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Knowing The Lamictal Side Effects

Lamictal Weight Loss And Other Antidepressants

Weight gain is a very real concern for most patients. Unfortunately , the majority of medications used to treat bipolar disorder have some degree of weight gain associated with them. Both lithium and depakote (valproate) are associated with weight gain, the mechanism of which is not understood.

The weight gain from depakote may be associated with polycystic ovarian syndrome, but mostly it occurs independently of the condition. Weight gain from the anti-convulstants may not occur in everyone, so it need not immediately rule out a potentially effective treatment. It is important to maintain good nutrition and healthy eating habits,as well as partake in regular exercise, to help offset the weight gain risks. Being cognizant of any appetite- including effects of the medicine can help you resist urges to eat more as well.

Of the atypical antipsychotics, Geodon (ziprasidone) and Abilfy (aripiprazole) appear to have the least overall risk for weight gain, while clozaril (clozapine) and zyperxa (olanzapine) appear to have the higher risk.

Aside from the obesity, there is the associated risk of metabolic syndrome atypical antipsychotics as well. Anitconvulsants with lower risk of weight gain include lamictal (lamical weight loss, lamotrigine) and topamax (topiramate), although topiramate does not have FDA approval for bipolar disorder. At the same time  Lamictal side effects is famous.  Topamax (topiramete) has been studied independently as a potential weight loss agent and has been reported to reverse the weight gain cause by other agents.

In terms of the antidepressants, the older antidepressants have been classically associated with weight gain (tricyclics, monoamine oxidase inhibitors). When the SSRIs first entered the market, they were believed to have no associated weight gain as a group, and some even were found to cause weight loss (e.g., Sarafem (fluoxetine).  Keep in mind that side effect profiles are typically developed from the early studies of medications, which are conducted over the short term (I.e, several weeks). In clinical practice, however, many physicians have found that SSRQs can be associated with weight gain over the long term.

Although clinical trials have typically found that weight gain does not differ significantly from placebo, uncontrolled studies have noted weight gain over the long term. Paxil appears to be more associated with weight gain clinically than the other SSRI s. Celxa has been reported to have early weight gain. There may be an increase in carbohydrate craving associated with SSRIs as a possible mechanism. Bupropion is one antidepressant that does not have weight gain associated with it and can be considered as one treatment option. More long term controlled studies are need to compare weight gain over time between antidepressant users and those who are not. Keeping in mind the potential for weight gain, good nutrition and exercise should be part of the treatment with antidepressant as well.

Ultimately, the risk for weight gain needs to be balanced against the risk for untreated bipolar disorder. Close monitoring of weight and vigilant efforts to prevent the initial weight gain can be very effective in limiting the amount that is gained. Weight gain on one agent does not necessitate the same on another agent, so different trials may be needed as well.

Lamictal Hair Loss And Other Side Effects Of Anticonvulsants

In the psychiatric mental health area, anticonvulstants are commonly used to treat bipolar disorder and are also considered mood stabilizer.  Valproate, carbamazepine and lamictal have FDA approval for the treatment of bipolar disorder, mania or mixed episodes. Other anticonvulsants, such as topiramate, oxcarbazepine and gapapentin are used off label as adjunctive treatments. In general, the anticonvulsant mood stabilizers have many actions, but it is their effects on ion channels, reducing repetitive firing of action potentials in the nerves, the most directly decreases manic symptoms. In addition, carbamzepine affects the release and reuptake of several neutortransmitters, including norepinephrien, GABA, dopamine and glutamate. It also changes several second messenger systems. No one action has successfully accounted for the anticonvulsants ability to stabilize mood.

The most common side effects of carbamazepine are dizziness, drowsiness, tremor, visual disturbance, nausea, and  vomiting. These side effects may be minimized by initiating treatment in low lamictal dosage. Patients should be advised that these symptoms will diminish, but care should be taken when changing positions or performing tasks that require visual alertness. Giving the drug with food may diminish nausea. Adverse reactions include rare, aplastic anemia, agrnulocytosis, severe lamictal rash, rare cardiac problems and AIADH due to hyponatremia.

