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Lamotrigine:

it is an antiseizure drug used to control or reduce the frequency of seizures.

What is Lamotrigine used for?

Focal onset seizures and generalized onset seizures
Trigeminal neuralgia
Bipolar disorder and acute bipolar major depression

How is Lamotrigine available?

Tablet
Extended-release tablet
Orally disintegrating tablet

How does Lamotrigine act?

Lamotrigine works by calming overactive nerves and also by reducing excessive brain Signals and stabilising the brain activity.

Why is Lamotrigine important for you/your child’s treatment?

It is important that your child takes Lamotrigine regularly so that you/your child doesn’t suffer from Seizures or have fewer seizures episodes.
Lamotrigine controls seizures but doesn’t cure epilepsy and works only while you keep taking it. So do not stop giving Lamotrigine all of a sudden, as it may result in having more seizures.

When should Lamotrigine be taken?

Twice a day; morning and evening. Ideally, 10-12 hours apart.
For example, anytime between 7 to 8 am and right after 12 hours between 7 to 8 pm. You can adjust the time slot according to your schedule. However, there are some exceptions when your doctor may advise to give it thrice a day. Please follow your doctor’s instructions in such case.
It should ideally be given at the same time every day to establish a routine as it minimizes the chances of missing a dose.

What if I miss a dose?

If you miss the dose, it can be taken as soon as you remember within the lapse of 6 hours. Do not take the missed dose if it is close to the next one; just take the next dose as normal. If you miss two or more doses, discuss with your doctor.

NEVER GIVE A DOUBLE DOSE OF LAMOTRIGINE.

If your child vomits out the content within 30 minutes of taking the medicine dosage then you can give the dose again; but if your child vomits after 30 minutes of taking the dose, then just leave it be and do not give it again.

How much of the drug should be given?

It is mandatory to follow the instructions given by your doctor about the dosage of medication.
Your doctor may start you on a low dose of Lamotrigine and gradually increase your dose, not more often than once every 2 weeks.

How should I give the medicine?

Tablets: A whole tablet must be swallowed with a glass of water, juice or milk. You may give it by crushing and mixing it in water/ juice or small serving of yogurt / Curd.
Modified Release (Controlled release): These tablets should not be crushed, as they lose their purpose. The whole tablet intact should be swallowed. If you need to crush to administer the medicine, use a standard tablet.

Could this medication have any side effects on my child?

Every medication has both positive and potential negative effects. Fortunately, adverse effects are not common for everyone, but it’s essential to be aware of them. Understanding possible side effects allows us to act quickly and effectively if they occur, ensuring that we can address any concerns promptly while continuing to benefit from the intended effects of medications.
Even though it may be rare, sometimes it may cause serious side effects when taking a drug. Consult your doctor or get medical help right away if you have any of the following signs or symptoms that may be related to a very bad side effect:

Side Effects :

1% to 10%:

Heart related (Cardiovascular): Chest pain, fluid build-up (oedema).
Skin related (Dermatologic): Skin inflammation (Dermatitis), skin rash, dry skin (xeroderma).
Hormonal (Endocrine & metabolic): Weight gain or weight loss.
Gastrointestinal: Abdominal pain, anorexia, constipation, indigestion (dyspepsia), farting (flatulence), peptic ulcer, vomiting, dry mouth (xerostomia).
Genitourinary: Menstrual cramps (Dysmenorrhea), urinary frequency.
Nervous system: Abnormal dreams, agitation, memory loss (amnesia), anxiety, confusion, depression, dizziness, drowsiness, emotional lability, fatigue, over responsive (hyperreflexia), reduced sense of touch (hypoesthesia), reduced reflexes (hyporeflexia), oversleep (insomnia), irritability, migraine, neurologic abnormality, pain, tingling effect (paraesthesia), suicidal ideation.
Neuromuscular & skeletal: Joint pain (Arthralgia), weakness (asthenia), back pain, muscle pain (myalgia), neck pain.
Eye related (Ophthalmic): Visual disturbance.

