Multiorgan Hypersensitivity Reactions And Organ Failure
Multiorgan hypersensitivity reactions, also known as drug reaction with eosinophilia and systemic symptoms , have occurred. This is a potentially fatal drug reaction.
Symptoms include fever, rash, and other organ problems. It sometimes resembles a viral infection. Report these symptoms to your medical provider right away.
Important Information About All Medicines
Never take more than the prescribed dose. If you suspect that you or someone else might have taken an overdose of this medicine, go to the accident and emergency department of your local hospital. Take the container with you, even if it is empty.
This medicine is for you. Never give it to other people even if their condition appears to be the same as yours.
If you are having an operation or dental treatment, tell the person carrying out the treatment which medicines you are taking.
Do not keep out-of-date or unwanted medicines. Take them to your local pharmacy which will dispose of them for you.
If you have any questions about this medicine ask your pharmacist.
Serious Skin Rash And Allergic Reactions
- Risk factors: Taking divalproex or valproic acid | Taking more lamotrigine than prescribed or raising the dose too quickly | Children | History of rash from other antiepileptic drugs
Although rare, lamotrigine can cause a serious or life-threatening skin rash or an allergic reaction with life-threatening organ failure. The risk is higher for people who are also taking divalproex or valproic acid. Severe rashes can happen at any time while you’re taking lamotrigine , but it usually happens 2 to 8 weeks after starting the medication. Get medical care right away if you have a rash, blistering or peeling skin, painful sores on your face, fever, swelling, or trouble breathing.
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Before Taking This Medicine
You should not take Lamictal if you are allergic to lamotrigine.
Lamictal may cause a severe or life-threatening skin rash, especially in children and in people who take a very high starting dose, or those who also take valproic acid or divalproex .
Tell your doctor if you have ever had:
a rash or allergic reaction after taking another seizure medication
heart problems such as heart block or irregular heartbeats
depression, suicidal thoughts or actions or
meningitis after taking Lamictal.
Some people have thoughts about suicide while taking lamotrigine. Your doctor will need to check your progress at regular visits. Your family or other caregivers should also be alert to changes in your mood or symptoms.
Do not start or stop taking seizure medication during pregnancy without your doctor’s advice. Having a seizure during pregnancy could harm both mother and baby. Tell your doctor right away if you become pregnant.
If you are pregnant, your name may be listed on a pregnancy registry to track the effects of lamotrigine on the baby.
Birth control pills can make lamotrigine less effective, resulting in increased seizures. Tell your doctor if you start or stop using birth control pills. Your lamotrigine dose may need to be changed.
It may not be safe to breastfeed while using this medicine. Ask your doctor about any risk.
Do Not Stop Taking Lamotrigine
Going cold turkey with lamotrigine may cause seizures even if the drug is prescribed for another condition. If the drug does not seem to be working or, worse, the side effects are too hard to take, see a healthcare professional for medical advice. The safest way to stop taking lamotrigine is with a steadily tapering doseover several weekssupervised by a healthcare provider.
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Potentially Serious Side Effects
Like any other drug, Lamictal also has some side effects but not everyone develops the symptoms.
Some of the symptoms include:
- Skin rashes or redness
- Ulcers in the mouth, throat, nose or genitals
- Sore mouth or swollen eyes
- Swelling around your face, or swollen glands in your neck, armpit or groin.
- Unexpected bleeding or bruising, or the fingers turning blue
- Sore throat, or more infections than usual.
- Increased levels of liver enzymes seen in blood tests
- An increase in a type of white blood cell
- Enlarged lymph nodes Involvement of the organs of the body including liver and kidneys
- A group of symptoms together including fever, nausea, vomiting, headache, stiff neck and extreme sensitivity to bright light.
