Lamotrigine

Definition

Lamotrigine is an anticonvulsant medication used in the treatment of epilepsy. Epilepsy is a neurological disorder in which excessive surges of electrical energy are emitted in the brain, causing seizures. Lamotrigine is usually reserved for difficult-to-control seizures that have not responded to other anticonvulsant medications. In psychiatry, lamotrigine is also indicated in the treatment of bipolar disorder (manic-depression).

Purpose

While lamotrigine controls seizures associated with epilepsy, there is no known cure for the disorder. Although the precise mechanism by which lamotrigine exerts its therapeutic effect is unknown, lamotrigine is thought to act at sodium channels in the neuron (nerve cell) to reduce the amount of excitatory neurotransmitters that the nerve cell releases. Neurotransmitters are chemicals that aid in the transfer of nerve impulses from one nerve junction to the next. With decreased levels of these neurotransmitters, the electrical activity in the brain that triggers seizures is reduced.

In the treatment of bipolar disorders, lamotrigine's effect upon neurochemicals stabilizes mood, preventing sudden, unpredictable, and severe episodes of mania and depression.

Description

For the treatment of epilepsy-related seizures, lamotrigine may be used alone or in combination with other anti-epileptic drugs (AEDs) or anticonvulsants. In the United States, lamotrigine is sold under the brand name Lamictal.

Recommended dosage

Lamotrigine is taken orally, in either tablet or chewable form. Chewable tablets may be dispersed into a liquid solution, according to the prescribing physician's instructions. Lamotrigine is prescribed by physicians in varying daily dosages, usually ranging 200–900 mg per day divided into two doses.

Beginning any course of treatment that includes lamotrigine requires a gradual dose-increasing regimen. The safety and effectiveness of lamotrigine in children under age 18 have not been proven; therefore, the drug is seldom used in children. Adults typically take an initial dose for the first two weeks that is slowly increased over time. It may take several weeks to realize the full benefits of lamotrigine, especially in those patients taking lamotrigine for the treatment of bipolar disorders.

A double dose of lamotrigine should not be taken. If a dose is missed, it should be taken as soon as possible. However, if it is within four hours of the next dose, then the missed dose should be skipped. When ending a course of treatment that includes lamotrigine, physicians typically direct patients to gradually taper down their daily dosages over a period of several weeks. Stopping the medicine suddenly may severely alter mood or cause seizures to occur, even in patients taking lamotrigine for the treatment of bipolar disorders.

Precautions

A physician should be consulted before taking lamotrigine with certain non-prescription medications. Patients should avoid alcohol and CNS depressants (medications that make one drowsy or tired, such as antihistimines, sleep medications, and some pain medications), while taking lamotrigine. Lamotrigine can exacerbate the side effects of alcohol and some other medications. Alcohol may also increase the risk or frequency of seizures.

Lamotrigine may not be suitable for persons with a history of liver or kidney disease, depressed renal function, mental illness, anemia, high blood pressure, angina (chest pain), or irregular heartbeats and other heart problems. Before beginning treatment with lamotrigine, patients should notify their physician if they consume a large amount of alcohol, have a history of drug use, are nursing, pregnant, or plan to become pregnant.

Lamotrigine's safety during pregnancy has not been established. Persons taking lamotrigine (and other AEDs or anticonvulsants) should be aware that many AEDs and anticonvulsants cause birth defects. Patients who become pregnant while taking any AED or anticonvulsants should contact their physician immediately.

Side effects

Lamotrigine is generally well tolerated. However, in some patients, lamotrigine may produce some of the traditionally mild side effects associated with anticonvulsants. Headache, nausea, and unusual tiredness and weakness are the most frequently reported side effects of anticonvulsants. Other possible side effects that do not usually require medical attention include:

• mild coordination problems
• mild dizziness
• abdominal pain
• sinus pain
• sleepiness or sleeplessness
• diarrhea or constipation
• heartburn or indigestion
• aching joints and muscles or chills
• unpleasant taste in mouth or dry mouth

Many of these side effects disappear or occur less frequently during treatment as the body adjusts to the medication. However, if any symptoms persist or become too uncomfortable, the prescribing physician should be consulted.

