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Published in Henry J. Woodford, Essential Geriatrics, 2022
Lamotrigine's potential adverse effects include rash, insomnia and tremor. Doses have to be slowly titrated upwards at two-week intervals and takes around six weeks to reach the lower end of the therapeutic range. Sodium valproate may cause tremor and weight gain. There is some limited evidence from heterogeneous populations (also used as a mood stabiliser) that it could occasionally cause parkinsonism.49 There have been rare reports of valproate-induced hyperammonaemic encephalopathy.50 Carbamazepine tends to be the least well tolerated AED in older people.47,48 It has a higher risk of drug interactions and hyponatraemia (secondary to SIADH).46 It can also cause a rash. It is usually best avoided in older people.39 When prescribed, controlled release formulations may cause fewer adverse effects.43 Gabapentin is associated with weight gain, tremor and ataxia. Possible adverse effects from levetiracetam include reduced concentration, drowsiness, depression, agitation and irritability.39 Psychosis has also been reported with levetiracetam and topiramate.51 Psychiatric disorders were the commonest adverse event with levetiracetam (26–30% of relatively young people in randomised studies).44,45 AEDs can increase the risk of osteoporosis.
Mood Disorders
Published in Vincenzo Berghella, Maternal-Fetal Evidence Based Guidelines, 2022
Madeleine A. Becker, Tal E. Weinberger, Leigh J. Ocker
Lamotrigine is excreted in relatively high levels in breast milk. Infant serum levels are approximately 30% of maternal levels, likely because of slow, immature elimination in infants. This has resulted in some concern about the safety of lamotrigine during breastfeeding. However, despite this, no clinically relevant adverse effects have been consistently described. One case report of apnea that resolved with the discontinuation of breastfeeding, and one case of toxicity have been reported, and some infants have demonstrated mild thrombocytosis of no clinical significance [217]. Breastfed infants of mothers exposed to lamotrigine in utero and through breast milk (for the treatment of epilepsy) demonstrated no cognitive deficits at ages 3 and 6, compared to those with perinatal exposure who did not breastfeed [210, 218]. It is reasonable for mothers taking lamotrigine to breastfeed if desired, given rare and generally mild adverse effects related to exposure, despite high milk concentration of this drug, as long as the infant is monitored closely. Some authors recommend monitoring serum lamotrigine levels in breastfeeding infants [217] (Table 21.2).
Meta-Analysis with Binary Data
Published in Ding-Geng (Din) Chen, Karl E. Peace, Applied Meta-Analysis with R and Stata, 2021
Ding-Geng (Din) Chen, Karl E. Peace
Bipolar disorder is a psychiatric condition historically known as manic-depressive disorder. Bipolar disorder is among the top causes of worldwide disability and is characterized by both depressive and manic episodes as described in Geddes et al. (2009). Bipolar disorder is a lifelong recurrent illness and there is no known cure. Patients usually require long-term treatment with psychotherapy drugs to control symptoms. Lamotrigine is one of several drugs used in the treatment of bipolar disorder. It is an anticonvulsant and has been approved by the US FDA as an adjunctive treatment for epilepsy and for maintenance treatment for Bipolar I disorder. Lamotrigine is marketed in the USA and in some European countries as “Lamictal” by GlaxoSmithKline.
An update on potential pharmacotherapies for cognitive impairment in bipolar disorder
Published in Expert Opinion on Pharmacotherapy, 2023
Danica E. Johnson, Roger S. McIntyre, Rodrigo B. Mansur, Joshua D. Rosenblat
Its mechanism of action may explain the potential pro-cognitive effects of lamotrigine. Compared to healthy controls, BD patients exhibit significantly greater activation in several brain regions, which correlates with poor performance on working memory tasks [52]. Neuronal hyperactivity also causes a neurotoxic cascade whereby excessive glutamate release triggers excitotoxic cell death, which could potentially cause permanent cognitive dysfunction [49]. Lamotrigine dampens neuronal hyperactivity by reducing glutamate release and inhibiting voltage-gated sodium and calcium channels [49]. Therefore, the ability of lamotrigine to decrease neuronal activity and consequently prevent further excitotoxic cell death may explain the improvements in cognition demonstrated after therapy. This will need to be explored further in future studies.
What’s Going on with Lamotrigine (Lamictal)? An Updated Look at the Popular Medication for Bipolar Disorder
Published in Issues in Mental Health Nursing, 2022
In my own clinical experience over the past 10 years, lamotrigine is a valuable medication for many patients, and I have seen countless individuals use it with great success. As it stands, the literature does not currently support a reflexive withdrawal of lamotrigine in situations when the patient has achieved long-term stability with the medication, and it does not support an overt avoidance of the medication. We cannot ignore the FDA’s safety warning, however, and must always properly educate our patients about the risks of the agent when discussing it as an option. In conclusion, it is probably wise to avoid overuse of lamotrigine in individuals with complex cardiac histories—at least for now—but I think we have sufficient evidence to continue promoting the use of the medication when clinically appropriate.
Interactions of antiepileptic drugs with drugs approved for the treatment of indications other than epilepsy
Published in Expert Review of Clinical Pharmacology, 2020
Kinga K. Borowicz-Reutt, Stanisław J. Czuczwar, Marta Rusek
Acute administration of bupropion leads to a biphasic effect in the MES model in mice. This antidepressant applied at lower doses demonstrated clear anti-electroshock activity with ED50 value of 19.4 mg/kg. At higher doses, it induced convulsions per se in mice with a CD97 value of 139.5 mg/kg [59,60]. Similarly, to reboxetine, bupropion reduced kainate-induced seizures in rats and PTZ-evoked convulsions in zebrafish larvae but facilitated pilocarpine-induced seizures in mice. However, this antidepressant did not exhibit any significant effect on other types of chemical seizures in mice, e.g., those induced by PTZ, kainate, or fluorothyl [49,56,59]. Chronically administered bupropion (5 mg/kg) increased the threshold for electroconvulsions and enhanced the anti-electroshock action of felbamate, lamotrigine, and topiramate. The interaction with lamotrigine could be at least partially of pharmacokinetic nature. However, intensification of the effect of topiramate occurred despite its decreased brain concentrations [61].