What are the indications for Lamotrigine (Lamictal)?

From the Guidelines

Lamotrigine is primarily indicated for the treatment of epilepsy and bipolar disorder, with specific approval for maintenance treatment to delay mood episodes in adults with bipolar I disorder, as well as for partial seizures, primary generalized tonic-clonic seizures, and seizures associated with Lennox-Gastaut syndrome in both adults and children. The medication works by inhibiting voltage-sensitive sodium channels and reducing the release of excitatory neurotransmitters like glutamate in the brain 1. When initiating lamotrigine, a slow titration schedule is essential to reduce the risk of serious rashes, including Stevens-Johnson syndrome. Typically, treatment begins at 25mg daily for two weeks, then 50mg daily for two weeks, with gradual increases thereafter until reaching the target dose (usually 100-200mg daily for bipolar disorder and 100-400mg daily for epilepsy) 1. This titration schedule must be even slower in patients taking valproate and can be faster in those on enzyme-inducing antiepileptics. Some key points to consider when using lamotrigine include:

• It is also used off-label for neuropathic pain, migraine prevention, and borderline personality disorder, though these uses aren't FDA-approved 1.
• The evidence for its use in neuropathic pain is mixed, with some studies suggesting it may be effective in certain cases, such as in patients with HIV-associated neuropathic pain, but others finding no significant benefit 1.
• It is not recommended for use in patients with a history of rash or intolerance, and caution should be exercised when using it in combination with other medications that may increase the risk of rash or other adverse effects 1. In summary, lamotrigine is a valuable treatment option for epilepsy and bipolar disorder, but its use should be carefully considered and monitored, particularly in patients with a history of rash or intolerance, and in combination with other medications.

From the Research

Lamotrigine Indications

• Lamotrigine is a broad-spectrum antiepileptic drug, initially approved for the adjunctive treatment of partial seizures in adults and for the generalized seizures of Lennox-Gastaut syndrome in pediatric and adult populations 2
• It is also used for the management of bipolar disorder type I, migraines, and neuropathic pain 2
• The drug has been shown to be effective in the treatment of various types of seizures, including:
  • Partial seizures 3, 4
  • Secondarily generalized tonic-clonic seizures 3, 4
  • Idiopathic generalized epilepsy 3
  • Absence seizures 5
  • Atonic seizures 5
  • Generalized tonic-clonic seizures 5
  • Myoclonic seizures 5
  • Lennox-Gastaut syndrome 2, 3, 5
• Lamotrigine is also used as monotherapy for the treatment of newly diagnosed epilepsy 3, 4

Patient Populations

• Lamotrigine has been shown to be effective in both adult and pediatric populations 2, 3, 5
• It has been used in patients with refractory epilepsy, as well as those with newly diagnosed epilepsy 3, 4
• The drug has also been used in patients with bipolar disorder, particularly those with a predominant depressive component 6

Dosage and Administration

• The dosage of lamotrigine varies depending on the patient population and the type of seizure being treated 3, 5
• The drug is typically started at a low dose and gradually increased to minimize the risk of adverse effects 3, 4
• The risk of skin rash can be minimized with slow titration of the drug and dose adjustment with concomitant medications 2, 3