lamotrigine

Question 1

important advice re side effects

Answer 1

Serious skin reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis have developed (especially in children)

Question 2

rash - what could this be

Answer 2

SJS
Toxic epidermal necrolysis
Most rashes occur in the first 8 weeks

Rash is sometimes associated with hypersensitivity syndrome and is more common in patients with history of allergy or rash from other antiepileptic drugs.

Question 3

Most rashes will occur within what time frame

Answer 3

first 8 weeks

Question 4

Factors associated with increased risk of serious skin reactions include (3)

Answer 4

concomitant use of valproate, initial lamotrigine dosing higher than recommended, and more rapid dose escalation than recommended.

Question 5

Antiepileptic hypersensitivity syndrome associated with lamotrigine?

Answer 5

yes

Question 6

monitoring in pregnancy

Answer 6

Plasma-drug concentration should be monitored before, during, and after pregnancy, including shortly after birth, and doses adjusted according to response—plasma levels alter during pregnancy and may increase rapidly after birth.

Question 7

treatment cessation, including for rash

Answer 7

Avoid abrupt withdrawal (taper off over 2 weeks or longer) unless serious skin reaction occurs.

If rash occurs consider discont

Question 8

which class of whether brands can be changed

Answer 8

2
may need to be maintained

Question 9

patient and carer advice - 2 SE to report

Answer 9

Skin reactions
Warn patients and carers to see their doctor immediately if rash or signs or symptoms of hypersensitivity syndrome develop.

Blood disorders
Patients and their carers should be alert for symptoms and signs suggestive of bone-marrow failure, such as anaemia, bruising, or infection. Aplastic anaemia, bone-marrow depression, and pancytopenia have been associated rarely with lamotrigine.

Question 10

It may exacerbate this neurological disorder

Answer 10

PD

Question 11

what category is it in

Answer 11

2

Question 12

it is used as adjunctive therapy in this mood disorder

Answer 12

bipolar disorder

Question 13

it is indicated as adjunctive therapy of these seizures (3)

Answer 13

focal seizures
primary & secondary generalised tonic clonic seizures
lennox-gastaut syndrome

Question 14

most SE are to d owith..

Answer 14

effects on CNS and sedation - if two or more drugs that have effects on CND, can increase risk of CNS depressant effects

Question 15

interaction with valproate

Answer 15

it increases exposure to lamotrigine. adjust lamot dose and monitor rash

Question 16

concomitant use with this drug increases risk of severe skin reactions

Answer 16

valproate