Other, uncommon side effects of lamotrigine can be serious and may indicate an allergic reaction. Severe and potentially life-threatening rashes have occurred during treatment with lamotrigine, occurring approximately once in every 1,000 persons who take the drug. In the unusual event that this rash develops, it normally occurs within the first eight weeks of treatment. A patient taking lamotrigine who experiences any of the following symptoms should contact a physician immediately:

• rash or bluish patches on the skin
• sores in the mouth or around the eyes
• depression or suicidal thoughts
• mood or mental changes, including excessive fear, anxiety, hostility
• general loss of motor skills
• persistent lack of appetite
• altered vision
• difficulty breathing
• chest pain or irregular heartbeat
• faintness or loss of consciousness
• persistent, severe headaches
• persistent fever or pain

Interactions

Lamotrigine may have negative interactions with some antacids, antihistamines, antidepressants, antibiotics, and monoamine oxidase inhibitors (MAOIs). Other medications such as HIV protease inhibitors (indinavir), ritonavir (Norvir), ipratropium (Atrovent), isoniazid, phenobarbital (Luminal, Solfoton), nefazodone, metronidazole, acetazolamide (Diamox), propranolol (Inderal), rifampin (Rifadin, Rimactane), and warfarin may also adversely react with lamotrigine. Oral contraceptives (birth control pills) may decrease the amount of lamotrigine absorbed by the body.

Lamotrigine may be used with other seizure prevention medications, if advised by a physician.

Resources

BOOKS

Devinsky, Orrin, M. D., Epilepsy: Patient and Family Guide, 2nd ed. Philadelphia: F. A. Davis Co., 2001.

Weaver, Donald F. Epilepsy and Seizures: Everything You Need to Know. Toronto: Firefly Books, 2001.

OTHER

"Lamotrigine." Medline Plus. National Library of Medicine. May 6, 2004 (June 1, 2004). http://www.nlm.nih.gov/medlineplus/druginfo/uspdi/202786.html.

"Lamotrigine." Yale New Haven Health Service Drug Guide. May 6, 2004 (June 1, 2004). http://yalenewhavenhealth.org/library/healthguide/enus/drugguide/topic.asp?hwid=multumd03809a1.

ORGANIZATIONS

Epilepsy Foundation. 4351 Garden City Drive, Landover, MD 20785-7223. (800) 332-1000. http://www.epilepsyfoundation.org.

American Epilepsy Society. 342 North Main Street, West Hartford, CT 06117-2507. http://www.aesnet.org.

Adrienne Wilmoth Lerner

trade name: Lamictal; drug class: antiepileptic; action: may be result of blockage of voltage-dependent sodium channels with inhibition of excitatory amino acids; uses: adjunctive treatment of refractive partial seizures in adults.

Brand names: Lamictal®Lamictal® Chewable

Chemical formula:

Drug Forms:
• Lamotrigine Chewable tablet (below)
• Lamotrigine Oral tablet
• Lamotrigine Oral tablet, Lamotrigine Oral tablet
• Lamotrigine Oral disintegrating tablet
• Lamotrigine Oral disintegrating tablet, Lamotrigine Oral disintegrating tablet
• Lamotrigine Oral disintegrating tablet, Lamotrigine Oral disintegrating tablet, Lamotrigine Oral disintegrating tablet
• Lamotrigine Oral tablet, extended-release
• Lamotrigine Oral tablet, extended-release, Lamotrigine Oral tablet, extended-release
• Lamotrigine Oral tablet, extended-release, Lamotrigine Oral tablet, extended-release, Lamotrigine Oral tablet, extended-release

Español:
• Lamotrigina, Tableta masticable
• Lamotrigina, Tableta oral
• Lamotrigina Tableta oral, Lamotrigina Tableta oral
• Lamotrigina, Tableta que se desintegra por vía oral
• Lamotrigina Tableta que se desintegra por vía oral, Lamotrigina Tableta que se desintegra por vía oral
• Lamotrigina Tableta que se desintegra por vía oral, Lamotrigina Tableta que se desintegra por vía oral, Lamotrigina Tableta que se desintegra por vía oral,
• Lamotrigina, Tableta oral de liberación prolongada
• Lamotrigina, Tableta oral de liberación prolongada; Lamotrigina, Tableta oral de liberación prolongada,
• Lamotrigina, Tableta oral de liberación prolongada; Lamotrigina, Tableta oral de liberación prolongada; Lamotrigina, Tableta oral de liberación prolongada

Lamotrigine Chewable tablet

What is this medicine?

