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Lamictal
lamotrigine
Black Box Warnings .
Serious Rash
serious rashes requiring hospitalization and D/C tx including Stevens-Johnson syndrome, incidence 0.3-0.8% in 2-17 yo and 0.08%-0.3% in adults, and rare cases of toxic epidermal necrolysis and rash-related deaths; factors that may increase risk of occurrence or severity of rash include age, concurrent valproate use, exceeding initial lamotrigine dose or dose escalation recommendations, or presence of HLA-B*15:02 allele; cases have occurred in absence of these factors; most life-threatening rashes occur within 2-8wk of tx initiation with isolated cases after prolonged tx; duration of therapy not reliable means to predict potential risk; though benign rashes may also occur, D/C tx at 1st sign of rash unless clearly not drug related; D/C tx may not prevent rash from becoming life-threatening or permanently disabling or disfiguring
Adult Dosing .
Dosage forms: TAB: 25 mg, 100 mg, 150 mg, 200 mg; TAB (5-wk blue starter pack): 25 mg x35; TAB (5-wk green starter pack): 25 mg x84 and 100 mg x14; TAB (5-wk orange starter pack): 25 mg x42 and 100 mg x7; CHEWABLE: 2 mg, 5 mg, 25 mg
bipolar I disorder, maintenance tx
- [patients taking valproate]
- Dose: 100 mg PO qd; Start: blue starter pack (25 mg PO qod x2wk, then 25 mg PO qd x2wk, then 50 mg PO qd x1wk); Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; periodically reassess need for tx after 16wk; see pkg insert for dose adjustment if D/C valproate; taper dose over >2wk to D/C
- [patients taking enzyme-inducing AED]
- Dose: up to 200 mg PO bid; Start: green starter pack (50 mg PO qd x2wk, then 50 mg PO bid x2wk, then 100 mg PO bid x1wk), then 150 mg PO bid x1wk; Info: enzyme-inducing AEDs including carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; periodically reassess need for tx after 16wk; see pkg insert for dose adjustment if D/C enzyme-inducing AED; taper dose over >2wk to D/C
- [patients not taking valproate or enzyme-inducing AED]
- Dose: 200 mg PO qd; Start: orange starter pack (25 mg PO qd x2wk, then 50 mg PO qd x2wk, then 100 mg PO qd x1wk); Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; periodically reassess need for tx after 16wk; taper dose over >2wk to D/C
partial seizures
- [valproate adjunct]
- Dose: 100-200 mg/day PO divided qd-bid with valproate alone; 100-400 mg/day PO divided qd-bid with valproate and enzyme-inducing AED; Start: blue starter pack (25 mg PO qod x2wk, then 25 mg PO qd x2wk, then 50 mg PO qd x1wk), then incr. by 25-50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C
- [enzyme-inducing AED adjunct]
- Dose: 150-250 mg PO bid; Start: green starter pack (50 mg PO qd x2wk, then 50 mg PO bid x2wk, then 100 mg PO bid x1wk), then incr. by 100 mg/day q1-2wk; Info: enzyme-inducing AEDs including carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C
- [non-valproate, non-enzyme inducing AED adjunct]
- Dose: 225-375 mg/day PO divided bid; Start: orange starter pack (25 mg PO qd x2wk, then 50 mg PO qd x2wk, then 100 mg PO qd x1wk), then incr. by 50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C
- [conversion from valproate or enzyme-inducing AED monotherapy]
- Dose: 250 mg PO bid; Start: see pkg insert for titration schedule; Info: for conversion to lamotrigine monotherapy; not for initial monotherapy; enzyme-inducing AEDs including carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C
seizures, Lennox-Gastaut syndrome
- [valproate adjunct]