Valproic acid also causes gastrointestinal disturbance tremor, and lethargy. In addition, it can produce weight gain and alopecia (hair loss). These symptoms are transient and should diminish with the course of treatment. Dietary supplements of zinc and selenium may be helpful to patients experiencing hair loss. Constipation and urinary retention occur in some individuals. It should monitor urinary output and assist patients to increase fluid consumption to decrease constipation.

Benign skin rash, sedation, blurred or double vision, dizziness, nausea, vomiting and other gastrointestinal symptoms are side effects of lamictal. Normally lamictal hair loss is not reported. One can use dietary supplements of zinc and selenium to reduce lamictal hair loss.  In rare cases lamictal produces severe, life threatening rashes that usually occur witihn 2  to 8 weeks of treatment. This rash is highest in children. Use of lamictal should be immediately discontinued if a rash is noted.

Transient elevations in liver enzymes occur with both carbmazepine and valproic acid but rarely do symptoms of hepatic injury occur. If the patient reports abnormal pain or show signs of jaundice the prescriber should be notified immediately. Several blood syscrasias are associated with carbanazepine, including aplastic anemia, arganulocytosis and leukopenia. Patients should be advised to report fever sore throat, rash petechiae or brushing immediately. In addition advise patients of the importance of completing routing blood tests throughout treatment. The increased risks for aplastic anemia and agranulocytosis with carbamazepine use still require close monitoring of CBCs during treatment. Valproate and its derivatives have had a similar course of development.

Of the off label mood stabilizers has relatively few lamictal side effects. Topanax carries an increased risk of kidney stone formation. It can also cause a decrease of oral birth control agents. In addition, ongoing ophthalmologic monitoring is required because of reports of acute myopia with secondary glaucoma.

Lamictal Pregnancy

Significant differences in the risk for MCM have been reported by two of the largest pregnancy registries, though the rate of MCM was similar. The UK epilepsy and pregnancy register noted a positive dose response relationship for MCMs with lamictal with a MCM rate of 5.4% for total daily doses for more than 200 mg. This MCM rate was similar to that in those receiving valproate at a dose of 1000mg or less.  While there was a trend towards lamictal being associated with fewer MCMs than valproate, the differences were minimized in those infants exposed to a dose of lamictal of more than 200 mg each day. The north American AED registry of pregnancy stated a 10.4 fold hike in unique cleft lip or cleft plate irregularity, but the abnormality has not been confirmed in the European and UK Surveillance of congential Anomalies registers.

The international lamictal pregnancy registry concluded that the risk of all major birth defects after first trimester exposure to lamictal mono therapy was similar to that in the general population, but this was considered to be an overestimate by the other authorities, who suggested that a more accurate conclusion may be the risk of major malformations associated with first trimester exposure to lamictal is only about twice that of the general population… when similar definitions, inclusions and case identification strategies are used. Furthermore, it would be even more difficult to assess the risks of MCM with lamictal precisely without TDM, if the finding of a dose related effect is replicated, because of the significant decrease in plasma levels of lamictal in the first trimester of lamictal pregnancy.

In poly therapy with lamictal and other AEDs, the risk of MCM is 5.3 percent and this doubles to around ten percent in combination with valproate. Alarmingly, lamictal and valporate is the most frequently used AED combination in pregnancy according to the recent EURAP report, despite the fact that it may harm one in ten exposed babies. This is twice the frequency seen with any other combination and indicated a lack of information reaching those prescribing AEDs for women; the messages either do not get through or are unclear. Lamictal has been downgraded to pregnancy category D by the Australian regulatory administration.

The discovery of lamictal´s positive effects on mood in epilepsy patients led to its investigations in and eventual approval for treating bipolar affective disorder. Although the exact mood stabilizing mechanism of action for this novel anticonvulsant is unknown, it is thought to work by inhibiting voltage sensitive sodium currents, in this manner stabilizing neuronal membranes and as result modulating the presynaptic transmitter release of excitatory amino acids such as glutamate. Although there is some suggestion that lamotrigine may have some beneficial effect in the treatment for unipolar depression, available evidence points to a primary role as a mood stabilizer in bipolar disorders that has moderate to marked acute and prophylactic antidepressant efficacy, only modest antimanic prphylaxis and no acute antimanic efficacy. Current data are strongest for bipolar 1 disorder. Its role in bipolar two is in need for further systematic studies.

