Lamotrigine (Lamictal®) for Epilepsy and other conditions
Unfortunately, almost a quarter of epilepsy patients also have depression which may be worsened by certain commonly used anti-seizure medications like Levetiracetam (Keppra®). Fortunately, Lamotrigine, a type of anti-seizure medication can simultaneously treat both epilepsy and depression.
What Types of Epilepsy Does Lamotrigine Treat?
Lamotrigine treats a broad spectrum of seizures. The United States Food and Drug Administration (FDA) has approved using it as treatment for focal and generalized seizures. Lamotrigine can be used as a treatment for newly diagnosed focal seizures and generalized tonic-clonic seizures and seizures in Lennox-Gastaut syndrome.
A recent study in 2021 which compared Lamotrigine with Levetiracetam and Zonisamide stated that it is better than both drugs in terms of ensuring efficacy and quality of life. This medication can be used by both adults and children above the age of two. Only concern is that it can worsen myoclonic jerks in juvenile myoclonic epilepsy.
What are the Other Conditions Treated by Lamotrigine?
Lamotrigine is helpful in treating many psychiatric conditions in addition to epilepsy. It acts as a mood stabilizer and therefore can be used to treat mood swings. It can be used as treatment for,
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Bipolar disorder
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Depression
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Obsessive Compulsive Disorder (OCD)
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Trigeminal neuralgia
How Does Lamotrigine Work?
The exact mechanism of action of Lamotrigine is still unknown. However, research shows that it selectively inhibits voltage-gated sodium channels in presynaptic membranes of neurons, stabilizing the membrane potential. It also inhibits release of excitatory neurotransmitters Glutamate and Aspartate release. Lamotrigine also enhances release of inhibitory neurotransmitter GABA, limiting the excessive electrical activity of the brain. That is why Lamotrigine is considered a broad spectrum antiseizure medication, treating all kinds of seizures.
How to Dose Lamotrigine?
Lamotrigine is only available as tablets and is not available in IV or liquid forms. Understanding the exact dosage is a little tricky. During administration of the medicine, we aim to slowly introduce the medicine to the body to avoid negative side effects.
Because lamotrigine is processed in the liver, it can interact with other medications and anti-seizure medications. We must take all these interactions into account when assigning the correct dosage and medication regime is adjusted accordingly,
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When the drug is not combined with any other liver inducing or inhibiting drugs (25 mg per day) (weeks 1, 2 25 mg nightly, weeks 3,4 25 mg twice a day, week 5 50 mg twice a day, week 6 75 mg twice a day and week 7 100 mg twice a day.)
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When it is combined with valproate (Depakote®), which is an enzyme inhibiter for liver, we give a much lower dosage (25 mg every other day) (Weeks 1,2 25 mg every other day, week 3, 4 25 mg once a day, week 5 25 mg twice a day)
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When combined with enzyme inducers such as carbamazepine, phenytoin, rifampin, etc. which make liver process lamotrigine faster, we give a higher dosage (25 mg twice a day) (weeks 1, 2 25 mg twice a day, weeks 3,4 50 mg twice a day, week 5 75 mg twice a day, week 6 100 mg twice a day)
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When patient has liver or kidney failure, we decrease the final dose of the drug
What are the Side Effects of Lamotrigine?
Common side effects include:
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Gastrointestinal symptoms such as abdominal pain, nausea, vomiting, diarrhea, etc.
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Dizziness
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Double vision
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Tremors
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Worsening of myoclonic jerks in Juvenile Myoclonic Epilepsy
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Skin rashes
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Stevens Johnsons syndrome (More serious skin reactions)
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Conductive problems in the heart
Amongst these, Stevens Johnsons syndrome, a rare but serious skin allergic condition should be avoided at all costs. If signs of allergies appear, patient should switch medications as soon as possible.
Can I Drive or Drink Alcohol with Lamotrigine?
Initially lamotrigine can cause dizziness or drowsiness, so it is recommended to avoid driving until you get used to the medication over time. Alcohol should be avoided as it worsens dizziness and drowsiness.
Is Lamotrigine Safe in Pregnancy and Breastfeeding?
Lamotrigine is one of the safest anti-seizure medications during pregnancy and breast feeding. It can be used on girls and women of childbearing age due to this excellent safety. In addition, it works very well for epilepsy in elderly but the dose may need to be lowered slightly.
Can Contraceptive Pills Interact with Lamotrigine?
Oral contraceptive pills with estrogen or estrogen implants can decrease levels of lamotrigine in blood. Therefore, the dose should be adjusted accordingly.
What to Do if Lamotrigine is Not Working for Me?
There are many reasons why an anti-seizure medication may not work for you.
People usually give up early or at too low of a dose.
One reason is non-compliance. Missing a dose of these anti-seizure medications can lead to breakthrough seizures So you can’t miss any doses. If you miss a dose, you should make it up right away during the day whenever you remember, and if you miss your doses for the whole day, you should double the dose at night. This is because it is important to maintain a steady level of lamotrigine in blood. Another reason is that your current dose may not be high enough. It is usually recommended to follow the medications for at least 3-6 months before you switch the medications.
In addition, drug resistant epilepsy which is seen in about 25% of people with epilepsy do not respond to treatment. For those people there are other options such as surgical intervention to treat their seizures.
How to Stop Lamotrigine?
Lamotrigine like other anti-seizure drugs, should not be stopped abruptly. It should be slowly tapered down with time to avoid withdrawal seizures. Medication can be stopped abruptly only in the case of a severe allergic reaction.
Lamotrigine works great on most people with epilepsy along with depression, anxiety, bipolar disorder and most other psychiatric conditions. Therefore, it is a revolutionary modern anti-seizure drug.