- Lower immunity because of lower levels of antibodies called immunoglobulins in the blood which help protect against infection
Which Conditions Are Treated With Lamotrigine
Although lamotrigine is not considered an antidepressant, it is used as a maintenance treatment for bipolar I disorder to help stabilize mood changes. 1,2
The drug manufacturers original studies of lamotrigine in bipolar depression found that improvements were stronger in bipolar 1 than bipolar II disorder, Dr. Goldberg recalls. Newer research suggests, however, that lamotrigine may be even more effective as a mood stabilizer in preventing relapses in treating bipolar II disorder.2
There are also conditions lamotrigine treats off-label including borderline personality disorder, schizoaffective disorder, and obsessive-compulsive disorder , Dr. Aiken says.
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Ltg Increases The Activity Of The Bcl
To assess whether enhanced levels of Bcl-2 mRNA and protein were triggered by an increase in Bcl-2 promoter activity, CGCs, HEK 293 cells and SH-SY5Y cells were transfected with a luciferase reporter driven by a 0.3-kb fragment of the human Bcl-2 promoter. Twenty-four hours after transfection, CGCs, HEK 293 cells and SH-SY5Y cells were treated with LTG for 24 h. Treatment with 100 µm LTG induced an approximately five-fold maximum increase in Bcl-2 promoter activity in CGCs and an even more robust increase in HEK 293 and SH-SY5Y cells , as quantified by a luciferase reporter assay system. Next, a ChIP assay was utilized to investigate whether LTG-induced Bcl-2 expression was related to increased association between the Bcl-2 promoter region and AH3. CGCs were treated with 100 µm LTG for 24 h and then harvested for ChIP analysis. PCR results showed that LTG treatment caused a significant increase in the AH3 × Bcl-2 promoter interaction .
Suicidal Thoughts Or Behaviors
Taking Lamictal may increase the risk of suicidal thoughts or behaviors. In studies of anti-epileptic drugs such as Lamictal, patients who took one type of drug had about twice the risk of suicidal thoughts and behaviors compared to people who took a placebo. These symptoms may start as early as one week after starting treatment.
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What The Lamictal Tablets Looks Like
- Lamotrigine 25mg tablets are Light yellow to yellow colored, capsule-shaped, biconvex, uncoated tablets debossed with E and 1 on either side of the scoreline on one side and breakline on the other side.
- Lamotrigine 50mg tablets are Light yellow to yellow colored, capsule-shaped, biconvex, uncoated tablets debossed with E and B on either side of the scoreline on one side and breakline on the other side.
- Lamotrigine 100mg tablets are Light yellow to yellow colored, capsule-shaped, biconvex, uncoated tablets debossed with E and C on either side of the scoreline on one side and breakline on the other side.
- Lamotrigine 200mg tablets are Light yellow to yellow colored, capsule-shaped, biconvex, uncoated tablets debossed with E and D on either side of the scoreline on one side and breakline on the other side.
- Lamotrigine tablets are available as blister packs in the pack sizes of 7, 14, 21, 28, 30, 56 and 100 tablets. .
What Does Lamictal Do
Lamictal is a medication based on minerals, the main ingredients that the human body would naturally benefit from if in the right quantities. Dosage depends on the age, weight, and needs of the individual. These tablets are offered in 25, 50, 100, and 200 mg. For children, there are 2, 5, and 10 mg chewable tablets offered. In either case, one would need to find the balance where the most benefit is being gained with the least amount of medication.
The use of this product along with a placebo indicate there is no change in the mental ability, driving ability, or primary motory functions for most people. The independent studies that tell us that also state that Lamictals effects can differ from individual to individual. It is important never to take more of the Lamictal than prescribed by a doctor. This is a very powerful form of medication, and it has to be used responsibly.
In adults, the use of this drug is to help extend the length of time between bipolar episodes. There is some information about various studies but not specifics about the exact ingredients in the format that is offered in Lamictal. There have been some studies about results with this product, but they are mixed. This indicates that the use of Lamictal can work for some people but not for everyone.