Lamictal Bipolar

Lamictal was initially examined in a double blind, placebo controlled study of lamictal mono therapy for the acute treatment of BD type 1 depression. More recently, this study was included in a review of five double blind, placebo controlled trials, all of which assessed the efficacy of lamictal in the acute treatment of bipolar depression. Although there is a wide spread belief that lamictal is antidepressant in bipolar disorder, the overall pooled effect was modest at best. The advantage of lamictal over placebo was greater in the more severely depressed participants and the slow dose titration necessary to minimize the risk of dangerous rashes may mitigate against and antidepressant effect fully manifesting in the time frame of acute treatment studies.

Two longer term studies compared the effectiveness of lithium and lamictal bipolar monotherapy over a period of eighteen months in 638 patients with BD type 1 and recent episodes of mania or depression. Bowden and colleagues demonstrated that placebo at prolonging the time to intervention for a depressive episode. Calabrese and co-workers also found that lamictal significantly prolonged time to a depressive episode. A pooled analysis of data from these trials showed that lamictal, but not lithium, was superior to placebo at delaying the time to intervention for a depressive episode. Lamictal is therefore typically used for the depression relapse in lamictal bipolar disorder, although this is likely to be most effective in patients who have some history of lamictal responsiveness.

The use of adjunctive lamictal for bipolar depression was recently evaluated in a 8 week, double blind randomized, placebo controlled trial; the results showed the lamictal in combination with lithium was superior to lithium monotherapy. However, a systematic treatment enhancement program for bipolar disorder study of open label lamotrigine, inositol or risperidone as adjuncts to a mood stabilizer for up to sixteen weeks in patients with treatment resistant BD type 1 or type II depression found no significant between group differences.

A comparison of the adjunctive use of lamotigine and lithium in the long term treatment of BD was carried out in an open, randomized trial. Patients were randomized to receive lithium or lamictal for up to six years, with concomitant pharmacologic therapy allowed for the first six months of the study period. No differences were noted between lamictal and lithium when used as adjunctive therapy with respect to the primary out come measure.

The adjunctive use of antidepressants is a common approach to the treatment of bipolar depression. A systematic review and meta analysis of five acute, randomized, double blind controlled trials compared the use of antidepressants or placebo as adjuncts to a mood stabilizer in patients with BD and a current depressive or mixed episode. The conclusion about this statement is that antidepressants were more effective adjunctive therapy than placebo, and moreover, were not associated with higher incidence of switching to mania.

The long term use of adjunctive antidepressants in patients with BD type 1 or type II depression was evaluated in a large 26 weeks, double blind, randomized, placebo controlled study. The primary outcome was durable recovery, defined as euthymia for at least eight consecutive weeks. Adjunctive treatment with paroxetine or bupropion did not significantly increase the rate of durable recovery compared with the use of mood stabilizers  alone.

Lamictal Depression

Lamictal is another mood stabilizer, also used for complex partial seizures, that in adults has been FDA approved for the treatment of depression in bipolar disorder. Lamictal is an extremely good medication for treating depression in youth with bipolar disorder without activating mania. Lamictal is often added to other medications for bipolar disorder such as Depakote. Like Depakote and Tegretol, Lamictal has a number of drug interactions, so your child´s blood levels should be monitored.

Major side effects of Lamictal are a skin rash, which can be serious, blurred and double vision, tiredness and dizziness. In adults, typical dosing of Lamictal is 150-250 mg twice daily. Dosing for childhood mood instability has not been established although we typically use between 150 mg and 300 mg daily. The dose of Lamictal should be increased very slowly in weekly increments by no more than 25 mg to avoid the risk of a rash. Many practitioners start the medication at 12.5 mg and increase it in 12.5 mg increments rather than 25 mg increments. The rash associated with Lamictal can be of two major types: a more minor rash that is typically on the trunk of the child that occurs in up to one out of ten children and a very serious rash, necessitating emergency care, that affects not only the body but the mouth, hands and feet of the child with blisters and loss of skin.

