Tablet, Generic Name: Lamotrigine USP, Manufacturer: Incepta Pharmaceuticals Ltd.
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Indications
Lamogin 50 is used to treat the following conditions:
Combination therapy for partial-onset seizures, primary generalized tonic-clonic seizures, and generalized seizures of Lennox-Gastaut syndrome in patients aged 2 years and older
Monotherapy for epilepsy in individuals aged 16 and up.
Adults suffering from bipolar disorder.
Pharmacology
Lamotrigine's specific mechanism of action is unknown, however it is thought to involve cellular actions that contribute to its efficacy in a variety of situations. Lamotrigine's activities are similar to those of phenytoin and carbamazepine, in that it inhibits voltage-sensitive sodium channels, stabilizes neuronal membranes, and modulates presynaptic excitatory neurotransmitter release.
Lamotrigine suppresses the release of the excitatory amino acid glutamate by blocking sodium currents by selectively binding to the inactive sodium channel.
Lamotrigine's mechanism of action in lowering anticonvulsant activity is most likely the same as it is in bipolar disorder treatment. Studies on lamotrigine have discovered that it binds to sodium channels in a similar way to local anesthetics, which could explain why it has been shown to help those with neuropathic pain.
Lamotrigine has the ability to connect to a variety of receptors.
Dosage & Administration
Epilepsy-
Table-1: Escalation Regimen for Lamotrigine in Patients Older than 12 Years with Epilepsy
Weeks 1 & 2:
In patients not taking Carbamazepine, Phenytoin, Phenobarbital, Primidone or Valproate: 25 mg every day
In patients taking Valproate: 25 mg every other day
In patients taking Carbamazepine, Phenytoin, Phenobarbital or Primidone and not taking Valproate: 50 mg/day
Weeks 3 & 4:
In patients not taking Carbamazepine, Phenytoin, Phenobarbital, Primidone or Valproate: 50 mg/day
In patients taking Valproate: 25 mg every day
In patients taking Carbamazepine, Phenytoin, Phenobarbital or Primidone and not taking Valproate: 100 mg/day (in 2 divided doses)
Week 5 onward to maintenance:
In patients not taking Carbamazepine, Phenytoin, Phenobarbital, Primidone or Valproate: Increase by 50 mg/day every 1 to 2 weeks
In patients taking Valproate: Increase by 25 to 50 mg/day every 1 to 2 weeks
In patients taking Carbamazepine, Phenytoin, Phenobarbital or Primidone and not taking Valproate: Increase by 100 mg/day every 1 to 2 weeks
Usual maintenance dose:
In patients not taking Carbamazepine, Phenytoin, Phenobarbital, Primidone or Valproate: 225 to 375 mg/day (in 2 divided doses)
In patients taking Valproate: 100 to 200 mg/day with Valproate alone 100 to 400 mg/day with Valproate and other drugs that induce glucuronidation (in 1 or 2 divided doses)
In patients taking Carbamazepine, Phenytoin, Phenobarbital or Primidone and not taking Valproate: 300 to 500 mg/day (in 2 divided doses)
Table-2: Escalation Regimen for Lamotrigine in Patients Aged 2 to 12 Years with Epilepsy
Weeks 1 & 2:
In patients not taking Carbamazepine, Phenytoin, Phenobarbital, Primidone or Valproate: 0.3 mg/kg/day in 1 or 2 divided doses
In patients taking Valproate: 0.15 mg/kg/day in 1 or 2 divided doses
In patients taking Carbamazepine, Phenytoin, Phenobarbital or Primidone and not taking Valproate: 0.6 mg/kg/day (in 2 divided doses)
Weeks 3 & 4:
In patients not taking Carbamazepine, Phenytoin, Phenobarbital, Primidone or Valproate: 0.6 mg/kg/day (in 2 divided doses)
In patients taking Valproate: 0.3 mg/kg/day in 1 or 2 divided doses
In patients taking Carbamazepine, Phenytoin, Phenobarbital or Primidone and not taking Valproate: 1.2 mg/kg/day (in 2 divided doses)
Week 5 onward to maintenance:
In patients not taking Carbamazepine, Phenytoin, Phenobarbital, Primidone or Valproate: The dose should be increased every 1 to 2 weeks as follows-calculate 0.6 mg/kg/day
In patients taking Valproate: The dose should be increased every 1 to 2 weeks as follows-calculate 0.3 mg/kg/day
In patients taking Carbamazepine, Phenytoin, Phenobarbital or Primidone and not taking Valproate: The dose should be increased every 1 to 2 weeks as follows-calculate 1.2 mg/kg/day