- very effective against partial seizures and long or moderate cycle bipolar disorder
- thoroughly researched drug
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Suicidal Thoughts Or Behavior
- Risk factors: History of depression
As with many other antiepileptic drugs , lamotrigine can raise the risk of suicidal thoughts or behavior as early as 1 week after starting treatment. Let your family or friends know to watch for worsening depression or any unusual mood or behaviorial changes, especially during the first few months of treatment or when your dose changes. Tell your provider if you notice these types of changes. If you feel like hurting yourself, call 911 or seek help immediately.
Dosage Of Lamictal For Anxiety
Although, the doctor is the best prescriber for any medicine, a typical dosage of Lamictal is usually 100 200 mg per day. The tablets for Lamictal depression are available in different forms including chewable and orally dissolving tablets. The full effect of the medicine takes a month to become evident.
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What Should I Know About Storage And Disposal Of This Medication
Keep this medication in the container it came in, tightly closed, and out of reach of children. Store it at room temperature, away from excess heat and moisture .
It is important to keep all medication out of sight and reach of children as many containers are not child-resistant and young children can open them easily. To protect young children from poisoning, always lock safety caps and immediately place the medication in a safe location â one that is up and away and out of their sight and reach.
Unneeded medications should be disposed of in special ways to ensure that pets, children, and other people cannot consume them. However, you should not flush this medication down the toilet. Instead, the best way to dispose of your medication is through a medicine take-back program. Talk to your pharmacist or contact your local garbage/recycling department to learn about take-back programs in your community. See the FDA’s Safe Disposal of Medicines website for more information if you do not have access to a take-back program.
Can I Take It With Other Medications
Lamotrigine does not mix well with some other medicines and drugs and may affect the way in which they work. Tell your doctor if you are taking any other medications including over-the-counter medicines for common illnesses and things you put on your skin.
Special information about contraceptive pills containing oestrogen
- When lamotrigine is taken with any type of the Pill containing oestrogen, it lowers the level of lamotrigine that you have in your body.
- If you have a pill-free week, the levels of lamotrigine will then rise, which may give you side effects.
- If you take the Pill without a break, it will make your lamotrigine levels stable. You will not be harmed by not having the break.
- Talk to your doctor or pharmacist before you start taking lamotrigine if you also take the Pill.
- The morning-after pill does not affect the level of lamotrigine in your body as it does not contain oestrogen.
If you have any further questions about this, you should speak to your doctor or pharmacist.
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Lamotrigine And Other Medicines
It is important to tell your doctor or pharmacist what medicines you are already taking, including those bought without a prescription and herbal medicines, before you start taking lamotrigine. Similarly, always check with your doctor or pharmacist before taking any new medicines with lamotrigine, to make sure that the combination is safe. Some key points are:
Valproate is often used in combination with lamotrigine, but it does increase the blood level of lamotrigine. If you’re taking a valproate medicine when you start treatment with lamotrigine, your starting dose of lamotrigine will be increased more gradually than usual. You should carefully follow the instructions given to you by your doctor or pharmacist.
It’s fine to take over-the-counter painkillers like paracetamol or ibuprofen with lamotrigine. However if you find that lamotrigine makes you feel sleepy it may be best to avoid taking painkillers that can cause drowsiness, like co-codamol, as they could make any sleepiness worse.
Combined hormonal contraceptives like the pill or patch can reduce the amount of lamotrigine in the blood and make it less effective, so they’re not usually recommended for women taking lamotrigine. When you start taking lamotrigine your doctor will review your contraception and advise on methods that are safe for you to use.
