Stahl's Essential Psychopharmacology Online
In Collaboration With
Lamotrigine
Therapeutics
Brands
• Lamictal, Lamictin
Generic?
Yes
Class
• Antiepileptic drug (AED)
Commonly Prescribed for
(FDA approved in bold)
• Complex partial seizures (adjunctive for age 16 or older)
• Conversion to monotherapy for partial seizures in adults 16 or older
• Lennox-Gastaut syndrome aged 2 and older
• Maintenance of bipolar disorder
• Generalized tonic-clonic seizures including juvenile myoclonic epilepsy
• Absence seizures (children and adults)
• Temporal lobe epilepsy (children and adults)
• Migraine prophylaxis
• SUNCT (Short-lasting unilateral neuralgiform headache with conjunctival injection and tearing)
• Trigeminal neuralgia
• Bipolar depression or mania
• Psychosis/Schizophrenia (adjunctive)
How the Drug Works
• A
use-dependent blocker of voltage-sensitive sodium channels, preventing
release of excitatory neurotransmitters such as glutamate
and aspartate
• May inhibit gamma-aminobutyric acid (GABA) release and interact with calcium channels
• Weakly inhibits serotonin-3 receptors
How Long Until It Works
• Seizures - should decrease by 2 weeks at a specific dose, but slow titration can delay time to effective dose
• Headaches - weeks to months
• Mania - may take weeks to months
If It Works
• Seizures - goal is the remission of seizures. Continue as long as effective and well-tolerated. Consider tapering and slowly
stopping after 2 years without seizures, depending on the type of epilepsy
• Headache - goal is a 50% or greater decrease in frequency or severity of pain or aura
If It Doesn't Work
• Increase to highest tolerated dose
• Epilepsy: consider changing to another agent, adding a second agent or referral for epilepsy surgery evaluation. When adding
a second agent keep in mind the drug interactions that can occur
• Headache: If not effective in 2 months, consider stopping or using another agent
Best Augmenting Combos for Partial Response or Treatment-Resistance
• Epilepsy: drug interactions complicate multi-drug therapy. Increase dose if using with enzyme-inducing drugs and lower when
using with valproate. May be particularly effective in combination with valproate
• Headache:
consider beta-blockers, antidepressants, natural products, other AEDs,
and non-medication treatments such as biofeedback
to improve headache control
Tests
• No regular blood tests are recommended