There are many important drug interactions with lamictal. Anticonvulsants that tend to slow liver metabolism (such as valproate) greatly raise the lamotrigine level. This explains the increased risk of Steve Johnson syndrome from the combination of lamotrigine and valproate. In contrast, lamotrigine levels are reduced in the presence of anticonvulsants that have revved up the liver such as carebamazepine, phenytoin and phenobarbital. Lamotrigine usually does not conversely alter the drug levels of the other anticonvulsants themselves. However, the combination of lamotrigine and carbamazepine  metabolites that are not measured with normal drug level tests.

The major worrisome possible side effect of lamotrigine is a rash in 10 percent of patients, which can progress to the severe condition called Steven Johnson syndrome. According to the manufacturers package insert, lamictal should ordinarily be stopped at the first sign of a rash unless there is another explanation for the rash. Risk factors of Stevens Johnson from lamictal include patient age being less than 16 years old: and apparently also, the simultaneous use of valproate or the rapid upward titration of the lamictal as it is being introduced.

Lamictal Weight Gain

Although lamictal was originally synthesized as a folate antagonist, it has very weak activity in that regard. Lamotrigine is a member of the phenyltriazine class and is believed to work by blockade of voltage sensitive sodium currents, slow binding of inactivated sodium channels, blockade of voltage activated calcium currents, inhibition of presynaptic N type calcium channels, and inhibition of glutamate and aspartate release. It inhibits the sodium channel in a manner that is different from other sodium channel inhibiting drugs such as phenytoin and carbamazepine.

Lamictal is approved as adjunctive therapy for patients 2 yr or older with partial seizures and for patients with Lennox Gastaut Syndrome. It can be used as monotherapy in patients being converted from carbamazepine, phenytoin, phenobarbital, primodine, or valproate monotherapy and is effective in a wide range of seizures, including partial, primary generalized tonic clonic, myoclonic, and absence. Lamotrigine is also indicated for the treatment of bipolar disorder. The reported ragne of effective concentrations is 2.5 -15mg/L

The pharmacokinetics of lamictal appear to be linear. It reaches peak concentrations in 1.4 to 4.8 hr and bioavailability is believed to be approximately 100%. Administration with food may reduce the maximum peak concentration but does not alter the total amount of drug absorbed. While the amount absorbed from the dispersible tablet given rectally is not the same as the amount following oral administration, there is adequate absorption to make this an alternative route of administration. Absorption also occurs when the compressed tablet is given rectally. The volume of distribution is 0.9 to 1.3 L/Kg, and the clearance averages 0.076 L/hr/kg. Lamotrigine is about 55 percent bound to plasma proteins and is metabolized predominately by glucuronidation catalyzed by UDPGT in the liver to inactive metabolites that are excreted renally.

Lamictal does not affect the metabolism of other drugs and does not affect the concentration of carbamazepine or its active 10, 11 di epoxide metabolite. Side effects may be increased in patients taking carbamazepine with lamotrigine is added, suggesting a potential pharmacodynamic interaction . Concurrent use of oral contraceptives in patients on lamotrigine has been reported to result in a decrease in lamotrigine concentrations and breakthrough seizures.

The most common side effects of lamotrigine are headache, nausea, vomiting, ataxia, somnolence, dizziness, sedation, blurred vision and diplopia. The incidence of CNS effects is increased in patients taking carbamazepine concurrently. The most troublesome side effects is skin rash, which generally occurs in the first 3-4 weeks of therapy. The initial rash is usually a generalized, erythematous, morbiliform rash that may progress to stevens johnson reaction or toxic epidermis necrolysis. It occurs more frequently in children than in adults and high starting doses rapid dosage titration and concurrent valproic acid therapy increase the incidence of rash. Therefore, the ode of lamotrigine should be started low and gradually titrated to the patients response. Doses up to 700 mg/day have been well tolerated. Patients who have been temporarily discontinued from lamotrigine in an epilepsy monitoring unit can be restarted with a single oral loading dose.