- Dose: 100-200 mg/day PO divided qd-bid with valproate alone; 100-400 mg/day PO divided qd-bid with valproate and enzyme-inducing AED; Start: blue starter pack (25 mg PO qod x2wk, then 25 mg PO qd x2wk, then 50 mg PO qd x1wk), then incr. by 25-50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C
- [enzyme-inducing AED adjunct]
- Dose: 150-250 mg PO bid; Start: green starter pack (50 mg PO qd x2wk, then 50 mg PO bid x2wk, then 100 mg PO bid x1wk), then incr. by 100 mg/day q1-2wk; Info: enzyme-inducing AEDs including carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C
- [non-valproate, non-enzyme inducing AED adjunct]
- Dose: 225-375 mg/day PO divided bid; Start: orange starter pack (25 mg PO qd x2wk, then 50 mg PO qd x2wk, then 100 mg PO qd x1wk), then incr. by 50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C
seizures, primary generalized tonic clonic
- [valproate adjunct]
- Dose: 100-200 mg/day PO divided qd-bid with valproate alone; 100-400 mg/day PO divided qd-bid with valproate and enzyme-inducing AED; Start: blue starter pack (25 mg PO qod x2wk, then 25 mg PO qd x2wk, then 50 mg PO qd x1wk), then incr. by 25-50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C
- [enzyme-inducing AED adjunct]
- Dose: 150-250 mg PO bid; Start: green starter pack (50 mg PO qd x2wk, then 50 mg PO bid x2wk, then 100 mg PO bid x1wk), then incr. by 100 mg/day q1-2wk; Info: enzyme-inducing AEDs including carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C
- [non-valproate, non-enzyme inducing AED adjunct]
- Dose: 225-375 mg/day PO divided bid; Start: orange starter pack (25 mg PO qd x2wk, then 50 mg PO qd x2wk, then 100 mg PO qd x1wk), then incr. by 50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C
short-lasting unilateral neuralgiform headache attacks prophylaxis (off-label)
- [150-200 mg PO bid]
- Start: 25 mg PO qd x1wk, may incr. by 25-50 mg/day qwk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C
neuropathic pain, diabetic (off-label)
- [100-200 mg PO bid]
- Start: 25 mg PO qd x2wk, then 50 mg/day PO divided qd-bid x2wk, then may incr. by up to 100 mg/day qwk; Info: retitrate if tx interrupted for >5 half-lives; dose adjustment may be needed during pregnancy and/or postpartum; taper dose over >2wk to D/C
renal dosing
- [see below]
- CrCl 10-50: decr. usual dose by 25%; CrCl <10: 100 mg qod
- HD: 100 mg x1 after each dialysis; no supplement; PD: 100 mg qod; supplement not defined
hepatic dosing
- [adjust dose amount]
- moderate-severe impairment without ascites: decr. usual dose by 25%; severe impairment with ascites: decr. usual dose by 50%
Peds Dosing .
- Dosage forms: TAB: 25 mg, 100 mg, 150 mg, 200 mg; TAB (5-wk blue starter pack): 25 mg x35; TAB (5-wk green starter pack): 25 mg x84 and 100 mg x14; TAB (5-wk orange starter pack): 25 mg x42 and 100 mg x7; CHEWABLE: 2 mg, 5 mg, 25 mg
partial seizures
- [valproate adjunct, 2-12 yo, 6.8-13.9 kg]
- Dose: 1-3 mg/kg/day PO divided qd-bid with valproate alone; 1-5 mg/kg/day PO divided qd-bid with valproate and other AEDs; Start: 2 mg PO qod x2wk, then 2 mg PO qd x2wk, then incr. by 0.3 mg/kg/day q1-2wk; Max: 200 mg/day; Info: round dose down to nearest whole tab size; oral suspension not available for this brand, see other lamotrigine products; up to 50% higher maintenance dose may be needed; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
- [valproate adjunct, 2-12 yo, >14 kg]
