Lamictal

hello dr. ken Linda thanks for watching let's talk about lamictal or lamotrigine this is a drug first approved by the Food and Drug Administration 1994 for partial seizures or generalized seizures that's epilepsy first and adults later on and children sometimes by itself sometimes in combination with other anticonvulsant then in 2003 the FDA said well it's probably okay to use the drug also in bipolar disorder not for treating the acute depression not for treating the acute mania but maintaining stability in between flares of the disease seems to be better at preventing the depression that it is in preventing the mania but it comes with a blackbox warning and the blackbox warning suggests that there's an increased incidence of life threatening skin reaction called either stevens-johnson syndrome toxic epidermal necrolysis or the dresse syndrome dr ESS it stands for drug reaction with eosinophilia and systemic symptoms nearly all cases occur in the first two months of taking the drug or if a person stops taking the drug and then suddenly we starts it at the same dose that they were taken there's a problem because rashes are very common with this particular pill and it seems that somewhere between five and ten percent of people may develop a rash but that rash is the typical drug rash unfortunately you can't tell early on which rash it is not statistically it's going to be the benign rash but you don't know that it's sort of more common rash in children than in adults so we like to limit the treatment as much as we can to adults it also is important to realize that if you happen to take valproate if you take valproate and lamictal at the same time the concentration of both of those drugs are going to be increased in the bloodstream and it's going to have a predisposition to develop the rash well the rash can start off sometimes with fever or fatigue aseptic meningitis and then the rash it's potentially very serious as I mentioned can lead to acute multi organ failure can be fatal more common in epilepsy hardly ever in bipolar disorder if ever in bipolar disorder the rashes as I said is more common in children than it is in adults and most of the time the rash is benign now some other side effects that you can have with this medicine include sleepiness or drowsiness or headache or trouble concentrating and trouble with coordination memory changes mood changes loss of balance double vision or cross diet or maybe sometimes the pupils are constricted you can have blurred vision other common side effects include headache a tremor and dry mouth or nausea vomiting diarrhea some people develop abdominal pain or fever some people with some dizziness or anxiety of the dreams or weight loss and about 7% of the people are going to develop an incapacitating in the Intolerable type of insomnia it's an alerting effect that comes with the drug on the other hand some people seems to improve the sleep stability and increase the remand eration well in 2010 the FDA added a warning and said that can cause aseptic meningitis and they also said it can cause certain types of white blood cells to gobble up the red blood cells something that we call hemophage ik lymphohistiocytosis rare condition but something that we know about it also can cause certain blood disgraces it can cause of suicidal behavior and thoughts that people have seems that it's a common side effect of most anti epileptic drugs increases the risk compared to a placebo and back to fold but again it's pretty rare even though the drug is an anti-seizure medicine it may induce seizures especially juvenile myoclonic seizures so if you're taking the drug and anything happens that's out of the ordinary you ought to call the doctor now side effects with lamictal seem to be more common women than they are in men which is opposite the most anticonvulsants they have side effects more common in men than in women interestingly if people are taking the birth control pill there is a potential problem because the estrogen decreases the concentration of the bloodstream about two fold it reduces it by about half on the other hand when you're taking the birth control pill most women have one week per month when there isn't any hormone in the pill and in that week the concentration of lamictal in the cotton in the bloodstream increases by a concentration of twofold and during that week person could have some dizziness or a taxi or double vision so you have to warn the doctor if you're taking the birth control pill and certainly if you stop taking the birth control pill your dose of lamictal needs to be adjusted now it comes in a variety of different strengths 25 fifties and hundreds hundred 50 s and 200 s both as tablets and oral disintegrating tablets that you put in your mouth and you suck and that dissolve crumbs in starter packs of 25 milligrams and some hundred milligrams or you can get the standard dose that I just mentioned whether you should take the drug in pregnancy is always a concern there's some minor malformations that have developed cleft palate among them the drug seems to be a weak inhibitor of an enzyme that's very important than folic acid metabolism called dihydrofolate reductase and unfortunately drugs in that family also methotrexate that family can be teratogen cause some sort of birth defect it interferes with the production of nucleic acids and with proteins so not a good idea nor should it be taken while a woman is breastfeeding the way it works is it increases the activity of gamma amino benzoic acid GABA which is an inhibitory neurotransmitter in the central nervous system so it works on the sodium channels in a cow channels it works to suppress the release of glutamate aspartate it seems to prevent the spread of seizures that's how it works in the seizure part how it works in the bipolar part having the slightest idea unfortunately seems not to have an effect on serotonin or dopamine or norepinephrine doesn't have any effect on the NMDA other chemicals in the brain well when you take the drug it's going to be absorbed it's going to be absorbed pretty rapidly the peak concentration of the bloodstream is going to be about an hour and a half to two hours but it might be lengthened up to about five hours doesn't change whether you eat or whether you don't eat the bioavailability is going to be almost a hundred percent the half-life of the drug is about