Lamotrigine
Louis A. Pagliaro, Ann Marie Pagliaro in PNDR: Psychologists’ Neuropsychotropic Drug Reference, 2020
Lamotrigine pharmacotherapy is not recommended for children and adolescents who are younger than 16 years of age. Lamotrigine generally is prescribed as adjunctive pharmacotherapy to other anticonvulsant pharmacotherapy (e.g., carbamazepine, phenobarbital, and phenytoin pharmacotherapy) to reduce the frequency of partial seizures. Lamotrigine is absorbed rapidly and completely from the GI tract following oral ingestion. Peak blood concentrations are achieved within 1 to 5 hours. Concurrent lamotrigine and carbamazepine (Tegretol®) pharmacotherapy may result in an increase in lamotrigine total body clearance by up to 100% and a corresponding decrease in the mean half-life of elimination to 15 hours. Concurrent lamotrigine pharmacotherapy and pharmacotherapy with opiate analgesics, sedative-hypnotics, or other drugs that produce CNS depression (e.g., antihistamines, phenothiazines, TCAs) may result in additive CNS depression. Lamotrigine pharmacotherapy has been associated commonly with: asthenia, blurred or double vision (diplopia), dizziness, fatigue, headache, nausea, rash, and somnolence.
ECT, epilepsy and obsessional personality style
Alan Weiss in The Electroconvulsive Therapy Workbook, 2018
You are referred a 66-year-old woman, ST, married to a war veteran who was on an army pension. ST has a supportive daughter and son who are both married with children. There is no clear family history of mood disorders or epilepsy. ST developed late onset grand mal epilepsy in her early 50s. The condition was very responsive to anticonvulsant medication, lamotrigine 50 mg twice a day, and she had been stable for 10 years. ST had an obsessional personality style and was described by her family as a perfectionistic, meticulous person who could not rest until the job was completed. ST said, "I have always been in control all my life".
Narcissistic Personality Disorder
S. Joseph in Personality Disorders, 2019
This chapter provides the DSM-IV criteria for narcissistic personality. Some of the dysfunctional features of narcissistic personality disorder can possibly be improved on mood stabilizers such as lithium, valproate, carbamazepine, gabapentin, or lamotrigine. Given the possibility that some narcissistic personalities have mild paranoid tendencies and hostility, a trial of a low dose of risperidone, olanzapine, or sertindole is potentially beneficial to the patient. Mood stabilizers alone may be sufficient to give some therapeutic benefits to individuals with narcissistic personality disorder, in which case they are the preferred and primary medications. Narcissistic personality disorders typically present to clinical attention due to Axis I symptoms such as depression or anxiety, as is true of all personality disorders. Among personality disorders, narcissistic, antisocial, schizoid, and paranoid personality disorders are, in the author’s experience, the most difficult to engage in treatment. Patients with narcissistic personality disorder typically come to clinical attention either due to external pressure or due to distressing Axis I symptoms.
Lamotrigine-induced seizures in a child: Case report and literature review
Published in Clinical Toxicology, 2007
Josef G. Thundiyil, Ilene B. Anderson, Pamela J. Stewart, Kent R. Olson
Introduction. Lamotrigine is an antiepileptic agent. There is only one previous report of a seizure associated with lamotrigine overdose with laboratory confirmation (a 2-year-old girl, lamotrigine level of 3.8 mg/L). Case Report. A healthy 19-month-old boy ingested an unknown amount of his sister's lamotrigine tablets. Twenty minutes later, the child experienced generalized seizure activity lasting 10 seconds, followed by another brief self-limited seizure. Vitals signs: heart rate 152–207 bpm crying, respiratory rate 26 /min, temperature 95.7°F, and pupils 3mm. The one-hour lamotrigine level = 20.3 mg/L. The child was discharged 24 hours later. Literature Review. Six previous case reports of lamotrigine poisoning with serum levels, as well as a retrospective review of lamotrigine exposures, are discussed. Conclusion. A case of lamotrigine-induced seizures in a pediatric patient is reported, with a level approximately five times the upper limit of the therapeutic range. The pediatric population may be at increased risk of seizures following lamotrigine poisoning, and serum levels may not be clinically useful for predicting outcome after overdose.
Stevens Johnson Syndrome—Toxic Epidermal Necrolysis Induced by A Combination of Lamotrigine and Valproic Acid: A Case Report
Published in Klinik Psikofarmakoloji Bülteni-Bulletin of Clinical Psychopharmacology, 2011
Serap Oflaz, Hira S. Kalkan, Esra Gokce, Cagatay Karsidag, M. Salih Gurel
ABSTRACT Both Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN) are rare and life-threatening acute allergic reactions affecting the skin and mucous membranes. We report a case with SJS-TEN likely induced by inappropriate lamotrigine titration during the use of a lamotrigine and valproic acid regimen. The present case report supports the clinical evidence that combination of lamotrigine with other psychiatric drugs increases the frequency and severity of skin reactions. Therefore in polypharmacy, lamotrigine should be used more carefully and lamotrigine should be discontinued if any rash appears.
Lamotrigine (Lamictal IR) for the treatment of bipolar disorder
Published in Expert Opinion on Pharmacotherapy, 2012
Introduction: Over the past decade the use of lamotrigine in bipolar disorder has increased. However, the evidence base suggests a more limited role for lamotrigine as part of an overall treatment regimen in bipolar disorder. Areas covered: We reviewed publications of randomized clinical trials of lamotrigine, emphasizing studies in bipolar disorder. The low burden of adverse effects with lamotrigine has been confirmed in these studies. Its lack of benefit in acute mania is established. Despite modest benefits for a subset of depressive episodes in bipolar disorder, it was not superior to placebo in well-designed studies. As monotherapy, in randomized, blinded trials in rapid cycling bipolar disorder it was not superior to placebo. Its role in maintenance treatment is relatively well established as one component of combination therapy, with evidence for benefits when combined with lithium or valproate. Combination regimens including lamotrigine appear to be superior to monotherapy. Monotherapy utilization of lamotrigine for maintenance treatment is not supported by these studies. Expert opinion: Lamotrigine has benefits in bipolar disorder management principally as a component of combination treatment which includes a mood stabilizer. The utility of lamotrigine in acute bipolar depression and major depressive disorder is modest.
Related Knowledge Centers
- Anticonvulsant
- Bipolar Disorder
- Epilepsy
- Epileptic Seizure
- Mood Stabilizer
- Major Depressive Disorder
- Tonic–Clonic Seizure