- Dose: 1-3 mg/kg/day PO divided qd-bid with valproate alone; 1-5 mg/kg/day PO divided qd-bid with valproate and other AEDs; Start: 0.15 mg/kg/day PO divided qd-bid x2wk, then 0.3 mg/kg/day PO divided qd-bid x2wk, then incr. by 0.3 mg/kg/day q1-2wk; Max: 200 mg/day; Info: round dose down to nearest whole tab size; oral suspension not available for this brand, see other lamotrigine products; patients <30 kg may need up to 50% higher maintenance dose; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
- [valproate adjunct, >12 yo]
- Dose: 100-200 mg/day PO divided qd-bid with valproate alone; 100-400 mg/day PO divided qd-bid with valproate and enzyme-inducing AED; Start: blue starter pack (25 mg PO qod x2wk, then 25 mg PO qd x2wk, then 50 mg PO qd x1wk), then incr. by 25-50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
- [enzyme-inducing AED adjunct, 2-12 yo]
- Dose: 5-15 mg/kg/day PO divided bid; Start: 0.6 mg/kg/day PO divided bid x2wk, then 1.2 mg/kg/day PO divided bid x2wk, then incr. by 1.2 mg/kg/day q1-2wk; Max: 400 mg/day; Info: enzyme-inducing AEDs including carbamazepine, phenytoin, phenobarbital, primidone; round dose down to nearest whole tab size; oral suspension not available for this brand, see other lamotrigine products; patients <30 kg may need up to 50% higher maintenance dose; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
- [enzyme-inducing AED adjunct, >12 yo]
- Dose: 150-250 mg PO bid; Start: green starter pack (50 mg PO qd x2wk, then 50 mg PO bid x2wk, then 100 mg PO bid x1wk), then incr. by 100 mg/day q1-2wk; Info: enzyme-inducing AEDs including carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
- [non-valproate, non-enzyme inducing AED adjunct, 2-12 yo]
- Dose: 4.5-7.5 mg/kg/day PO divided bid; Start: 0.3 mg/kg/day PO divided qd-bid x2wk, then 0.6 mg/kg/day PO divided bid x2wk, then incr. by 0.6 mg/kg/day q1-2wk; Max: 300 mg/day; Info: round dose down to nearest whole tab size; oral suspension not available for this brand, see other lamotrigine products; patients <30 kg may need up to 50% higher maintenance dose; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
- [non-valproate, non-enzyme inducing AED adjunct, >12 yo]
- Dose: 225-375 mg/day PO divided bid; Start: orange starter pack (25 mg PO qd x2wk, then 50 mg PO qd x2wk, then 100 mg PO qd x1wk), then incr. by 50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
- [conversion from valproate or enzyme-inducing AED monotherapy, 16 yo and older]
- Dose: 250 mg PO bid; Start: see pkg insert for titration schedule; Info: for conversion to lamotrigine monotherapy; not for initial monotherapy; enzyme-inducing AEDs including carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
seizures, Lennox-Gastaut syndrome
- [valproate adjunct, 2-12 yo, 6.8-13.9 kg]
- Dose: 1-3 mg/kg/day PO divided qd-bid with valproate alone; 1-5 mg/kg/day PO divided qd-bid with valproate and other AEDs; Start: 2 mg PO qod x2wk, then 2 mg PO qd x2wk, then incr. by 0.3 mg/kg/day q1-2wk; Max: 200 mg/day; Info: round dose down to nearest whole tab size; oral suspension not available for this brand, see other lamotrigine products; up to 50% higher maintenance dose may be needed; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
- [valproate adjunct, 2-12 yo, >14 kg]
- Dose: 1-3 mg/kg/day PO divided qd-bid with valproate alone; 1-5 mg/kg/day PO divided qd-bid with valproate and other AEDs; Start: 0.15 mg/kg/day PO divided qd-bid x2wk, then 0.3 mg/kg/day PO divided qd-bid x2wk, then incr. by 0.3 mg/kg/day q1-2wk; Max: 200 mg/day; Info: round dose down to nearest whole tab size; oral suspension not available for this brand, see other lamotrigine products; patients <30 kg may need up to 50% higher maintenance dose; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
