Adult Dosing
Epilepsy adjunct
Lamotrigine, Lamictal
- Patients taking valproate
- Start 25 mg PO every other day x 2 wks, then 25 mg daily x 2 wks. Then increase 25-50 mg/day q1-2 wks
- Max: 400 mg/day; 200 mg/day if valproate alone
- Patients taking carbamazepine (or other enzyme inducers), but not taking valproate
- Start 50 mg PO daily x 2 wks, then 50 mg bid x 2 wks. Then increase by 100 mg/day q1-2 wks
- Max: 500 mg/day
- Patients taking AEDs other than carbamazepine, phenytion, phenobarbital, primidone or valproate
- Start 25 mg PO daily x 2wks, then 50 mg/day divided daily-bid x 2wks. Then increase 50 mg/day q1-2 wks
- Max: 375 mg/day
Lamictal XR
- Patients taking valproate
- Start 25 mg PO every other day x 2 wks, then 25 mg daily x 2 wks. Then increase 50 mg/day qwk x2wk; then increase up to 100 mg/day qwk
- Patients taking carbamazepine (or other enzyme inducers), but not taking valproate
- Start 50 mg PO daily x 2 wks, then 100 mg PO daily x2wk, then increase by 100 mg/day qwk x3wk; then increase up to 100 mg/day qwk
- Patients taking AEDs other than carbamazepine, phenytion, phenobarbital, primidone or valproate
- Start: 25 mg PO daily x2 wk, then 50 mg PO daily x2 wk, then increase 50 mg/day qwk x3 wk, then increase up to 100 mg/day qwk
Epilepsy - Conversion to lamotrigine monotherapy
16 yrs
- Patients taking carbamazepine, phenobarbital, phenytoin, or primidone
- After achieving lamotrigine dose of 500 mg/day, withdraw concomitant AED by 20% decrements qwk over a 4-wk period
- Patients taking valproate
- After achieving maintenance dose of 200 mg/day, decrease valproate to 500 mg/day by decrements no greater than 500 mg/wk, then maintain valproate dose at 500 mg/day for 1 wk. Then increase lamotrigine to 300 mg/day for 1 wk while simultaneously decreasing valproate to 250 mg/day for 1 wk. Finally increase lamotrigine by 100 mg/day qwk to achieve maintenance dose of 500 mg/day and discontinue valproate
Bipolar disorder maintenance; escalation regimen
Lamotrigine, Lamictal
- Monotherapy
- Start 25 mg PO Daily x 2 wks; then 50 mg Daily x 2 wks followed by 100 mg Daily x 1 wk
- Max: 200 mg/day
- Patients taking valproate
- Start 25 mg PO every other day x 2 wks, then 25 mg Daily x 2 wks followed by 50 mg Daily x 1wk
- Max: 100 mg/day]
- Patients taking carbamazepine (or other enzyme inducers), but not taking valproate
- 50 mg PO Daily x 2 wks, then 100 mg/day (in divided doses) x 2 wks. Then 200 mg/day (in divided doses) x 1 wk, then 300 mg/day (in divided doses) x 1 wk
- Max: 400 mg/day
Bipolar disorder; dosage adjustments following discontinuation of psychotropic medicines
Lamotrigine, Lamictal
- Following discontinuation of valproate: 100 mg/day, then increase to 150 mg/day x 1 wk; then 200 mg/day or the dose should be doubled over a 2 wk period in equal weekly increments
- Following discontinuation of carbamazepine or other enzyme-inducers: 400 mg/day x 1 wk, then 300 mg/day x 1 wk, then 200 mg/day or the dose of lamotrigine should remain the same for 1st week and then should be decreased by half over a 2 wk period in equal weekly decrements
- Following discontinuation of other psychotropics: Maintain previous lamotrigine dose
Pediatric Dosing
Epilepsy adjunct
Lamotrigine, Lamictal
- Patients taking valproate
- Safety and efficacy in pediatric patients with acute mood disorders has not been established
- 2-12 yrs: Start 0.15 mg/kg/day PO divided daily-bid x 2wks, then 0.3 mg/kg/day divided daily-bid x 2wks. Then increase 0.3 mg/kg/day q1-2 wks
- Max: 200 mg/day
- Usual dose: 1-5 mg/kg/day; 1-3 mg/kg/day if valproate alone. [Max: 200 mg/day]
- Patients taking carbamazepine (or other enzyme inducers), but not taking valproate:
- 2-12 yrs: Start 0.6 mg/kg/day PO div bid x 2 wks, then 1.2 mg/kg/day divided bid x 2 wks. Then increase 1.2 mg/kg/day q1-2wk
