What is the use of Lamictal (lamotrigine)?

From the Guidelines

Lamictal (lamotrigine) is a recommended treatment option for bipolar disorder, particularly for bipolar depression, due to its efficacy and favorable side effect profile, as supported by the most recent evidence 1.

Key Points

• The typical starting dose for adults with bipolar disorder is 25mg daily for two weeks, then 50mg daily for two weeks, gradually increasing to a target dose of 100-200mg daily.
• Lamictal must be started at a low dose and increased slowly to reduce the risk of serious skin rashes, including Stevens-Johnson syndrome, which occurs in approximately 0.1% of patients.
• Common side effects include headache, dizziness, double vision, and nausea.
• Lamictal works by inhibiting voltage-sensitive sodium channels and reducing the release of excitatory neurotransmitters in the brain.
• It's particularly effective for bipolar depression without triggering mania and has a more favorable side effect profile than many mood stabilizers, with minimal weight gain and no significant impact on cognition.
• Regular blood monitoring is not typically required, unlike some other mood stabilizers, making it convenient for long-term use.

Considerations

• According to a recent study, lamotrigine may result in clinically meaningful driving impairment under acute administration, but not under chronic administration 1.
• The evidence suggests that lamotrigine is effective in treating pain in diabetic neuropathy, with five medium-quality studies supporting its role in this condition 1.
• However, the use of lamotrigine should be individualized, taking into account factors such as drug dosage, drug interactions, and pharmacokinetics, to minimize its impact on driving and ensure safe driving for each patient.

From the Research

Overview of Lamictal

• Lamictal, also known as lamotrigine, is a medication used in the treatment of bipolar disorder, particularly for the prevention of depressive relapse in euthymic patients 2.
• It has been shown to be effective in the maintenance treatment of bipolar disorder, with possible advantages over placebo in preventing recurrence of manic symptoms and clinical worsening 3.

Efficacy and Safety

• The strongest evidence supports the utility of lamotrigine in the prevention of recurrence and relapse, particularly depressive relapse, in stabilized patients 2.
• Some evidence suggests efficacy in acute bipolar depression, but findings are inconsistent, and there is little or no strong evidence in support of efficacy in acute mania, unipolar depression, or rapid-cycling bipolar disorder 2.
• Lamotrigine has been shown to be as effective as lithium in the maintenance treatment of bipolar disorder, with similar efficacy except for recurrence of mania episode at one year 3.
• The incidence rates of adverse effects were similar between the lamotrigine group and the placebo group, with low- to moderate-certainty evidence suggesting that lamotrigine may be superior to placebo as a treatment modality for bipolar disorder 3.

Comparison with Other Medications

• Lamotrigine may be considered a first-line drug for bipolar disorder, except for acute manic episodes or where rapid symptom control is required, due to its relatively favorable indications for safety, tolerability, and patient acceptability 2.
• In comparison to lithium, people with bipolar disorder seem to tolerate lamotrigine better in the long run, with a lower proportion of participants experiencing at least one adverse effect when treated with lamotrigine compared to lithium 3.
• Other antiepileptic drugs, such as carbamazepine and valproate, have been found to be valuable alternatives to lithium in the treatment of bipolar affective disorder, with lamotrigine being a potential option for bipolar depression 4, 5, 6.