Dr. Saltiel received his Pharm.D. from the University of California, San Francisco, in 1980, following undergraduate work at UCLA. At UCSF, he was the recipient of the Outstanding Service Award and the Bowl of Hygeia Award. He completed a residency in clinical pharmacy practice at the University of Illinois, in Chicago.
Jay W. Marks, MD, is a board-certified internist and gastroenterologist. He graduated from Yale University School of Medicine and trained in internal medicine and gastroenterology at UCLA/Cedars-Sinai Medical Center in Los Angeles.
DRUG CLASS AND MECHANISM: Lamotrigine is an oral drug that is used for treating seizures. It is chemically unrelated to other anti-seizure drugs. The precise mechanism by which lamotrigine exerts its anti-seizure action is not known.
STORAGE: Tablets should be stored at room temperature, between 15 and 30°C (59-86°F).
PRESCRIBED FOR: Lamotrigine is used in combination with other anti-seizure drugs in the treatment of some types of seizures. It also is used alone for treating partial seizures in patients 16 years and older when converting from the anti-epileptic drug valproate.
DOSING: The initial dose of lamotrigine in patients not taking valproic
acid (Depakote) is 50 mg once daily for two weeks, followed by 100 mg daily given in two divided doses for two weeks. Thereafter, the usual maintenance dose is 300 to 500 mg daily given in two divided doses. In patients taking valproic acid, the initial dose of lamotrigine is 25 mg every other day for two weeks, then 25 mg once daily for two weeks, slowly increasing the dose (by 25 to 50 mg per day) every one to two weeks) until a dose of 100 to 150 mg daily is reached. Standard doses of lamotrigine are given twice daily.
DRUG INTERACTIONS: Lamotrigine can interact with valproic acid. When lamotrigine is begun in patients already receiving valproic acid, the blood concentrations of valproic acid can decrease over a 3-week period. This may result in loss of seizure control. The risk of severe skin rash may be increased by combining lamotrigine with valproic acid.
There may be a higher incidence of dizziness, double vision, and blurred vision in patients receiving carbamazepine together with lamotrigine. The mechanism of this interaction is unclear.
PREGNANCY: Damage to the fetus has been shown in some but not all pregnant animal species given lamotrigine. There have been no good studies in pregnant women. Physicians may choose to prescribe lamotrigine to pregnant women if they feel the benefit outweighs the potential risk.
NURSING MOTHERS: Lamotrigine is secreted into human breast milk. Because the effects on the infant are unknown, breast-feeding while taking lamotrigine is not recommended.
SIDE EFFECTS: Severe, life-threatening rashes have occurred with lamotrigine. The risk in children (for whom lamotrigine is not approved) is as high as 1 in 50 to 1 in 100 patients. Rash is rare in adults, but the risk is increased if the dose is increased faster than recommended or if patients also are taking valproic acid. Nearly all reported rashes have occurred within 2 to 8 weeks of starting therapy. Patients taking lamotrigine should report any rash to a physician immediately.
Severe liver disease has been reported with lamotrigine rarely (less than 1 per 1000 patients).
As a general rule, anti-seizure medicines should not be
abruptly stopped because of the possibility of increasing the frequency of
seizures. In most cases, the dose of lamotrigine should be gradually lowered
over a period of at least two weeks.
The most commonly noted side effects reported by patients taking lamotrigine
(in combination with other anti-seizure medicines) are dizziness, somnolence,
headache, double vision, blurred vision, nausea, vomiting and rash.
Antiepileptic medications have been associated
with increased risk of suicidal thinking and behavior. Anyone
considering the use of antiepileptic drugs must balance this risk of suicide with the clinical need. Patients who are
started on therapy should be closely observed for clinical worsening, suicidal
thoughts, or unusual changes in behavior.
Post-traumatic stress disorder (PTSD), a psychiatric condition, can develop after any catastrophic life event. Symptoms include nightmares, flashbacks, sweating, rapid heart rate, detachment, amnesia, sleep problems, irritability, and exaggerated startle response. Treatment may involve psychotherapy, group support, and medication.
Bipolar disorder (or manic depression) is a mental illness characterized by depression, mania, and severe mood swings. Treatment may incorporate mood stabilizer medications, antidepressants, and psychotherapy.
Epilepsy is a brain disorder in which the person has seizures. There are two kinds of seizures, focal and generalized. There are many causes of epilepsy. Treatment of epilepsy (seizures) depends upon the cause and type of seizures experienced.
Fragile X syndrome is the most common inherited form of mental retardation. It's caused by a mutation on the X chromosome. People with Fragile X syndrome suffer from physical, social, emotional, speech, language, sensory, intelligence, and learning impairments. There is no definitive treatment for Fragile X, though there are ways to minimize the symptoms.
Postpartum depression is a form of depression that occurs within a year after delivery. It is thought that rapid hormone changes after childbirth may lead to depression. Symptoms of postpartum depression include crying a lot, headaches, chest pains, eating too little or too much, sleeping too little or too much, withdrawal from friends and family, and feeling irritable, sad, hopeless, worthless, guilty, and overwhelmed. Treatment typically involves talk therapy and medication.
Bipolar disorder, or manic-depressive illness, is a disorder that causes unusual and extreme mood changes. Symptoms of bipolar disorder in children and teens include having trouble concentrating, behaving in risky ways and losing interest in activities they once enjoyed. Treatment for bipolar disorder in children and teenagers incorporates psychotherapy and medications.
Bipolar disorder, also called manic depression, is a mental illness that is characterized by severe mood swings, repeated episodes of depression, and at least one episode of mania. Bipolar disorder is one kind of mood disorder that afflicts more than
1% of adults in the United States, up to as many as 4 million people. Here are
some additional statistics about bipolar disorder:
Bipolar disorder is the fifth leading cause of disability worldwide.
Bipolar disorder is the ninth leading cause of years lost to death or disability worldwide.
The number of individuals with bipolar disorder who commit suicide is 60 times higher than that of the general population.
People who have bipolar disorder are at a higher risk of also suffering from substance abuse and other mental health problems.
Males may develop bipolar disorder earlier in life compared to females.
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