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Lamictal® (Lamotrigine)

Lamictal® or Lamotrigine is one of the newer anti-epileptic drugs (AEDs) which is considered broad spectrum. This means it is effective in both partial-onset and generalized-onset epilepsy. Like many other AEDs, it is thought to inhibit sodium (Na) channels. It also appears to reduce glutamate release, an excitatory neurotransmitter. Lamictal is available in tablets of various sizes including smaller sizes that are chewable are available for children. It is dosed twice daily.

Lamictal® has one uncommon, serious potential side effect of skin rash which seems to be most closely related with the rate of increase of the medication. This side effect dictates that the rate of medication be raised slowly over time. It can take a few months to get a patient on their final dose of Lamictal. In addition, Lamictal® has significant drug interactions with many other AEDs therefore, its rate of administration must be individualized based upon the type of medication the patient is already taking. Dr. Loftus is aware of one case report where Lamictal® apparently caused severe bone marrow suppression. While it does not appear to interfere with birth control medications, its safety in pregnancy is unknown. Early data suggests it is at least as safe as the older AEDs. This is actually more information than the medical community has for many of the newer antiepileptic medications. It has clearly been shown to not affect weight and it does not appear to have any cosmetic side effectsAs an AED, it is a highly effective treatment medication. Because it is a broad spectrum medication, and because it does not interfere with birth control pills or with other medications, it is an excellent AED if there is time to allow it to rise to a desirable serum level. Guidelines by the American Academy of Neurology support Lamictal's use in new onset partial epilepsy in adults and children, newly diagnosed Absence Seizures, and its use in monothearpy.

Other Uses

Lamictal® is also being used to treat neuropathic pain. Multiple small studies have demonstrated that it is useful in this area.Lamictal® is also being used for prevention of migraines. Multiple small studies have shown it is useful but large scale placebo controlled trials are not currently available for this treatment. Lamictal® is also used by psychiatrists and is expected to be approved soon for bipolar disease.