What is Lamictal (Lamotrigine)?
Lamictal is a Brand name for antiepileptic (anticonvulsive) prescription drug that contain lamotrigine as an active ingredient. It is also used to delay mood episodes in adults with bipolar disorder (manic depression).
Lamictal available dosages and forms
- Lamictal is available in 4 forms to be orally taken: regular tablets, orally disintegrating tablets chewable tablets and extended-release tablets. Lamictal XR is a Brand name for extended-release tablets. This drug is also available as a generic drug.
- Lamictal regular tablets are available for oral administration in following doses and color: 25-mg (white), 100-mg (peach), 150-mg (cream), and 200-mg (blue) tablets.
- Lamictal chewable dispersible tablets are available for oral administration in following doses: contain 2 mg, 5 mg or 25 mg, all of these are white color.
- Lamictal ODT orally disintegrating tablets are available for oral administration in following doses: 25 mg, 50 mg, 100 mg or 200 mg, all of these are white to off- white color.
- Lamictal XR extended release film coated tablets are available for oral administration in following doses: 25 mg, 50 mg, 100 mg, 200 mg, 250 mg and 300 mg.
Epilepsy Adjunctive therapy in patients who are 2 years or older for following disorders: partial onset seizures, primary generalized tonic-clonic seizures and generalized seizures of Lennox-Gastaut syndrome
Epilepsy monotherapy in adults with partial-onset seizures.
Bipolar disorders, delay the time to occurrence of mood episodes (depression and hypomania). Treatment of acute manic or mixed episodes is not recommended.
Lamictal side effects
The most common side effects with their incidence that can occur after Lamictal use include:
· Dizziness (38%)
· Diplopia (26-30%)
· Headache (29%)
· Ataxia (22%)
· Blurred vision (16-20%)
· Rhinitis (11-15%)
· Somnolence (14%)
· Insomnia (6-10%)
· Fatigue (8%)
· Rash (5-10%)
· Chest pain (5%)
· Peripheral edema (2-5%)
· Suicidal ideation (2-5%)
· Dermatitis (2-5%)
· Dry skin (2-5%)
· Increased libido (2-5%)
· Rectal hemorrhage (2-5%)
· Weakness (2-5%)
· Agitation (1-5%)
· Dysarthria (1-5%)
· Edema (1-5%)
· Fever (1-5%)
· Migraine (1-5%)
· Abnormal thoughts (1-5%)
· Urinary frequency (1-5%)
· Tremor (4%)
If these effects are mild, they may go away within a few days or a couple of weeks. If they’re more severe or don’t go away, patients should talk with their doctor or pharmacist.
What is Lamictal rash?
Patients who are on Lamictal therapy, in not so uncommon cases may develop some type of a rash. Usually, it is present as red blotchy patches or hives all over the body. The incidence of rash is more common among pediatric patients than in adults. In very rare cases lamictal skin rashes may lead to more serious and potentially life-threatening conditions, such as toxic epidermal necrolysis or Stevens-Johnsons Syndrome. Both of these complications are very serious and can lead to death.
Why Lamictal causes Rash?
It is still unknown why Lamictal causes rash in many cases. One of thoughts is that rash is caused by administering high initial dose or when dose adjustment is done too fast. Because of this, the manufacturer recommends that patients should be always given a lower initial dose and that dose should be adjusted in slower schedule.
There is also a higher chance to develop Lamictal rash when it taken togther with valproic acid. Studies have been shown that valproic acid may interfere with Lamictal excretion resulting in increased serum levels. Also, the failure to adjust the Lamictal dosage increases the risk for rash.
Lamictal Rash types and diagnosis
A rash that occurs between 5 days to 8 weeks of initiating Lamictale treatment is probably lamotrigine related. The skin rash may be also accompanied by some flu-like or fever symptoms.
However, not all Lamictal rashes are considered serious. If rash occurs during the first 5 days after beginning the treatment, it is considered that is no likely due to the medication but, though, patients are advised to discontinue Lamictal and seek medical help immediatelly. Doctor will require certain pathology tests on their patients to fully review the situation. There are 2 types of Lamictal rash:
· Less serious rash is more common and usually have next characteristics: fine red spots that are widely spaced, may be itchy but not tender, it is resolved after 10-14 days and it is nor accompanied with flu or fever-like symptoms
· Potentially serious rash is less common and usually have next characteristics: involves the mouth, tongue, face and genital or anal areas and it is more prominent on the neck and upper trunk, it is accompanied with flu or fever like symptoms and with appetite loss, it can look like purplish, small spots tender to touch, and like merging rash that appear swollen and red or like redness and swelling of the skin all over the body, with or without skin shedding. These symptoms are potentially life treating, and patient must seek urgent medical attention if they got them. In case of serious rash, even if you discontinue Lamictal, the rash could still be life-threatening. If Stevens – Johnson syndrome occurs, hospitalization is needed, potentially in the intensive care or burn unit. You may need several months to recover.
Treatment and Prevention of Lamictal rash
A lower starting dose of Lamictal should be given to the patients and the dosage should be more gradually titrated. Patients should take this drug exactly as prescribed. Patients should never increase the dose unless it is instructed by theirr healthcare provider. While taking Lamictal, patients should avoid using the other antiepileptic drugs, such as divalproex and valproic acid. Regular physician visits can also help prevent this adverse reaction.
Lamictal Rash Warning
· Between 5 and 10% of patients on Lamictal therapy will develop a rash, but only 0.1% to 0.8% will develop a serious rash such as Steven-Johnson Syndrome, Toxic Epidermal Necrolysis or DRESS Syndrome. It is about that 1-8 in 1000 patients will develop serious rash, and it is a significant number.
· Rash and different skin reactions after Lamictal use are more common in children, so this medication is often reserved for adults.
· Patients with bipolar and other mood disorders have less ranges of rash and incidence is about 0.08 to 0.13 %
· Deaths from the rashes are very rare but it do do occur. About 5% of people with Stevens – Johnson syndrome die from this condition.
· Lamictal prescribing information label has a black box warning with life-threatening skin reactions that may cause, including Stevens–Johnson syndrome, toxic epidermal necrolysis and DRESS syndrome.