- [valproate adjunct, >12 yo]
- Dose: 100-200 mg/day PO divided qd-bid with valproate alone; 100-400 mg/day PO divided qd-bid with valproate and enzyme-inducing AED; Start: blue starter pack (25 mg PO qod x2wk, then 25 mg PO qd x2wk, then 50 mg PO qd x1wk), then incr. by 25-50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
- [enzyme-inducing AED adjunct, 2-12 yo]
- Dose: 5-15 mg/kg/day PO divided bid; Start: 0.6 mg/kg/day PO divided bid x2wk, then 1.2 mg/kg/day PO divided bid x2wk, then incr. by 1.2 mg/kg/day q1-2wk; Max: 400 mg/day; Info: enzyme-inducing AEDs including carbamazepine, phenytoin, phenobarbital, primidone; round dose down to nearest whole tab size; oral suspension not available for this brand, see other lamotrigine products; patients <30 kg may need up to 50% higher maintenance dose; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
- [enzyme-inducing AED adjunct, >12 yo]
- Dose: 150-250 mg PO bid; Start: green starter pack (50 mg PO qd x2wk, then 50 mg PO bid x2wk, then 100 mg PO bid x1wk), then incr. by 100 mg/day q1-2wk; Info: enzyme-inducing AEDs including carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
- [non-valproate, non-enzyme inducing AED adjunct, 2-12 yo]
- Dose: 4.5-7.5 mg/kg/day PO divided bid; Start: 0.3 mg/kg/day PO divided qd-bid x2wk, then 0.6 mg/kg/day PO divided bid x2wk, then incr. by 0.6 mg/kg/day q1-2wk; Max: 300 mg/day; Info: round dose down to nearest whole tab size; oral suspension not available for this brand, see other lamotrigine products; patients <30 kg may need up to 50% higher maintenance dose; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
- [non-valproate, non-enzyme inducing AED adjunct, >12 yo]
- Dose: 225-375 mg/day PO divided bid; Start: orange starter pack (25 mg PO qd x2wk, then 50 mg PO qd x2wk, then 100 mg PO qd x1wk), then incr. by 50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
seizures, primary generalized tonic clonic
- [valproate adjunct, 2-12 yo, 6.8-13.9 kg]
- Dose: 1-3 mg/kg/day PO divided qd-bid with valproate alone; 1-5 mg/kg/day PO divided qd-bid with valproate and other AEDs; Start: 2 mg PO qod x2wk, then 2 mg PO qd x2wk, then incr. by 0.3 mg/kg/day q1-2wk; Max: 200 mg/day; Info: round dose down to nearest whole tab size; oral suspension not available for this brand, see other lamotrigine products; up to 50% higher maintenance dose may be needed; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
- [valproate adjunct, 2-12 yo, >14 kg]
- Dose: 1-3 mg/kg/day PO divided qd-bid with valproate alone; 1-5 mg/kg/day PO divided qd-bid with valproate and other AEDs; Start: 0.15 mg/kg/day PO divided qd-bid x2wk, then 0.3 mg/kg/day PO divided qd-bid x2wk, then incr. by 0.3 mg/kg/day q1-2wk; Max: 200 mg/day; Info: round dose down to nearest whole tab size; oral suspension not available for this brand, see other lamotrigine products; patients <30 kg may need up to 50% higher maintenance dose; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
- [valproate adjunct, >12 yo]
- Dose: 100-200 mg/day PO divided qd-bid with valproate alone; 100-400 mg/day PO divided qd-bid with valproate and enzyme-inducing AED; Start: blue starter pack (25 mg PO qod x2wk, then 25 mg PO qd x2wk, then 50 mg PO qd x1wk), then incr. by 25-50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
- [enzyme-inducing AED adjunct, 2-12 yo]