LAMOTRIGINE (la MOE tri jeen) is used to control seizures in adults and children with epilepsy and Lennox-Gastaut syndrome. It is also used in adults to treat bipolar disorder.
 
This medicine may be used for other purposes; ask your health care provider or pharmacist if you have questions.

What should I tell my health care provider before I take this medicine?

They need to know if you have any of these conditions:
•a history of depression or bipolar disorder
•folate deficiency
•kidney disease
•liver disease
•suicidal thoughts, plans, or attempt; a previous suicide attempt by you or a family member
•an unusual or allergic reaction to lamotrigine or other seizure medications, other medicines, foods, dyes, or preservatives
•pregnant or trying to get pregnant
•breast-feeding

How should I use this medicine?

Take this medicine by mouth. These tablets may be swallowed whole, chewed, mixed in water, or diluted in fruit juice to aid swallowing. Follow the directions on the prescription label. To mix the tablets in water or juice, add the tablets to a small amount of liquid (1 teaspoon or enough to cover the medicine) in a glass or spoon. The tablets will dissolve in about 1 minute. Once dissolved, mix or swirl the liquid and take the entire solution immediately. It is important that you swallow all of the liquid used to prepare the dose, so that the full prescribed dose is given. Take your doses at regular intervals. Do not take your medicine more often than directed.
 
A special MedGuide will be given to you by the pharmacist with each new prescription and refill. Be sure to read this information carefully each time.
 
Talk to your pediatrician regarding the use of this medicine in children. While this drug may be prescribed for children as young as 2 years for selected conditions, precautions do apply.
 
Overdosage: If you think you have taken too much of this medicine contact a poison control center or emergency room at once.
 
NOTE: This medicine is only for you. Do not share this medicine with others.

What may interact with this medicine?

•carbamazepine
•female hormones, including contraceptive or birth control pills
•methotrexate
•phenobarbital
•phenytoin
•primidone
•pyrimethamine
•rifampin
•trimethoprim
•valproic acid

This list may not describe all possible interactions. Give your health care provider a list of all the medicines, herbs, non-prescription drugs, or dietary supplements you use. Also tell them if you smoke, drink alcohol, or use illegal drugs. Some items may interact with your medicine.

What should I watch for while using this medicine?

Visit your doctor or health care professional for regular checks on your progress. If you take this medicine for seizures, wear a Medic Alert bracelet or necklace. Carry an identification card with information about your condition, medicines, and doctor or health care professional.
 
It is important to take this medicine exactly as directed. When first starting treatment, your dose will need to be adjusted slowly. It may take weeks or months before your dose is stable. You should contact your doctor or health care professional if your seizures get worse or if you have any new types of seizures. Do not stop taking this medicine unless instructed by your doctor or health care professional. Stopping your medicine suddenly can increase your seizures or their severity.
 
Contact your doctor or health care professional right away if you develop a rash while taking this medicine. Rashes may be very severe and sometimes require treatment in the hospital. Deaths from rashes have occurred. Serious rashes occur more often in children than adults taking this medicine. It is more common for these serious rashes to occur during the first 2 months of treatment, but a rash can occur at any time.
 
You may get drowsy, dizzy, or have blurred vision. Do not drive, use machinery, or do anything that needs mental alertness until you know how this medicine affects you. To reduce dizzy or fainting spells, do not sit or stand up quickly, especially if you are an older patient. Alcohol can increase drowsiness and dizziness. Avoid alcoholic drinks.
 