Lamictal dosage

Lamictal is another very nice option for treating unstable mood disorders. It is taken once a day; there are no blood tests and usually no side effects. All medications can cause allergic reactions. A person´s chance of having allergic reaction to Lamictal is greatly increased if the dosage is raised too quickly. Therefore, Lamictal is always titrated (increased slowly until the best dose is found). It has been well established in both Germany and the United states that the risk of allergic reaction is only 0.08% if the dose is raised according to certain guidelines. In patients who are taking any other medications known as “enzyme inducing” anticonvulsants, such as carbamazepine (Tegretol), the dosage is started at 25 mg daily for two weeks and then increased 25 mg per day, every two weeks. For patients who are not on these enzyme-inducing anticonvulsants, the dose can be raised at twice the speed. The dosage would begin with the same 25 mg per day for the first two weeks and then 50 mg per day for weeks three and four. The daily dose then can be increased by 50 mg every two weeks until the 500 -700 mg range is reached. It has been published that lamictal is effective in treating unstable mood at a dose of 200 mg a day. It is necessary, however, to understand how the research studies define “effective.” The Federal Drug Administration (FDA) only requires the medication to reduce mood symptoms by half to be shown effective; it is not necessary to eliminate the symptoms. Since patients are interested in the absence of symptoms, not merely reducing them, it is common with Lamictal to have to work up to a dose of 500 to 700 mg a day in order to completely achieve stability. Far too many people have given up on lamictal at doses of 200 mg a day because of this mistaken belief about how effectiveness is defined.

It is possible, but uncommon, to see the earliest clinical benefit three weeks into this titration; more usual to see the symptoms cut in half by the end of two months, then to see symptoms eliminated in approximately five months. Should any rash develop, the patient should stop taking the Lamictal and immediate medical consultation should be obtained. This may be the beginning of the allergic reaction of most concern, Stevens-Johnson Syndrome (SJS). SJS is an immune reaction of person’s body that affects the skin. Untreated, it can rapidly progress to a life-threatening status. Often, early rashes that will progress to SJS will be particularly itchy or painful, though it is never safe to try and draw too many conclusions from these two symptoms alone.

Every single medicine may provoke Stevens-Johnson Syndrome.  For most, the risk is so tiny that no one talks about it. The reason it is discussed as a side effect of Lamictal is because an increased risk was observed when the dose was raised too rapidly. It is now felt that an effective and safe dosing schedule has been worked out in order to minimize the risk of Stevens-Johnson Syndrome. If, for any reason at all, a patient is off lamictal for more than five days it must be restarted at the original starting dose.

Lamictal withdrawal

Lamotrigine (lamictal), another anticonvulsant used in the treatment of epilepsy is being used more and more for people with bipolar depression. It has become fairly popular in the last 10 years because of its mild side effect profile and its ability to prevent depressive episodes without causing a switch into mania or hypomania. A meta-analysis of five randomized trials found that it has modest effects on the acute treatment of bipolar depression . As illustrated by the young woman quoted above, it is most effective for people who have more severe bipolar depression when they start treatment (for example, intensely sad mood that rarely lifts, nightly sleep disturbance, severe problems with inertia) and less effective with people whose depressions arc milder (i.e., feeling tearful and sad but still able to function with extra effort).