- Usual dose: 5-15 mg/kg/day. [Max: 400 mg/day]
- Patients taking AEDs other than carbamazepine, phenytion, Phenobarbital, primidone or valproate
- 2-12 yrs: Start 0.3 mg/kg/day PO div bid x 2 wks, then 0.6 mg/kg/day divided bid x 2 wks. Then increase 0.6 mg/kg/day q1-2 wks
- Usual dose: 4.5 - 7.5 mg/kg/day. [Max: 300 mg/day]
Lamotrigine, Lamictal
- Patients taking valproate
- >12 yrs: Start 25 mg PO every other day x 2 wks, then 25 mg daily x 2 wks. Then increase 25-50 mg/day q1-2 wks
- Max: 400 mg/day; 200 mg/day if valproate alone
- Patients taking carbamazepine (or other enzyme inducers), but not taking valproate
- >12 yrs: Start 50 mg PO daily x 2 wks, then 50 mg bid x 2 wks. Then increase by 100 mg/day q1-2 wks
- Max: 500 mg/day
- Patients taking AEDs other than carbamazepine, phenytion, phenobarbital, primidone or valproate
- >12 yrs: Start 25 mg PO daily x 2wks, then 50 mg/day divided daily-bid x 2wks. Then increase 50 mg/day q1-2 wks
- Max: 375 mg/day
Lamictal XR
- Patients taking valproate
- Safety and efficacy of extended release lamotrigine in patients below 13 years of age has not been established
- >13 yrs: Start 25 mg PO every other day x 2 wks, then 25 mg daily x 2 wks. Then increase 50 mg/day qwk x2wk; then increase up to 100 mg/day qwk
- Patients taking carbamazepine (or other enzyme inducers), but not taking valproate
- >13 yrs: Start 50 mg PO daily x 2 wks, then 100 mg PO daily x2wk, then increase by 100 mg/day qwk x3wk; then increase up to 100 mg/day qwk
- Patients taking AEDs other than carbamazepine, phenytion, phenobarbital, primidone or valproate
- >13 yrs: Start: 25 mg PO daily x2 wk, then 50 mg PO daily x2 wk, then increase 50 mg/day qwk x3 wk, then increase up to 100 mg/day qwk
[Outline]
Renal Dose Adjustment (Based on CrCl)
- <10 mL/min: Reduce dose by 50%
- Hemodialysis: No supplement
Hepatic Dose Adjustment
- Moderate-severe impairment without ascites: Reduce dose by 25%
- Severe impairment with ascites: Reduce dose by 50%
Discontinuation of Dosing
- Lamotrigine should be decreased about 50% per week over at least 2 wks, unless concerns for safety require more rapid withdrawal
See Supplemental Patient Information
- Serious rashes may occur requiring hospitalization and discontinuation of therapy. Incidence of rashes including Stevens Johnson syndrome has occurred in approximately 0.8% of pediatric patients and 0.3% of adults receiving adjunctive therapy for epilepsy. Rare cases of toxic epidermal necrolysis with and without permanent sequelae and/or death have been reported on postmarketing surveillance [US Black Box Warning]
- Inclusion of valproate in a multidrug regimen may increase the risk of serious, potentially life-threatening rash in pediatric patients. The rate of serious rash has occurred at the rate of 0.08% in adult patients receiving treatment as an initial monotherapy and 0.13% in adult patients receiving treatment as an adjunctive therapy for bipolar and other mood disorders [US Black Box Warning]. Stevens-Johnson syndrome, toxic epidermal necrolysis, angioedema, fever, lymphadenopathy, facial swelling, and hematologic and hepatologic abnormalities may occur leading to hospitalization
- Risk of nonserious rash may be increased when the recommended initial dose and/or the rate of dose escalation is exceeded; patients having a history of allergy or rash to other AEDs are more susceptible
- Hypersensitivity reactions including fatal or life-threatening may occur. Multiorgan failure/dysfunction, including hepatic abnormalities and evidence of disseminated intravascular coagulation may occur. Early manifestations of hypersensitivity (e.g., fever, lymphadenopathy) may be present even though a rash is not evident; on presence of such signs or symptoms immediately is not established