Other prescribed medicines
Tell The Healthcare Provider About All Medical Conditions And Medications
The first step in preventing side effects is to tell the healthcare provider prescribing lamotrigine about all medical conditions, especially:
- Any history of a rash or skin reactions to other epilepsy medications
- Any history of depression, mood problems, or suicidality
- Any heart problems or heart rhythm problems
- Any history of aseptic meningitis while taking lamotrigine
- Kidney or liver disease
- Pregnancy or pregnancy plans
- Breastfeeding or plans to breastfeed
Some side effects are caused or worsened by combining lamotrigine with other prescription or over-the-counter drugs. Keep a list of all medications being taken and share it with the healthcare provider prescribing lamotrigine. They will especially need to know about oral contraceptives or female hormone replacement therapy.
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What If I Forget To Take It
If you take lamotrigine and you forget a dose:
- once a day take the missed dose as soon as you remember. If it’s less than 12 hours until your next dose is due, leave out the missed dose and take your next dose as normal.
- twice a day take the missed dose as soon as you remember. If it’s less than 8 hours before the next dose is due, it’s better to leave out the missed dose and take your next dose as normal.
Do not take 2 doses at the same time. Never take an extra dose to make up for a forgotten one.
If you have epilepsy, it’s important to take this medicine regularly. Missing doses may trigger a seizure.
If you forget to take your tablets for more than 5 days in a row, speak to your doctor, as you’ll need to start on a low dose again and gradually increase to your usual dose.
If you forget doses often, it may help to set an alarm to remind you.
You could also ask your pharmacist for advice on other ways to help you remember to take your medicine.
Lamictal Black Box Warning
The Lamictal label includes a Black Box Warning the most urgent safety notice possible regarding a severe or life-threatening skin rash, especially:
- In children
- In people who take too high of a starting a dose
- Those who also take Depakene or Depakote
Lamictal patients should seek emergency medical attention if they experience:
- Swelling in the face or tongue
- Burning in the eyes
- Skin pain, followed by a red or purple skin rash that spreads and causes blistering and peeling.
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Lamotrigine In Bipolar Depression Augmentation
In various clinical trials lamotrigine use as an augmentation agent was explored for bipolar disorder with depressive episodes not responsive to typical mood stabilizers. In a randomized, double-blind, 7-week pilot trial, lamotrigine augmentation was compared with citalopram augmentation for bipolar I and II depression . Total MADRS score difference was significant for both lamotrigine and citalopram. compared lamotrigine, risperidone, and inositol in a 16-week, randomized, equipoise-stratified study in subjects with bipolar I or II disorder. Although no significant difference was found between groups for primary outcome, subjects in lamotrigine group remained in the randomized phase significantly longer compared to other groups. in an 8-week, multicenter, double-blind, randomized, placebo-controlled trial studied lamotrigine augmentation to lithium in non-lithium responding subjects, for treating bipolar depression. This study evaluated efficacy of lithium plus lamotrigine for the treatment of acute bipolar depression. MADRS score change was significantly different between groups. Further, subjects were more responsive in lithium plus lamotrigine treated group compared to placebo. In a recent study, reported that in treatment-resistant depressive plasma lamotrigine concentration of 12.7 mol/L may be a threshold for better therapeutic response.
Bipolar Disorder In Bipolar I Disorder
Efficacy of lamotrigine was evaluated in subjects with bipolar I depression in a double-blind, parallel-group, multicenter trial . In this study, lamotrigine 50 mg/d , lamotrigine 200 mg/d , or placebo were given to the patients showing 17-item HDRS score 18. After 7 weeks of treatment, primary measures were not significantly different secondary measures, had a significantly superior response rate on mean ± SD observed scores on 17-item HDRS, CGI-Severity of Illness, and CGI-Improvement in lamotrigine 200 mg/d group. In the four other studies subjects diagnosed with bipolar I disorder were treated with lamotrigine 200 mg/d or placebo. 17-item HDRS total scores or the MADRS was not significantly different in treated or placebo, with the exception of 1 trial . However, CGI-Improvement score was significantly greater with lamotrigine treated group in two studies . suggested that sufficient evidence are not available to recommend use of lamotrigine in the treatment of rapidly-cycling bipolar I.
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