Usual maintenance dose:
In patients not taking Carbamazepine, Phenytoin, Phenobarbital, Primidone or Valproate: 4.5 to 7.5 mg/kg/day (maximum 300 mg/day in 2 divided doses)
In patients taking Valproate: 1 to 3 mg/kg/day with Valproate alone 1 to 5 mg/kg/day (maximum 200 mg/day in 1 or 2 divided doses)
In patients taking Carbamazepine, Phenytoin, Phenobarbital or Primidone and not taking Valproate: 5 to 15 mg/kg/day (maximum 400 mg/day in 2 divided doses)
Table-3: The Initial Weight-Based Dosing Guide for Patients Aged 2 to 12 Years Taking Valproate (Weeks 1 to 4) with Epilepsy
Weeks 1 & 2:
If the patients weight is 6.7 kg to 14 kg: 2 mg every other day
If the patients weight is 14.1 kg to 27 kg: 2 mg every day
If the patients weight is 27.1 kg to 34 kg: 4 mg every day
If the patients weight is 34.1 kg to 40 kg: 5 mg every day
Weeks 3 & 4:
If the patients weight is 6.7 kg to 14 kg: 2 mg every day
If the patients weight is 14.1 kg to 27 kg: 4 mg every day
If the patients weight is 27.1 kg to 34 kg: 8 mg every day
If the patients weight is 34.1 kg to 40 kg: 10 mg every day
Bipolar disorder-
Table-4: Escalation Regimen for Lamotrigine in Adults with Bipolar Disorder
Weeks 1 & 2:
In patients not taking Carbamazepine, Phenytoin, Phenobarbital, Primidone or Valproate: 25 mg daily
In patients taking Valproate: 25 mg every other day
In patients taking Carbamazepine, Phenytoin, Phenobarbital or Primidone and not taking Valproate: 50 mg daily
Weeks 3 & 4:
In patients not taking Carbamazepine, Phenytoin, Phenobarbital, Primidone or Valproate: 50 mg daily
In patients taking Valproate: 25 mg daily
In patients taking Carbamazepine, Phenytoin, Phenobarbital or Primidone and not taking Valproate: 100 mg daily (in divided doses)
Week 5:
In patients not taking Carbamazepine, Phenytoin, Phenobarbital, Primidone or Valproate: 100 mg daily
In patients taking Valproate: 50 mg daily
In patients taking Carbamazepine, Phenytoin, Phenobarbital or Primidone and not taking Valproate: 200 mg daily (in divided doses)
Week 6:
In patients not taking Carbamazepine, Phenytoin, Phenobarbital, Primidone or Valproate: 200 mg daily
In patients taking Valproate: 100 mg daily
In patients taking Carbamazepine, Phenytoin, Phenobarbital or Primidone and not taking Valproate: 300 mg daily (in divided doses)
Week 7:
In patients not taking Carbamazepine, Phenytoin, Phenobarbital, Primidone or Valproate: 200 mg daily
In patients taking Valproate: 100 mg daily
In patients taking Carbamazepine, Phenytoin, Phenobarbital or Primidone and not taking Valproate: up to 400 mg daily (in divided doses)
Interaction
Oral contraceptives, Atazanavir/ritonavir, Carbamazepine, Levetiracetam, Lithium, Lopinavir/ritonavir, Olanzapine, Phenobarbital/primidone, Phenytoin, Pregabalin, and others interact with Lamotrigine.
Contraindications
Dizziness, tremor, headache, rash, blurred vision, fever, lack of coordination, abdominal discomfort, infections, sleepiness, back pain, vomiting, diarrhea, weariness, sleeplessness, dry mouth, stuffy nose, and sore throat are all common Lamotrigine side effects.
Side Effect
Common side effects include headache, dyspepsia, back discomfort, myalgia, nasal pharyngitis, and nasal congestion. Changes in color vision, sudden vision loss, hearing loss, Stevens-Johnson Syndrome, exfoliative dermatitis, angina, stroke, myocardial infarction, severe hypotension, and tachycardia are all unusual but possible complications.
Pregnancy & Lactation
Pregnancy Classification C. Human milk contains lamotrigine, which is expelled. Because Lamotrigine has the potential to produce major adverse reactions in nursing infants, a decision should be made whether to stop breastfeeding or stop taking the medicine, taking into account the drug's importance to the mother.
Precautions & Warnings
Both adults and children can develop serious skin rashes, blood dyscrasias, suicidal behavior, and aseptic meningitis.
Therapeutic Class
Primary anti-epileptic drugs
Storage Conditions
Keep away from light and heat in a dry location. Keep out of children's reach.
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