- Dose: 5-15 mg/kg/day PO divided bid; Start: 0.6 mg/kg/day PO divided bid x2wk, then 1.2 mg/kg/day PO divided bid x2wk, then incr. by 1.2 mg/kg/day q1-2wk; Max: 400 mg/day; Info: enzyme-inducing AEDs including carbamazepine, phenytoin, phenobarbital, primidone; round dose down to nearest whole tab size; oral suspension not available for this brand, see other lamotrigine products; patients <30 kg may need up to 50% higher maintenance dose; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
- [enzyme-inducing AED adjunct, >12 yo]
- Dose: 150-250 mg PO bid; Start: green starter pack (50 mg PO qd x2wk, then 50 mg PO bid x2wk, then 100 mg PO bid x1wk), then incr. by 100 mg/day q1-2wk; Info: enzyme-inducing AEDs including carbamazepine, phenytoin, phenobarbital, primidone; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
- [non-valproate, non-enzyme inducing AED adjunct, 2-12 yo]
- Dose: 4.5-7.5 mg/kg/day PO divided bid; Start: 0.3 mg/kg/day PO divided qd-bid x2wk, then 0.6 mg/kg/day PO divided bid x2wk, then incr. by 0.6 mg/kg/day q1-2wk; Max: 300 mg/day; Info: round dose down to nearest whole tab size; oral suspension not available for this brand, see other lamotrigine products; patients <30 kg may need up to 50% higher maintenance dose; retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
- [non-valproate, non-enzyme inducing AED adjunct, >12 yo]
- Dose: 225-375 mg/day PO divided bid; Start: orange starter pack (25 mg PO qd x2wk, then 50 mg PO qd x2wk, then 100 mg PO qd x1wk), then incr. by 50 mg/day q1-2wk; Info: retitrate if tx interrupted for >5 half-lives; taper dose over >2wk to D/C
renal dosing
- [adjust dose amount]
- CrCl <10: decr. usual dose by 50%
- HD: decr. usual dose by 50%; supplement after dialysis not defined; PD: decr. usual dose by 50%; supplement not defined
hepatic dosing
- [adjust dose amount]
- moderate-severe impairment without ascites: decr. usual dose by 25%; severe impairment with ascites: decr. usual dose by 50%
Contraindications / Cautions .
- hypersensitivity to drug or ingredient
- abrupt withdrawal
- caution: hypersensitivity to antiepileptics
- caution: peds patients
- caution: pregnancy
- caution: Asian patients (incr. prevalence of HLA-B*15:02 allele)
- caution: HLA-B*15:02 allele carriers
- caution: CrCl <50 (IR form)
- caution: renal impairment, significant (ER form)
- caution: hepatic impairment, moderate-severe
- caution: heart failure
- caution: valvular heart disease
- caution: heart disease, congenital
- caution: cardiac conduction disturbance
- caution: ventricular arrhythmia
- caution: cardiac sodium channelopathy
- caution: Brugada syndrome
- caution: ischemic heart disease
- caution: CAD risk
- caution: suicide risk
- caution: PKU (phenylalanine-containing form)
Drug Interactions .
Overview
lamotrigine
sodium channel blocker
- UGT1A4 substrate
- UGT2B7 substrate
- OCT2 inhibitor
- affected by altered fat absorption
- antiepileptic agent
- bradycardia
- CNS depression
- delays atrioventricular conduction
- hyponatremia
- caution advised with other sodium channel blockers; combo may increase risk of ECG changes, cardiac arrhythmias; additive effects
Contraindicated
- amifampridine
- bupropion
- dalfampridine
Avoid/Use Alternative
- brigatinib
- butalbital
- ceritinib
- clonidine
- codeine
- crizotinib
- dofetilide
- doxylamine
- ethanol (alcoholic beverage)
- ethanol injection
- etrasimod
- fexinidazole
- fingolimod
- ginkgo
- haloperidol
- hydrocodone
- isocarboxazid
- kava
- kratom
- landiolol
