Mood Stabilisers: Lamotrigine

Question 1

What are the indications of lamotrigine?

Answer 1

Used to treat bipolar depression. It is less teratogenic than the other mood stabilizers and therefore usually the drug of choice in women of child bearing age. Lamotrigine does not treat or prevent manic episodes.

Question 2

What is the mechanism of action of lamotrigine?

Answer 2

Lamotrigine is thought to work by inhibition of sodium and calcium channels in presynaptic neurons and subsequent stabilization of the neuronal membrane.

Question 3

What are the side effects of lamotrigine?

Answer 3

GI disturbances, rash (in around 5% of patients), headache and tremor.

Question 4

What are the contraindications of lamotrigine?

Answer 4

A combination of lamotrigine and carbamazepine may cause neurotoxicity.

Question 5

What monitoring is required for lamotrigine?

Question 6

How may antiepileptic hypersensitivity syndrome present?

Answer 6

Inform patients to see doctor if signs of hypersensitivity e.g. severe rash, fever, lymphadenopathy (antiepileptic hypersensitivity syndrome).

Question 7

What is the dose of lamotrigine?

Answer 7

Must be initiated very gradually beginning at 25 mg daily.

Avoid abrupt withdrawal (unless serious Stevens– Johnson rash).

Question 8

What is the route of administration of lamotrigine?

Answer 8

Oral.