- Multiorgan failure, various degrees of hepatic failure may occur. These manifestations may be fatal or irreversible. Majority of deaths may occur in association with serious medical events, including status epilepticus and overwhelming sepsis, and hantavirus
- Blood dyscrasias may occur which may or may not be associated with the 416 hypersensitivity syndrome. Neutropenia, leukopenia, anemia, thrombocytopenia, pancytopenia, and, rarely, aplastic anemia and pure red cell aplasia may occur
- Therapy is associated with increasing the risk of suicidal thoughts or behavior in patients taking these drugs for any indication. Monitor patients treated with any AED for the emergence or worsening of depression, suicidal thoughts or behavior, and/or any unusual changes in mood or behavior. While considering prescribing use of this drug balance the risk of suicidal thoughts or behavior with the risk of untreated illness. On emergence of suicidal thoughts and behavior consider whether the emergence of these symptoms in any given patient are related to the illness being treated
- Safety and effectiveness of in the acute treatment of mood episodes have not been established
- Safety and effectiveness of in patients <18 yrs of age with mood disorders have not been established
- Worsening of depression and/or the emergence of suicidal ideation and behavior (suicidality) or unusual changes in behavior may occur in patients with bipolar disorders. During the initial few months of therapy, or at times of dose changes, close monitoring should be done for clinical worsening, suicidality, or unusual changes in behavior. Patients having a history of suicidal behavior or thoughts, those exhibiting a significant degree of suicidal ideation prior to commencement of therapy, and young adults are at a higher risk for suicidal thoughts or suicide attempts. Closely monitor such patients during treatment
- Consider changing the therapeutic regimen, including possibly discontinuing the medication, in patients experiencing clinical worsening and/or the emergence of suicidal ideation/behavior especially if these symptoms are severe, abrupt in onset, or are not part of the patients presenting symptoms. Prescribe this drug for the smallest quantity of tablets consistent with good patient management in order to reduce the risk of overdose. Overdoses may occur some of which may prove fatal
- Therapy is associated with increasing the risk for developing aseptic meningitis. As the potential for serious outcomes of untreated meningitis due to other causes exists evaluate patients for other causes of meningitis and treat appropriately. Some of the patients treated with this drug who developed aseptic meningitis had underlying diagnoses of systemic lupus erythematosus or other autoimmune diseases
- Cerebrospinal fluid (CSF) analyzed at the time of clinical presentation in reported cases was characterized by a mild to moderate pleocytosis, normal glucose levels, and mild to moderate increase in protein. CSF, WBC count differentials shows a predominance of neutrophils in a majority of the cases
- Medication errors related to this drug may occur. In particular the names lamotrigine may be confused with names of other commonly used medications. Medication errors have also occurred between the different formulations of this drug
- Concomitant use with oral contraceptives decreases serum concentrations of lamotrigine. Dosage adjustments are essential in most patients who start or stop estrogen-containing oral contraceptives while taking this drug. During the week of inactive hormone preparation ("pill-free" week) of oral contraceptive treatment, plasma lamotrigine levels will rise to double at the end of the week. Dizziness, ataxia, and diplopia may occur in association with elevated levels of lamotrigine