If you are taking this medicine for bipolar disorder, it is important to report any changes in your mood to your doctor or health care professional. If your condition gets worse, you get mentally depressed, feel very hyperactive or manic, have difficulty sleeping, or have thoughts of hurting yourself or committing suicide, you need to get help from your health care professional right away. If you are a caregiver for someone taking this medicine for bipolar disorder, you should also report these behavioral changes right away. The use of this medicine may increase the chance of suicidal thoughts or actions. Pay special attention to how you are responding while on this medicine.
 
Your mouth may get dry. Chewing sugarless gum or sucking hard candy, and drinking plenty of water may help. Contact your doctor if the problem does not go away or is severe.
 
Women who become pregnant while using this medicine may enroll in the North American Antiepileptic Drug Pregnancy Registry by calling 1-888-233-2334. This registry collects information about the safety of antiepileptic drug use during pregnancy.

What side effects may I notice from receiving this medicine?

Side effects you should report to your doctor or health care professional as soon as possible:
•allergic reactions like skin rash, itching or hives, swelling of the face, lips, or tongue
•blurred, or double vision
•difficulty walking or controlling muscle movements
•fever
•painful sores in the mouth, eyes, or nose
•redness, blistering, peeling or loosening of the skin, including inside the mouth
•severe muscle pain
•swollen lymph glands
•uncontrollable eye movements
•unusual bruising or bleeding
•unusually weak or tired
•worsening of mood, thoughts or actions of suicide or dying
•yellowing of the eyes or skin

Side effects that usually do not require medical attention (report to your doctor or health care professional if they continue or are bothersome):
•diarrhea, or constipation
•difficulty sleeping
•headache
•nausea, vomiting
•tremors

This list may not describe all possible side effects. Call your doctor for medical advice about side effects. You may report side effects to FDA at 1-800-FDA-1088.

Where should I keep my medicine?

Keep out of reach of children.

Store at room temperature between 15 and 30 degrees C (59 and 86 degrees F). Protect from light and moisture. Throw away any unused medicine after the expiration date.

Last updated: 7/1/2002

Important Disclaimer: The drug information provided here is for educational purposes only. It is intended to supplement, not substitute for, the diagnosis, treatment and advice of a medical professional. This drug information does not cover all possible uses, precautions, side effects and interactions. It should not be construed to indicate that this or any drug is safe for you. Consult your medical professional for guidance before using any prescription or over the counter drugs.

Lamotrigine
Systematic (IUPAC) name
6-(2,3-dichlorophenyl)-1,2,4-triazine-3,5-diamine
Identifiers
CAS number	84057-84-1
ATC code	N03AX09
PubChem	3878
DrugBank	APRD00570
ChemSpider	3741
Chemical data
Formula	C9H7Cl2N5
Mol. mass	256.091 g/mol
SMILES	eMolecules & PubChem
Pharmacokinetic data
Bioavailability	98%
Protein binding	55%
Metabolism	Hepatic (mostly UGT1A4-mediated)
Half life	24–34 hours (healthy adults)
Excretion	Renal
Therapeutic considerations
Pregnancy cat.	C(US)
Legal status	POM(UK) ℞-only(US)
Routes	Oral
Y(what is this?)  (verify)

Lamotrigine (marketed as Lamictal (pronounced /ləˈmɪktəl/) by GlaxoSmithKline, called Lamictin in South Africa, למוג'ין (Lamogine)^[1] 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 approved 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." ^[2] Lamotrigine is inactivated by hepatic glucuronidation.

Contents 1 U.S. Food and Drug Administration approval history 2 Therapeutic uses 2.1 Epilepsy and seizures 2.2 Bipolar disorder 2.3 Other uses 3 Mechanism of action 4 Pharmacokinetics 5 Side effects 5.1 Effects in women 5.2 Other types of effects 6 Availability 7 References 8 External links

U.S. Food and Drug Administration approval history

• December 1994 - Lamotrigine was approved for the treatment of partial seizures.^[3]
• 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 - Lamotrigine approved for maintenance treatment of Bipolar I disorder; the first since lithium.^[4]
• 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 seizures

Lamotrigine is approved in the US for the treatment of partial seizures.^[3] 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.^[5] 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.^[6]

Lamotrigine is also used as first line therapy for childhood absence epilepsy.

