All about Lamotrigine/Lamictin for non-psychiatrists

are psychiatric medications addictive?
Are Psychiatric Medications addictive?
19 Nov 2014
Show all

All about Lamotrigine/Lamictin for non-psychiatrists

Lamicitin is an antiepileptic which is registered for use for Bipolar Disorder 1- maintenance phase, and Epilepsy. It is commonly used by psychiatrists to treat Treatment-resistant depression, Bipolar Spectrum disorders and mood instability associated with Borderline Personality Disorder. Lamicitin works on voltage sensitive sodium channels and gated sodium and calcium channels / sigma opioid receptors.

What do you need to know about Lamicitin which your patients are taking?

Pros

  • Generally considered to be one the best drug on the market for Bipolar Disorder II, due to its antidepressant and mood stabiliser effect.
  • Weight neutral.
  • One of the safest meds to use during pregnancy.
  • The side effects are much less than the other meds with FDA approval for maintenance treatment of bipolar disorder.
  • Acts as an anti-depressant without risk of inducing mania ( although some patients may be still a bit activated when they start taking it)

Cons

  • Very complicated dosing structure and slow titration upwards average 25mg every 2 weeks) which results in in taking longer to start working properly. (Average dose in depression is about 100mg-200mg and Epilepsy between 200-400mg a day.) The reason for this slow titration is because of the RASH, which occurs more frequently when the dose is escalated too quickly.
  • The RASH – The most important side effect to be very aware of is a severe hypersensitivity reaction (Stevens – Johnson syndrome). This can be life threatening. It typically presents with flu-like symptoms and a rash. (Occurs in between 1/1000 and 1/10 000 people). It is most commonly found in the first 8 weeks, but can occur at any time.

What to do if your patient has a rash?

• Tell them to stop the medication immediately and seek medical advice.
• Benign rashes are common – but because of the risk that any rash could be very serious, most doctors would opt to stop the medication.
• A rechallenge of medication may be sometimes possible at a later stage under strict medical guidance.

Other Side Effects

Rash, insomnia, itchy skin, lethargy, photosensitivity, memory and cognitive problems, rashes, and headaches (when start or change dose). Muscle aches. Anxiety/hypomania symptoms. Avoid alcohol – increases toxicity. I