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Published online by Cambridge University Press: 06 October 2020
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
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