an anticonvulsant drug used in the treatment of epilepsy and bipolar disorder. For epilepsy it is used to treat partial seizures, primary and secondary tonic-clonic seizures, and seizures associated with Lennox-Gastaut syndrome. Lamotrigine also acts as a mood stabilizer. It is the first medication since lithium to be granted approval by the U.S. Food and Drug Administration (FDA) for the maintenance treatment of bipolar type I. Chemically unrelated to other anticonvulsants (due to Lamotrigine being a Phenyltriazine), lamotrigine has relatively few side-effects and does not require blood monitoring in monotherapy. The exact way lamotrigine works is unknown. Some think that it is a Na+ (sodium) channel blocker, though it is interesting to note that lamotrigine shares very few side-effects with other, unrelated anticonvulsants known to inhibit sodium channels, (e.g. Oxcarbazepine), which may suggest that lamotrigine has a different mechanism of action. The drug information provided at the time of prescription notes that "it is thought to work by restoring the balance of certain natural substances (neurotransmitters) in the brain." (Lamotrigine is inactivated by hepatic glucuronidation.However, lamotrigine has also been successful in controlling rapid cycling and mixed bipolar states in persons with more serious psychiatric disorders and who have not received what is considered to be adequate relief from lithium, carbamazepine or valproate, because it is deemed to possibly have significantly more antidepressant potency than either carbamazepine or valproate.// U.S. Food and Drug Administration approval historyThis section does not cite any references or sources. Please help improve this article by adding citations to reliable sources. Unverifiable material may be challenged and removed. (December 2008)December 1994 - for use as adjunctive treatment for partial seizures with or without secondary generalization in adult patients (16 years of age and older).August 1998 - for use as adjunctive treatment of Lennox-Gastaut syndrome in pediatric and adult patients, new dosage form: chewable dispersible tablets.December 1998 - for use as monotherapy for treatment of partial seizures in adult patients when converting from a single enzyme-inducing anti-epileptic drug (EIAED).January 2003 - for use as adjunctive therapy for partial seizures in pediatric patients as young as 2 years of age.June 2003 - for the maintenance treatment of adults with Bipolar I Disorder to delay the time to occurrence of mood episodes (depression, mania, hypomania, mixed episodes) in patients treated for acute mood episodes with standard therapy. Additionally, the FDA has noted that findings for Lamictal maintenance treatment were more robust in bipolar depression.January 2004 - for use as monotherapy for treatment of partial seizures in adult patients when converting from the anti-epileptic drug valproate (including valproic acid (Depakene); sodium valproate (Epilim) and divalproex sodium (Depakote)). Therapeutic uses Epilepsy and seizuresLamotrigine was approved in 1994 by the US FDA for the treatment of partial seizures. Lamotrigine is one of a small number of FDA-approved therapies for seizures associated with Lennox-Gastaut syndrome, a severe form of epilepsy. Typically developing before four years of age, LGS is associated with developmental delays. There is no cure, treatment is often complicated, and complete recovery is rare. Symptoms include the atonic seizure (also known as a "drop attack"), during which brief loss of muscle tone and consciousness cause abrupt falls. Lamotrigine significantly reduces the frequency of LGS seizures, and is one of two medications known to decrease the severity of drop attacks. Combination with valproate is common, but this increases the risk of lamotrigine-induced rash, and necessitates reduced dosing due to the interaction of these drugs. Bipolar disorderLamotrigine approved in 2003 by the FDA for maintenance treatment of Bipolar I disorder; the first since lithium. While traditional anticonvulsant drugs are predominantley antimanics, lamotrigine is most effective in the treatment and prophylaxis of bipolar depression. Lamotrigine treats bipolar depression without triggering mania, hypomania, mixed states, or rapid-cycling. It has not demonstrated efficacy in the treatment of acute mania. The 2002 American Psychiatric Association guidelines recommended lamotrigine as a first-line treatment for acute depression in bipolar disorder as well as a maintenance therapy.However, lamotrigine is not indicated on label for the treatment of acute bipolar symptoms. Because the dosage must be slowly increased from a sub-therapeutic level to the therapeutic level, the drug's utility in the management of acute manic symptoms is debatable; typically benzodiazepines or another anticonvulsant will be used to manage the acute mania until the lamotrigine reaches therapeutic blood concentration.At doses considered sub-therapeutic, lamotrigine is thought to have a mild anti-depressant effect, leading some to question its safety