<1%:

Heart related (Cardiovascular): Redness of skin (Flushing), increased blood pressure (hypertension), BP while standing up or lying down (orthostatic hypotension), irregular heartbeat (palpitations), fainting (syncope), fast heart rate (tachycardia), dilation of blood vessels (vasodilation).
Skin related (Dermatologic): Acne vulgaris, hair loss (alopecia), skin inflammation (dermatitis), bruises (ecchymoses), erythema multiforme, redness (erythema of skin), hypopigmentation (leukoderma), maculopapular rash, itching (pruritus), skin discoloration, Stevens-Johnson syndrome, hives (urticaria).
Hormonal (Endocrine & metabolic): Heavy menstrual bleeding, excessive hair growth (hirsutism), increased blood sugar (hyperglycaemia), hypothyroidism.
Gastrointestinal: Difficulty swallowing (Dysphagia), gastric ulcer, stomach inflammation (gastritis), gastrointestinal bleeding (haemorrhage), bleeding gums (gingival hyperplasia), blood vomiting (hematemesis), increased appetite, blood in stools (melena), oral mucosa ulcer.
Genitourinary: Bladder inflammation (cystitis), painful urination (dysuria), blood in urine (haematuria), inability to control urination (urinary incontinence), inability to fully empty the bladder (urinary retention), urinary urgency.
Blood related (Hematologic & oncologic): Increased eosinophils count (Eosinophilia), reduced red blood cells (anaemia), low white blood cell count (leukopenia), increased lymphocytes (lymphocytosis), reduced platelet count (thrombocytopenia).
Liver related (Hepatic): Abnormal hepatic function tests.
Immunologic: Drug reaction with eosinophilia and systemic symptoms (DRESS).
Nervous system: Restlessness (Akathisia), altered sense of smell, depression, delirium, delusion, involuntary muscle movement (dystonia), excitement (euphoria), hallucination, increased muscle movement (hypertonia), decreased muscle movement (hypotonia), discomfort (malaise), manic depressive reaction, memory impairment, movement disorder, muscle contraction (myoclonus), nerve pain (neuralgia), paranoid ideation, personality disorder, psychosis, sleep disorder, stupor.
Neuromuscular & skeletal: Arthritis, involuntary muscle movements (dyskinesia), muscle spasm.
Renal: Acute renal failure.

If your child starts developing skin Rash, Stop Medications right there and SEEK IMMEDIATE MEDICAL ADVICE from your DOCTOR.

IF YOU NOTICE ANY SKIN RASH OR ULCERS IN MOUTH or GENITAL AREA, THEN STOP MEDICINE IMMEDIATELY AND RUSH TO HOSPITAL’S EMERGENCY DEPARTMENT.

Sometimes your child may experience other side-effects that are not listed above. If you notice any abnormalities with your child’s body or behaviour, do not hesitate and immediately contact your doctor.

Can other common medicines be given along with lamotrigine?

Yes, many common medications, such as ibuprofen, paracetamol, and antibiotics, can usually be taken with lamotrigine, but it’s important to consult your doctor first, especially for children. Here are a few important things to keep in mind.

Other Over-the-Counter Medications: Before combining lamotrigine with any over-the-counter products, it’s essential to check with your doctor or pharmacist, especially for medications that affect the central nervous system, like those for colds or allergies, as they might interact with lamotrigine.

Herbal or Complementary Medicines: These could interact with lamotrigine and affect its effectiveness or increase the risk of side effects. Always inform your doctor if you’re using any herbal or alternative treatments.
If your child experiences a change in seizure frequency or any new side effects after starting a new medication, it is crucial to contact your doctor immediately. Maintaining regular communication with your healthcare provider helps ensure the treatment plan is safe and effective.

Pregnancy and Lactation:

Lamotrigine is excreted in breast milk; the decision to breastfeed during the therapy should be made while taking into consideration the risk of infant exposure, the benefits of breastfeeding to the infant, and benefits of treatment to the mother.

Alcohol:

Avoid, drug and alcohol will enhance sedative effect.

Withdrawal:

Drug should not be discontinued abruptly because the possibility of increasing seizure frequency; therapy should be withdrawn gradually to minimize the potential of increased seizure frequency.

Monitoring Parameters:

Serum levels of concurrent anticonvulsants, liver function test, renal function, hypersensitivity reactions including signs and symptoms of DRESS.
ECG prior to initiation in patients aged > 60 years or any concurrent comorbidities.
Repeat serum concentration level of Lamotrigine frequently.
Suicidal thoughts and behavioural changes.

Author:
1. Dr Praveen Kumar, B.Pharm,Pharm D(PB), Head Clinical Pharmacologist, Aster Hospitals, Bengaluru
2. Dr. Ramya. R, Pharm D, Clinical pharmacologist, Aster Hospitals, Bengaluru
3. Dr C P Ravi Kumar, Consultant Paediatric Neurologist, Aster CMI Hospital

Lamotrigine

Dr. C P Ravi Kumar