Bipolar disorder

Lamotrigine is approved in the US for maintenance treatment of Bipolar I disorder.^[7] While traditional anticonvulsant drugs are predominantly 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.^[8] 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.^{[citation needed]}

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.^{[citation needed]}

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.^{[citation needed]}

Other uses

Off-label uses include the treatment of peripheral neuropathy, trigeminal neuralgia, cluster headaches, migraines, and reducing neuropathic pain. ^[9][10][11] 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. ^[12]

Mechanism of action

One proposed mechanism of action for lamotrigine involves an effect on sodium channels,^[13] 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). ^[14]

Pharmacokinetics

The 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 effects

Lamotrigine prescribing information has a black box warning about life threatening skin reactions, including Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis.^[14] 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.

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, mouth ulcers, damage to tooth enamel, fatigue, memory and cognitive problems, irritability, weight changes, hair loss, changes in libido, frequent urination, nausea, appetite changes 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.

Effects in women

In clinical trials women were more likely than men to have side effects^{[citation needed]}. This is the opposite of most other anticonvulsants and antipsychotics.

There is evidence showing interactions between lamotrigine and female hormones, which can be of particular concern for women on estrogen-containing hormonal contraceptives. Ethinyl estradiol, the ingredient of such contraceptives, has been shown to decrease serum levels of lamotrigine^[15]. Women starting an estrogen-containing oral contraceptive may need to increase the dosage of lamotrigine to maintain its level of efficacy. Similarily, women may experience an increase in lamotrigine side effects upon discontinuation of the pill. This may include the "pill free" week where lamotrigine serum levels have been shown to increase two-fold^[14]. Another study showed a significant increase in follicle stimulating hormone (FSH) and luteinizing hormone (LH) in women taking lamotrigine with oral contraceptive compared to women taking oral contraceptives alone^[16]. However, these increases were not in conjunction with increased progesterone, indicating that oral contraceptives maintained suppression of ovulation^[16].

Use during pregnancy is recommended only if benefits outweigh potential risks. It was also reported on CNN in September 2006 that taking Lamictal during the first trimester of pregnancy can lead to a cleft palate in babies.^{[citation needed]} Lamotrigine is found in breast milk; breastfeeding is not recommended during treatment.

Lamotrigine can inhibit sleep. It is best taken in the morning.^{[citation needed]}

Other types of effects

Lamotrigine binds to melanin-containing tissues such as the iris of the eye. The long-term consequences of this are unknown.^[17]

Some patients have reported experiencing a loss of concentration, even with very small doses, while some others have actually reported an increase in alertness and concentration. GlaxoSmithKline investigated lamotrigine for the treatment of ADHD. The results were inconclusive. No detrimental effects on cognitive function were observed, however, the only statistical improvement in core ADHD symptoms was an improvement on a test, PASAT (Paced Auditory Serial Addition Test), that measures auditory processing speed and calculation ability.^[18]

Lamotrigine can induce a type of seizure known as a Myoclonic Jerk. When used in the treatment of myoclonic epilepsies such as Juvenile myoclonic epilepsy, lower doses (and lower plasma levels) are usually needed, as even moderate doses of this drug can lead to induction of seizures, including tonic-clonic seizures, which can develop into Status epilepticus (a medical emergency). It can also cause Myoclonic Status Epilepticus.

In overdose, Lamotrigine can cause uncontrolled seizures in most patients regardless of the reason they were prescribed the drug.

Availability

Lamictal 200 mg tablets

GlaxoSmithKline's trademarked brand of Lamotrigine, Lamictal, is manufactured in scored tablets (25 mg, 100 mg, 150 mg and 200 mg) and chewable dispersible tablets (2 mg, 5 mg and 25 mg). Five-week sample kits are also available; these include titration instructions and scored tablets (25 mg for patients taking valproate, 25 mg and 100 mg for patients not taking valproate). Lamotrigine is also available in un-scored tablet form. In 2005, Teva Pharmaceutical Industries Ltd. began selling generic Lamotrigine in the United States, but only in 5 mg and 25 mg chewable dispersible tablets.^[19] On 23 July 2008 Teva began offering the full line of generic Lamotrigine in the US.^[20] Lamotrigine is also available in generic form^[21] in the United States, the United Kingdom and Canada.