for use in bipolar disorder, as partial remediation of cyclically depressed individuals (especially teens and young adults) has an elevated corelation to suicide until remission attains therapeutically acceptable levels. If lamotrigine's mechanism of action involves an increase in serotonin levels, this may potentially increase the risk of Serotonin syndrome. Other usesOff-label uses include the treatment of peripheral neuropathy, trigeminal neuralgia, cluster headaches, migraines, and reducing neuropathic pain. Off-label psychiatric usage includes the treatment of depersonalization disorder, bipolar II disorders, schizoaffective disorder, borderline personality disorder, post traumatic stress disorder, and as adjunctive therapy for treatment refractory unipolar depression. Mechanism of actionOne proposed mechanism of action for lamotrigine involves an effect on sodium channels, although this remains to be established in humans. In vitro pharmacological studies suggest that lamotrigine inhibits voltage-sensitive sodium channels, thereby stabilizing neuronal membranes and consequently modulating presynaptic transmitter release of excitatory amino acids (for example glutamate and aspartate). PharmacokineticsThe pharmacokinetics of lamotrigine are quite complicated, with highly varying half-life and blood plasma levels. Lamotrigine has fewer drug interactions than many anticonvulsant drugs, although pharmacokinetic interactions with Sodium Valproate in particular is an indication for blood monitoring. Side effectsLamotrigine prescribing information has a black box warning about life threatening skin reactions, including Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. The manufacturer states that nearly all cases appear in the first 2 to 8 weeks of therapy and if medication is suddenly stopped then resumed at the normal dosage. Patients should seek medical attention for any unexpected skin rash as its presence is an indication of a possible serious or even deadly side effect of the drug. Not all rashes that occur while taking lamotrigine progress to Stevens-Johnson Syndrome or Toxic Epidermal Necrolysis It is estimated that 5 to 10 % of patients will develop a rash, but that only one in a thousand patients will develop a serious rash. It is thought that one in 50,000 exposed patients may die from a rash.Cognitive side effects are common with doses over 50 mg qid (quarter in die - four times daily), as shown in the 2001–2003 Glaxo-sponsored Clinical Trials comparing quality of life between Topiramate and Lamotrigine in healthy volunteers (unpublished). Common side effects include headaches, dizziness and insomnia. Other side effects may include acne and skin irritation, vivid dreams or nightmares, night sweats, body aches and cramps, muscle aches, dry mouth, fatigue, memory and cognitive problems, irritability, weight changes, hair loss, changes in libido, frequent urination, nausea, and other side effects. In very rare cases, Lamotrigine has been known to cause the development of a dangerous rash called Stevens-Johnson syndrome (or SJS). The rash is more common in children, so this medication is often reserved for adults. There is also an increased incidence of this rash in patients who are currently on, or recently discontinued a valproate-type anticonvulsant drug, as these medications interact in such a way that the clearance of both is decreased and the effective dose of lamotrigine is increased.In clinical trials women were more likely than men to have side effects. This is the opposite of most other anticonvulsants and antipsychotics. It has been suggested that genetic background makes a difference in dosages, with those of non-Caucasian background typically needing lower doses.Lamotrigine binds to melanin-containing tissues such as
Lamictal is a drug that is a prescription medication that is used to help treat Bipolar disorder as well as other diseases. Quack's programs have often featured shows important to the companies that he consults. Dr.. Includes a regimen to help clear your acne. On 09/20/05, Dr. How do I deal with the acne?One of the side effects or reactions of Lamictal, is Lamictal acne. LAMICTAL does not take away the initial feelings of depression or mania you may be experiencing. I have IBS, but this is way beyond anything I have ever experienced.This is a recently updated list of the top Bipolar Medications for 2007.Pretty self-explanatory title :)The drug Lamictal, manufactured by GlaxoSmithKline, has been approved by the FDA to treat patients with a serious form of epilepsy.LAMICTAL was the first FDA-approved medication for the long-term treatment of adults with bipolar I disorder since lithium was approved in 1970.There are so many people that are taking the drug Lamictal for depression or bipolar symptoms who are experiencing lamictal acne side effects. In addition to his mood stabilizing effects, Lamictal has antidepressant effects as well that, for bipolar or manic-depressive patients. Find out why Lamictal medication is better
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