Lamotrigine is somewhat better than lithium in protecting people against depressive relapses, but not as good as lithium in preventing manic relapses. Lamictal is often recommended as an adjunct to lithium for stabilizing depression or preventing recurrences. It also seems to be effective for people with rapid cycling bipolar II disorder, which is characterized by frequent episodes of depression that never fully remit. Sometimes it is prescribed, usually in combination with other drugs, when people with manic or mixed episodes don’t respond well to other medications. It is not a particularly good treatment for mania by itself.
Lamotrigine is easier to take than lithium or valproate because it is less likely  to cause serious weight gain, tremors, or other unpleasant side effects. Typically the side effects are temporary and include problems with physical coordination, dizziness, vision, nausea, vomiting, and headaches. Nonetheless, there are some concerns about this drug because 5-10% of people who use it develop a benign skin rash within 2 to 8 weeks of beginning treatment. This typically mild rash can, in rare instances (about 1 in 1 ,000), lead to more serious skin

conditions such as Stevens-Johnson syndrome, a potentially life-threatening condition involving a blistering or burning of the skin tissue or lining of the mucous membranes, often accompanied by fever. Rashes are more likely when doctors increase the dosage of lamictal too quickly or combine it with divalproex. Only a small proportion of rashes develop into Stevens-Johnson syndrome, but doctors are usually conservative and stop prescribing lamictal at the first indication of a rash.

Your doctor can try to prevent rashes by increasing your dosage very slowly to bring you up to a therapeutic level. Generally, doctors recommend starting at 25 mg per day and then gradually increasing the dosage for the first 4-6 weeks until you are getting some therapeutic benefit.

Lamotrigine/Lamictal Side Effects Tablets 5 mg Dispersible / Chewable

Like all medicines, Lamictal can cause side effects, although not everybody gets them.

Allergic reactions or Lamictal skin reactions potentially serious, consult your doctor immediately.

A small number of people taking Lamictal have allergic reactions or skin reactions potentially serious. If untreated, these reactions can worsen or even be fatal.

Symptoms of these reactions include:
• rash or redness
• ulcers and sores in the mouth or eyes
• high temperature (fever), flu-like symptoms or sleepiness (somnolence)
• swelling of face or swollen glands in the neck, armpits
• bleeding or bruising unexpectedly, or fingers to turn blue
• sore throat, or have more infections than usual (such as colds).
In many cases, these symptoms may be signs of less serious side effects. But you should be aware that these are potentially serious, if you have any of these symptoms of lamictal side effects:
See a doctor immediately. Your doctor may decide to do tests to assess liver function, kidney or blood and can also tell you to stop Lamictal.

Very Common Side Effects
They affect more than 1 in 10 persons:
• headache
• dizziness
• sleepiness or drowsiness
• clumsiness and loss of coordination (ataxia)
• double vision or blurred vision
• nausea or vomiting
• rash

Common Side Effects
They affect up to 1 in 10 people:
• aggression or irritability
• rapid eye movements and uncontrollable movements (nystagmus)
• muscle spasms or tremors
• trouble sleeping
• diarrhea
• dry mouth
• tiredness
• back pain or joint, or elsewhere.

Rare Side Effects
They affect up to 1 in 1,000 people:
• Itching of eyes, with discharge and crusting of the eyelids (conjunctivitis)
• rare skin disease in which severe blisters and bleeding in the lips, eyes, mouth, nose and genital area (Stevens Johnson Syndrome)

Very Rare Side Effects
They affect up to 1 in 10,000 people:
• hallucinations ( seeing things that are not really).
• confusion or agitation.
• trembling or unsteady feeling moved.
• body movements (tics), muscle spasms affecting the eyes, head and torso  or other unusual movements such as shaking, spasms or stiffness
• severe skin reaction, this reaction begins with the appearance of a painful red area then large blisters appear and finally, these vesicles are shed layers of skin (toxic epidermal necrolysis).
• in people who have had epilepsy, seizures occur more frequently.
• changes in liver function, which can be observed in blood or liver failure.
• changes which may occur in the blood, including reduced number of red blood cells (anemia), reduced number of white blood cells.
reduced number of platelets , reduced number of all types of blood cells , and disruption of the spinal cord called anemia.
• abnormal blood clotting, which can cause bleeding or bruising unexpected appearance (DIC).
• high temperature (fever) lamictal side effects.
• swelling around the face (edema) or swelling of the glands in the neck or armpits .
• in people with Parkinson’s disease, worsening of symptoms.
If you have side effects
If any side effects gets serious, or if you notice any side effects not listed in this leaflet, tell your doctor or pharmacist.