References

1. ^ anonymous (2007). "LAMOTRIGINE". www.drug.co.il. http://www.drug.co.il/bygeneric.asp?gen_id=775&drugID=7007&wel=. Retrieved 2008-04-14. 
2. ^ DRUG INFORMATION" Sheet, Copyright 2008, First DataBank, Inc. provided by Savon Pharmacy.
3. ^ ^{a b} anonymous (19 March 2004). "EFFICACY SUPPLEMENTS APPROVED IN CALENDAR YEAR 2003". FDA/Center for Drug Evaluation and Research. http://www.fda.gov/cder/rdmt/ESCY03AP.HTM. Retrieved 2008-04-09. 
4. ^ GlaxoSmithKline, 2003
5. ^ French, J.A. et al. (2004). Efficacy and tolerability of the new antiepileptic drugs II: Treatment of refractory epilepsy [electronic version]. Neurology. 62:1261–1273.
6. ^ Pellock, J.M. (1999). Managing pediatric epilepsy syndromes with new antiepileptic drugs [Special issue, electronic version]. Pediatrics. 104(5): 1106–1116.
7. ^ GlaxoSmithKline, 2003
8. ^ Goldsmith DR, Wagstaff AJ, Ibbotson T, Perry CM (2003). "Lamotrigine: a review of its use in bipolar disorder". Drugs 63 (19): 2029–50. PMID 12962521. 
9. ^ Backonja, M. (2004). Neuromodulating drugs for the symptomatic treatment of neuropathic pain. Cur Pain Headache Rep. 8(3):212–6
10. ^ Jensen, T.S. (2002). Anticonvulsants in neuropathic pain: rationale and clinical evidence. [Abstract]. Eur J Pain. 6 Suppl A:61–68.
11. ^ Pappagallo, M. (2003). Newer antiepileptic drugs: possible uses in the treatment of neuropathic pain and migraine. [Abstract]. Clin. Ther. 25(10):2506–38.
12. ^ Barbosa, L. Berk, M. Vorster, M. (2003). A double-blind, randomized, placebo-controlled trial of augmentation with lamotrigine or placebo in patients concomitantly treated with fluoxetine for resistant major depressive episodes. [Abstract]. J Clin Psychiatry. 64(4):403–407.
13. ^ Curia G, Biagini G, Perucca E, Avoli M (2009). "Lacosamide: a new approach to target voltage-gated sodium currents in epileptic disorders". CNS Drugs 23 (7): 555–68. PMID 19552484. 
14. ^ ^{a b c} anonymous (May 2007). "LAMICTAL PRESCRIBING INFORMATION" (PDF). GlaxoSmithKline.. http://us.gsk.com/products/assets/us_lamictal.pdf. Retrieved 2008-04-09. 
15. ^ Reimers A; Helde G, Brodtkorb E (September 2005). "Ethinyl estradiol, not progestogens, reduces lamotrigine serum concentrations". Epilepsia (Blackwell Science) 46 (9): 1414-7. PMID 16146436. 
16. ^ ^{a b} Sidhu J; Job S, Singh S, Philipson R (February 2006). "The pharmacokinetic and pharmacodynamic consequences of the co-administration of lamotrigine and a combined oral contraceptive in healthy female subjects.". Br J Clin Pharmacol. 61 (2): 191-9. PMID 16433873. 
17. ^ anonymous. "Lamictal, Warnings & Precautions". RxList Inc.. http://www.rxlist.com/cgi/generic/lamotrigine_wcp.htm. Retrieved 2008-04-09. 
18. ^ anonymous. "lamotrigine studies". GlaxoSmithKline. http://ctr.gsk.co.uk/Summary/lamotrigine/studylist.asp. Retrieved 2008-04-09. 
19. ^ anonymous (17 February 2005). "Press Release, Teva Announces Settlement Of Lamictal Litigation With Glaxosmithkline". Teva Pharmaceutical Industries Ltd.. http://www.tevapharm.com/pr/2005/pr_513.asp. Retrieved 2008-04-09. 
20. ^ http://www.tevapharm.com/pr/2008/pr_779.asp
21. ^ anonymous (2 March 2005). "Treatment for epilepsy: generic lamotrigine". Department of Health (UK). http://www.dh.gov.uk/en/Healthcare/Medicinespharmacyandindustry/Prescriptions/DH_4104966. Retrieved 2008-04-09. 

