Lamictal

Lamictal Side Effects: Lamictal is an anticonvulsant with medication, generic name lamotrigine, and Lamictal side effects are quite common. Lamictal has increased in popularity since becoming available as generic product. This increase in use has likely seen the concurrent increase in severe Lamictal side effects including severe rashes like Stevens-Johnson syndrome, rare cases of toxic epidermal necrolysis and even rash related deaths. Less severe Lamictal side effects are fairly common.

Lamictal is available in 25 mg, 100 mg, 150 mg, and 200 mg tablets to be swallowed and as 25 mg, 50 mg, 100 mg, and 200 mg orally dissolving tablets. It’s also available as 2.5 and 25 mg chewable tablets. Lamictal indications include maintenance therapy of bipolar disorder, management of partial complex seizures, treatment of Lennox-Gastair seizures, treatment of primary generalized tonic clonic seizures and for pediatric patients treatment of the same conditions. For treatment of bipolar disorder typical Lamictal dosage is 200 mg. daily after a slow titration up to this dosage. For seizure management dosage of up to 500 mg is more typical.

Black Box Warning:  Among the serious Lamictal side effects is a black box warning mandated by the FDA regarding serious rashes. These can include Stevens-Johnson syndrome, rarely toxic epidermal necrolysis, and even rash related deaths. The incidence of these serious rashes is fairly high potentially 0.8% in adjunctive epilepsy therapy in children and 0.3% in adults treated for bipolar disorder other mood disorders. The incidence is felt to be 0.08% when Lamictal is used as initial monotherapy and somewhat higher with adjunctive therapy. Most life-threatening rashes occur within the first two months of therapy and only isolated cases have been noted later. Lamictal therapy must be discontinued at the first sign of a rash unless the rash is clearly not related to the Lamictal therapy. That stated the rash from Lamictal can continue to be very serious even after discontinuation of the medication and can be life-threatening or permanently disfiguring.

Common Lament Side Effects: Among the more common Lamictal side effects are those of the central nervous system including dizziness and vertigo, visual disturbances, ataxia or balance problems, headache, insomnia, tremor, loss of coordination, anxiety, irritability and even seizures. Common gastrointestinal Lamictal side effects include nausea and vomiting, diarrhea, abdominal pain, constipation and dyspepsia. A rash that’s often itchy is a fairly common Lamictal side effect as is runny nose, cough, painful menses, back pain and loss of appetite. Accidental injury, usually related to loss of coordination or other neurologic Lamictal side effects, is fairly common.

Serious Lamictal Side Effects: The severe skin reactions mentioned black box warning above are among the most serious Lamictal side effects. Additional allergic type reactions including angioedema, sometimes severe or even fatal hypersensitivity reactions and a rash often associated with systemic symptoms and eosinophilia. Severe hematologic Lamictal side effects can include neutropenia, leukopenia, thrombocytopenia, anemia, aplastic anemia, and pancytopenia as well as disseminated intravascular coagulation. Pure red cell a pleasure and hemolytic anemia are additional hematologic Lamictal side effects. Neurologic Lamictal side effects that can be serious include status epilepticus, withdrawal seizures, aseptic meningitis and sudden death as well as suicidality often associated with worsening depression. With first trimester use in pregnant women neonatal cleft lip and cleft palate have been associated with Lamictal. Hepatic failure and pancreatitis as well as rhabdomyolysis have been noted as serious Lamictal side effects.

Cautions, contraindications and drug interactions: Contraindications to the use of Lamictal include hypersensitivity to Lamictal or other drugs in its class. Serious cautions include avoidance of abrupt withdrawal of Lamictal especially in therapy for seizures, caution if there is significant renal or hepatic impairment, pregnancy, suicide risk or known hypersensitivity to other anticonvulsant type medications. Lamictal has numerous drug interactions. Lamictal may decrease the effectiveness of progestin only contraception and combination estrogen progestin oral contraceptives are preferred during Lamictal therapy. Two herbal medications that need to be strictly avoided are ginkgo biloba and St. John’s wort. The list of drugs requiring modification of therapy or monitoring is extensive and only some of the more commonly used medications will be listed here. For more complete information see the manufacturers prescribing guidelines and for specific questions about medication interactions consult your physician or pharmacist. Modification of therapy or careful monitoring may be needed when Lamictal is used with carbamazepine for seizures, when used with combination oral contraceptives, estrogen and estrogen progestin combination hormone replacement therapy, phenobarbital and Dilantin as well as other phenytoin, primidone, rifampin and the valproic acid class of medications. Caution is advised with ingestion of alcohol containing beverages with Lamictal because of the potential for increased central nervous system sedation and the related Lamictal side effects. Milk Thistle is another fairly commonly used herbal product with potential for increasing Lamictal drug levels and should be avoided. Trimethoprim and trimethoprim sulfamethoxazole are antibiotics where the combination with Lamictal may lead to an increased incidence of blood dyscrasias.

Pharmacology: Lamictal is not felt have hepatic metabolism using the CYP 450 pathway. An interesting observation is that Lamictal may induce its own metabolism with monotherapy and increased Lamictal doses may be needed with prolonged use.

Pregnancy and Lactation: Lamictal is pregnancy category C with specific first trimester concerns of left lipid cleft palate. Lamictal is considered unsafe for use during breast-feeding.

Lamictal is a commonly used anti-convulsant medication as well as a mood stabilizing medication bipolar disorder and patients need to be carefully counseled about the potential for serious and life-threatening rashes. Other Lamictal side effects can be serious but are less common.

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