- lofexidine
- metaxalone
- metoclopramide
- midazolam
- oxybate
- ozanimod
- phenelzine
- ponesimod
- promethazine
- ropeginterferon alfa-2b
- scopolamine
- siponimod
- thalidomide
- tradipitant
- tranylcypromine
- trimethobenzamide
- zuranolone
Monitor/Modify Tx
- acebutolol
- adenosine
- aldesleukin
- alectinib
- alfentanil
- alprazolam
- amiodarone
- apraclonidine ophthalmic
- arsenic trioxide
- articaine
- atazanavir
- atenolol
- baclofen intrathecal
- betaxolol
- betaxolol ophthalmic
- bisoprolol
- bupivacaine
- bupivacaine liposomal
- buprenorphine
- butorphanol
- carbamazepine
- carteolol ophthalmic
- carvedilol
- cenobamate
- chlordiazepoxide
- chloroprocaine
- chlorpromazine
- clobazam
- clonazepam
- clorazepate
- clozapine
- daridorexant
- desflurane
- desmopressin
- dexmedetomidine
- dexmedetomidine injection
- diazepam
- digoxin
- dihydrocodeine
- diltiazem
- disopyramide
- donepezil
- dronedarone
- droperidol
- dulaglutide
- eliglustat
- ensartinib
- esketamine
- esmolol
- estazolam
- estetrol (contraceptive)
- estradiol (contraceptive)
- estradiol (hormone replacement)
- estrogens, conjugated (hormone replacement)
- estrogens, esterified (hormone replacement)
- eszopiclone
- ethanol (in some formulations)
- ethinyl estradiol (contraceptive)
- ethinyl estradiol (hormone replacement)
- etomidate
- etripamil nasal
- fentanyl
- flecainide
- fluconazole
- fluphenazine
- flurazepam
- fosphenytoin
- gabapentin
- gabapentin enacarbil
- gadobenate dimeglumine
- galantamine
- guanfacine
- hydromorphone
- hydroxyzine
- ifosfamide
- isoflurane
- ivabradine
- ketamine
- labetalol
- lacosamide
- lanreotide
- lemborexant
- levobunolol ophthalmic
- levorphanol
- lidocaine
- lopinavir/ritonavir
- lorazepam
- lorlatinib
- mefloquine
- meperidine
- mepivacaine
- metformin
- methadone
- methohexital
- metoprolol
- midodrine
- mirtazapine
- morphine
- nadolol
- nalbuphine
- nebivolol
- nelarabine
- nelfinavir
- neostigmine
- octreotide
- olanzapine
- oliceridine
- opicapone
- opium
- oxazepam
- oxybutynin
- oxycodone
- oxymorphone
- paltusotine
- pasireotide
- pentazocine
- pentobarbital
- perphenazine
- phenobarbital
- phenytoin
- pindolol
- praziquantel
- pregabalin
- primidone
- probenecid
- procainamide
- propafenone
- propofol
- propranolol
- pyridostigmine
- quazepam
- quinidine (antiarrhythmic)
- quinine
- regadenoson
- remifentanil
- remimazolam
- rifampin
- ritonavir
- rivastigmine
- ropivacaine
- sevoflurane
- sotalol
- succinylcholine
- sufentanil
- sugammadex
- suvorexant
- tapentadol
- temazepam
- thioridazine
- thiothixene
- ticagrelor
- timolol
- timolol ophthalmic
- tramadol
- triazolam
- valproic acid
- vasopressin
- verapamil
- zaleplon
- ziconotide
- zolpidem
Caution Advised
- 5-HTP
- acetaminophen
- acyclovir
- allopurinol
- almotriptan
- amantadine
- aminophylline
- amitriptyline
- amoxapine
- amoxicillin
- amphetamine
- ampicillin
- apalutamide
- apomorphine
- aripiprazole bimonthly injection
- aripiprazole lauroxil
- aripiprazole monthly injection
- aripiprazole oral
- asenapine
- axicabtagene ciloleucel
- baclofen
- benzphetamine
- betamethasone
- brexpiprazole
- brexucabtagene autoleucel
- brimonidine ophthalmic
- brimonidine topical
- brivaracetam
- bromocriptine
- brompheniramine
- buspirone
- busulfan
- cannabidiol
- cannabis
- carbinoxamine
- cariprazine
- carisoprodol
- cefazolin
- cefepime
- cefiderocol
- ceftaroline
- ceftazidime
- ceftobiprole
- cetirizine
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Adverse Reactions .