- Avoid abrupt discontinuation of this drug. Unless safety concerns require a more rapid withdrawal, taper the dose of this drug over a period of at least 2 wks (approximately 50% reduction/wk)
- Treatment-emergent status epilepticus may occur in patients. Seizure exacerbation (e.g., seizure clusters, seizure flurries, etc.) may occur
- Sudden unexplained death may occur in epilepsy (SUDEP)
- Valproate is associated with reducing the clearance of lamotrigine, It is essential for using the dosage of lamotrigine in the presence of valproate to less than half of that required in its absence
- Prolong use is associated with raising the possibility of toxicity in the eye and other melanin-containing tissues. Remain aware to the possibility of long-term ophthalmologic effects
- As possible pharmacokinetic interactions between lamotrigine and other drugs including AEDs exists. Monitor plasma levels of lamotrigine and concomitant drugs particularly during dosage adjustments
- Exercise clinical judgment regarding monitoring of plasma levels of lamotrigine and other drugs and whether or not dosage modifications are necessary
Cautions: Use cautiously in
- Renal impairment
- Hepatic impairment
- Cardiac disease
- Depression
- Suicidal tendencies
Supplemental Patient Information
- Prior to initiating treatment with this drug, instruct the patient that a rash or other signs or symptoms of hypersensitivity may herald a serious medical event and advise patients to immediately report such occurrence of events
Pregnancy Category:C
Breastfeeding: Unsafe. Lamotrigine is excreted in breastmilk. Infant plasma concentration averages 30-35% of maternal serum levels. It can cause potentially fatal skin reactions in the breastfed infants. If breastfeeding is continued during therapy, monitor infants for side effects such as rash, drowsiness or poor sucking, including measurement of serum levels to rule out toxicity. Discontinue breastfeeding if rash occurs. This information is based upon LactMed database (available at http://toxnet.nlm.nih.gov/cgi-bin/sis/htmlgen?LACT last accessed 6 April 2011). Manufacturer advises caution. Discontinue breastfeeding if lamotrigine toxicity is evident in infants
Pricing data from www.DrugStore.com in U.S.A.
- LaMICtal 200 MG TABS [Bottle] (GLAXO SMITH KLINE)
60 mg = $409.99
180 mg = $1187.96 - LaMICtal 100 MG TABS [Bottle] (GLAXO SMITH KLINE)
60 mg = $343.99
180 mg = $1012.97 - LaMICtal 25 MG CHEW [Bottle] (GLAXO SMITH KLINE)
30 mg = $176.99
100 mg = $564.99 - LaMICtal XR 300 MG TB24 [Bottle] (GLAXO SMITH KLINE)
30 mg = $589.98
90 mg = $1699.98 - LaMICtal XR 100 MG TB24 [Bottle] (GLAXO SMITH KLINE)
30 mg = $357.99
90 mg = $1037.98 - LamoTRIgine 25 MG CHEW [Bottle] (ZYDUS PHARMACEUTICALS (USA))
30 mg = $89.99
90 mg = $244.94 - LamoTRIgine 150 MG TABS [Bottle] (ZYDUS PHARMACEUTICALS (USA))
60 mg = $31.99
120 mg = $39.98 - LaMICtal ODT 25 MG TBDP [Box] (GLAXO SMITH KLINE)
30 mg = $165.99
90 mg = $459.97 - LaMICtal Starter 25 (42)-100 (7) MG KIT [Box] (GLAXO SMITH KLINE)
49 mg = $270
147 mg = $789.99 - LamoTRIgine 25 MG TABS [Bottle] (ZYDUS PHARMACEUTICALS (USA))
100 mg = $29.99
200 mg = $49.98 - LaMICtal XR 200 MG TB24 [Bottle] (GLAXO SMITH KLINE)
30 mg = $365.98
90 mg = $1085.95 - LamoTRIgine 100 MG TABS [Bottle] (ZYDUS PHARMACEUTICALS (USA))
100 mg = $29.99
200 mg = $49.98 - LamoTRIgine 200 MG TABS [Bottle] (ZYDUS PHARMACEUTICALS (USA))
60 mg = $31.99
120 mg = $39.98 - LaMICtal ODT 100 MG TBDP [Box] (GLAXO SMITH KLINE)
30 mg = $199.98
90 mg = $575.97 - LaMICtal 150 MG TABS [Bottle] (GLAXO SMITH KLINE)
60 mg = $374.99
180 mg = $1096.97 - LaMICtal 25 MG TABS [Bottle] (GLAXO SMITH KLINE)
60 mg = $304.99
180 mg = $892.96
Warning: This pricing information is subject to change at the sole discretion of DS Pharmacy. For the most current and up-to-date pricing information, please visit drugstore.com.