EPILEPSY: LAMOTRIGINE

Question 1

Which type of epilepsy is lamotrigine mainly used for?

Answer 1

• T-C
• A
• Focal

Question 2

What are the other uses of lamotrigine apart from epilepsy?

Answer 2

• Monotherapy in bipolar
  or
• Adjunct therapy for bipolar with sodium valproate

Question 3

Cautions

Answer 3

• Parkinson’s (may be exacerbated)
• Myoclonic seizures (may be exacerbated)

Question 4

Side effects

Answer 4

• Diarrhoea
• Dry mouth
• N&V
• Skin reactions
• Blood disorders

Question 5

Serious side effects to look out for

Answer 5

• Skin reactions
• Blood disorders

Question 6

Skin reactions

Answer 6

• SJS
• toxic epidermal necrolysis

Question 7

Blood disorders

Answer 7

Aware of symptoms suggestive of bone marrow failure
* anaemia
* bruising
* bleeding e.g. nose bleeds
* infection

Question 8

When are skin reactions most like to occur and to who when taking lamotrigine?

Answer 8

• AHS
• SJS
• 8 weeks
• PMHx of allergy or rash from other AEDs
• Concomitant use of SV
• Initial dose higher than recommended

Question 9

What happens if a patient experiences a rash whilst on Lamotrigine?

Answer 9

• Don’t stop abruptly unless serious skin reaction occurs
• 8 weeks

Question 10

Valproate and lamotrigine

Answer 10

Valproate increases Cp of lamotrigine = increase SEs such as SJS

Question 11

Lamotrigine + hormonal contraceptives

Answer 11

• EHC and pills can reduces effectiveness of lamotrigine

Question 12

Can lamotrigine be taken in pregnancy?

Answer 12

Yes
- But the dose should be adjusted on the basis of drug-plasma concentration

Question 13

Can lamotrigine be taken in
breastfeeding?

Answer 13

Yes
- But infants must be monitored for any ADRs

Question 14

Can lamotrigine be administered in patients with hepatic impairment?

Answer 14

• Yes, BUT..
• In moderate impairment, half dose
• In severe impairment, a quarter dose