Serious Reactions
- rash, severe
- Stevens-Johnson syndrome
- toxic epidermal necrolysis
- angioedema
- hypersensitivity reaction, severe or life-threatening
- drug reaction with eosinophilia and systemic symptoms
- hemophagocytic lymphohistiocytosis
- blood dyscrasia
- status epilepticus
- withdrawal seizures if abrupt D/C
- aseptic meningitis
- hepatic failure
- suicidality
- depression exacerbation
- tubulointerstitial nephritis
- arrhythmia risk
Common Reactions
- dizziness
- diplopia
- headache
- ataxia
- nausea
- blurred vision
- vomiting
- somnolence
- fever
- URI symptoms
- rash
- diarrhea
- insomnia
- tremor
- pain
- influenza-like symptoms
- asthenia
- dysmenorrhea
- impaired coordination
- dyspepsia
- xerostomia
- constipation
- depression
- anorexia
- anxiety
- irritability
- vaginitis
- emotional lability
- seizures
- speech disturbance
- visual disturbance
- UTI
- vertigo
- pruritus
- impaired concentration
- hot flashes
- nystagmus
- photosensitivity
- amenorrhea
- edema
- lymphadenopathy
- rectal hemorrhage
- peptic ulcer
- amnesia
- hypesthesia
- epistaxis
- xeroderma
- diaphoresis
Safety/Monitoring .
Monitoring Parameters
Cr at baseline; CBC; signs/symptoms of depression, suicidality, and/or unusual behavior changes; consider ECG at baseline in patients >60 yo or patients <60 yo with cardiac disease or risk, then consider repeat ECG at target dose or serum level
Look/Sound-Alike Drug Names
LaMICtal confused with: Geocillin; labetalol; Lactinex; LamISIL; Lomotil; Loxitane; Ludiomil
lamoTRIgine confused with: labetalol; lamiVUDine; levETIRAcetam; levothyroxine
Pregnancy/Lactation .
Pregnancy
Clinical Summary
weigh risk/benefit during pregnancy; dose adjustment may be needed during pregnancy and/or postpartum; possible risk of teratogenicity based on conflicting human data; risk of neurodevelopmental delay not expected based on limited human data; possible risk of decr. drug levels, efficacy in pregnant patients
Pregnancy Registry
encourage patients to enroll in North American Antiepileptic Drug Pregnancy Registry at 1-888-233-2334 or www.aedpregnancyregistry.org
Lactation
Clinical Summary
Seizure Disorder Use: benefits of breastfeeding and AED tx outweigh risks while breastfeeding, consider monitoring infant lamotrigine levels; low risk of infant harm, including CNS depression, apnea, rash, and poor weight gain, based on human data; no human data available to assess effects on milk production
All Other Uses: weigh risk/benefit while breastfeeding, consider monitoring infant lamotrigine levels; low risk of infant harm, including CNS depression, apnea, rash, and poor weight gain, based on human data; no human data available to assess effects on milk production
Pharmacology .
Metabolism: for lamotrigine: liver; CYP450: none; UGT: 1A4 (major), 2B7 substrate; Info: may induce own metabolism as monotherapy
Excretion: for lamotrigine: urine 94% (10% unchanged), feces 2%; Half-life: 32.8h (single dose), 25.4h (multiple dose), 12.6-14.4h (with enzyme-inducing AED), 58.8h (with valproate), 27.2h (with enzyme-inducing AED and valproate)
Subclass: Bipolar Disorder ; Headache/Migraine ; Neuropathy/Neuralgia ; Seizure Disorders
Mechanism of Action
for lamotrigine: exact mechanism of action unknown; inhibits voltage-dependent sodium channels, decreasing presynaptic glutamate and aspartate release
Formulary .
No Formulary Selected
Manufacturer/Pricing .
Manufacturer: GlaxoSmithKline
DEA/FDA: Rx
Retail Price
Estimated prices only. For current pricing, visit GoodRx.
oral tablet:
- 25 mg (60 ea): $855.00
- 100 mg (60 ea): $975.00
- 150 mg (30 ea): $539.00
- 200 mg (30 ea): $586.00
oral tablet, dispersible:
- 5 mg (56 ea): $773.00
- 25 mg (240 ea): $3,522.00
oral tablet:
- 25 mg and 100 mg (1 green kit, 98 tablets): $1,418.00
oral tablet:
- 25 mg and 100 mg (1 orange kit, 49 tablets): $714.00
oral tablet:
- 25 mg (1 blue kit, 35 tablets): $503.00
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