THERAPEUTICS

Brands

• Lamictal, Lamictin

Generic?

• Yes

Class

• Antiepileptic drug (AED)

Commonly Prescribed for

(FDA approved in bold)

• Adjunctive therapy in patients ≥ 2 years of age: partial seizure, primary generalized tonic-clonic seizures, Lennox-Gastaut syndrome

• Conversion to monotherapy for partial seizures in patients ≥ 16 years of age

• Maintenance of bipolar II disorder in patients ≥ 18 years of age

• Generalized tonic-clonic seizures including juvenile myoclonic epilepsy

• Absence seizures (children and adults)

• Temporal lobe epilepsy (children and adults)

• Migraine with aura

• SUNCT (short-lasting unilateral neuralgiform headache with conjunctival injection and tearing)

• Post-stroke pain

• Trigeminal neuralgia

• Bipolar depression or mania

• Psychosis/schizophrenia (adjunctive)

• Obesity

How the Drug Works

• Inhibits voltage-sensitive sodium channels and calcium (N, P/Q, R, T types) channels

• Suppresses NMDA, AMPA receptors and GABAA receptors

• Weakly inhibits serotonin 5-HT3 receptors

How Long Until It Works

• Seizures: should decrease by 2 weeks at a specific dose, but slow titration can delay time to effective dose

• Headaches: weeks to months

• Mania: may take weeks to months

If It Works

• Seizures: goal is the remission of seizures. Continue as long as effective and well tolerated. Consider tapering and slowly stopping after 2 years without seizures, depending on the type of epilepsy

• Headache: goal is a 50% or greater decrease in frequency or severity of pain or aura

If It Doesn't Work

• Increase to highest tolerated dose

• Epilepsy: consider changing to another agent, adding a second agent, using a medical device, or a referral for epilepsy surgery evaluation. When adding a second agent, keep drug interactions in mind

• Headache: if not effective in 2 months, consider stopping or using another agent

Best Augmenting Combos for Partial Response or Treatment-Resistance

• Epilepsy: drug interactions complicate multi-drug therapy. Increase dose if using with enzyme-inducing drugs and lower when using with valproate. May be particularly effective in combination with valproate