External links

• FAQ: Psychiatric Uses of Lamotrigine (Lamictal), by Ivan K. Goldberg, MD. Includes many references from the medical literature.
• Center for Drug Evaluation and Research: Lamictal - documents related to the FDA approval process, including medical reviews and correspondence letters.
• Epilepsy South Africa: MEDICATION FOR EPILEPSY - an Epilepsy FAQ with a list of medicines for treatment thereof, includes Lamotrigine with South African trade name Lamictin.
• Adverse Reactions - Reported adverse reactions and side effects.

v • d • e Anticonvulsants (N03) GABAA receptor agonist Barbiturates Barbexaclone · Metharbital · Methylphenobarbital · Pentobarbital · Phenobarbital · Primidone Benzodiazepines Clobazam · Clonazepam · Clorazepate · Diazepam · Flutoprazepam · Lorazepam · Midazolam · Nimetazepam · Nitrazepam · Temazepam Other GABA agents Aromatic allylic alcohols Stiripentol Carbonic anhydrase inhibitor Sulfa drugs Acetazolamide · Ethoxzolamide · Sultiame · Zonisamide Channel blockers Primarily sodium Hydantoins Ethotoin · Fosphenytoin · Mephenytoin · Phenytoin Carboxamides Carbamazepine · Eslicarbazepine acetate · Oxcarbazepine · Rufinamide Primarily calcium Succinimides Ethosuximide · Mesuximide · Phensuximide Unknown/ungrouped Phenyltriazines Lamotrigine Oxazolidinediones Ethadione · Paramethadione · Trimethadione Ureas Phenacemide · Pheneturide Monosaccharides Topiramate Indirect GABA agents Carboxylic acids/ Fatty acid derivatives GABA transaminase inhibitor: Valproic acid (Sodium valproate & Valproate semisodium) · Valpromide · Valnoctamide GABA reuptake inhibitor: Tiagabine GABA analogs Gabapentin · Pregabalin · Progabide · Vigabatrin Unknown/multiple/ unsorted Carbamates Emylcamate · Felbamate · Meprobamate · Carisbamate Pyrrolidines Brivaracetam · Levetiracetam · Nefiracetam · Seletracetam Propionates Beclamide · Lacosamide Aldehydes Paraldehyde Bromides Potassium bromide · Sodium bromide

v • d • e Mood disorder: Bipolar disorder History Emil Kraepelin · Karl Leonhard · John Cade · Mogens Schou · Frederick K. Goodwin · Kay Redfield Jamison Symptoms Hallucination · Delusion · Emotional dysregulation (Anhedonia, Dysphoria, Suicidal ideation) · sleep disorder (Hypersomnia, Insomnia) · Psychosis · Racing thoughts Spectrum Bipolar I · Bipolar II · Cyclothymia · Dysthymia · Major depressive disorder · Schizoaffective disorder Mania · Mixed state · Hypomania · Major depressive episode · Rapid cycling Treatment Anticonvulsants Carbamazepine · Gabapentin · Lamotrigine · Oxcarbazepine · Topiramate · Valproic acid (Sodium valproate, Valproate semisodium) Other mood stabilizers Lithium pharmacology (Lithium carbonate, Lithium citrate, Lithium sulfate) · Antipsychotics Non-pharmaceutical Clinical psychology · Electroconvulsive therapy · Involuntary commitment · Light therapy · Psychotherapy · Transcranial magnetic stimulation Related Affective spectrum · List of people affected by bipolar disorder · Bipolar disorder in children

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