a day twenty nine hours but if you take the valproate with it it's two or three days about half of it is bound to plasma proteins its inactivated in the urine and it's excreted almost 95% in the urine it has fewer interactions than some of the anticonvulsant but it does certainly have significant interaction with other antiepileptic medicine so if you happen to be taken by lanten or phenobarbital if you happen to take primidone or if you're taking some of the other drugs or even if you're taking refampin or estrogen it's going to decrease the concentration of the lamictal by about 40% or thereabout doesn't seem to have any effect on lithium but you do have to be careful of valproate if you take valproate the concentration of both the valproate and the lamictal goes up while you're taking the drug you need to have your kidney function and your liver function periodically monitored when you take the drug you start off at a slow dose and you gradually increase it you don't do it too fast and you don't take too much of the drug to start otherwise you may well end up with the rash so it comes as a starter kit of low dose so you can take it slowly you don't crush the pills you don't chew the pills you don't break the pills you swallow them whole but they do make an oral disintegrating tablet that you just put on your and let dissolve so let's say you have bipolar disorder well the target dose is going to be 200 milligrams a day but if you're taking valproate the target dose is a hundred milligrams a day but if you're taking tegretol or dilantin or primidone or you're taking phenobarbital the target dose is 400 milligrams a day so let's say you have my polar disorder and you're going to start the lamictal what you do is you take 25 milligrams once a day for the first two weeks the second two weeks you take 50 milligrams a day the fifth we could take 100 milligrams and then you're at your target those on the sixth week on the other hand if you're taking tegretol or dilantin or phenobarbital you increase quite considerably end up with 400 milligrams so on week six and spent at 200 milligrams you take 300 milligrams and week seven you're up to 400 milligrams but if you're on valproate for the first two weeks you take 25 milligrams every other day and that's followed week three and four by twenty-five milligrams a day week five 50 milligrams a day and you're at targets 100 milligrams a day on week six now as I mentioned that comes in starter packs that combine mostly the 25 milligram pills and some of the hundred milligram pills you have to be careful if you decide you're going to stop taking the drug you don't do it too quickly too abruptly because otherwise you may well increase the likelihood of having seizures even if you never had seizures before if you're taking it for the bipolar disorder so it's good idea sometimes to wear a medi alert bracelet now people who are taking the drug for epilepsy are going to discontinue it because the side effects in about 11% so one in nine people who take the drug gonna stop bipolar disorder it's going to be one in six or about 16% you could overdose on the medicine if you take too much and get some ataxia difficulty walking or some nystagmus with your eyes going back and forth decreased level of consciousness or uncontrolled seizures or cardiac arrhythmias or coma or ultimately some people die because of taking the drug and interestingly the drug seems to bind to tissues that contain melanin like the iris in the eye we don't know that it has any long-term consequences but it's suggested that if you take Lamech though you ought to see the eye doctor every once in a while even if you take just one pill one time the medicine is going to be present in your you vo track for up to a year and if you happen to take the drug it could interfere with some of the lab screening of the urine now it's important to realize that most of the anti epileptic drugs seem to work about the same so your choice of an antiepileptic drug should be based on tolerability lamictal it's the first choice for people who have partial or focal epilepsy it's relatively well tolerated there's relatively little sedation or cognitive impairment doesn't seem to make it wait go up seems that it's less effective compared to valproate if you happen to have generalized epilepsy or tonic-clonic epilepsy the kind with the shakes if we're talking about bipolar disorder well if you have mania the standard treatment would either be tegretol or valproate or best choice perhaps would be lithium if you take them the mythical remember it doesn't change the depressive episodes it doesn't change it's not a treatment for the manic episodes it's a drug that helps prevent the recurrence of those symptoms and it seems that there are two types of bipolar disorder type 1 that's where a person has the more severe mania and type 2 where the person has what we call hypomania less severe mania it seems that the mikta works better when a person has the less severe type now several studies have shown that it's not good for the treatment of depression but remember it's good for the maintenance so when a person has bipolar disorder we used to call it manic depressive disorder and most of the manifestations are depression hey this is a good drug it's not recommended for treatment of any psychiatric disease it's often used off-label for a variety of disorders without good proof that it works oh it's used for peripheral neuropathy or trigeminal neuralgia teas for migraine or G's for a cluster headache or neuropathic pain or treatment-resistant obsessive-compulsive disorder or depersonalization disorder post-traumatic stress borderline personality disorder schizoaffective disorder well in classic studies of epilepsy it seems as I mentioned that all drugs seem to work okay but oftentimes a person needs a combination of therapies the first drug might not control the epilepsy so then you might add another drug well is there any benefit of tecna's versus the old drugs sold drugs like tegretol or valproate or dilantin the newer drugs may be like lamictal or keppra now it all depends on how well they're tolerated they all seem to work about the same now there is a failure to control the epilepsy in a certain percentage of the people people who seem to have a lot of seizures before you begin therapy people who have a longer duration of their epilepsy people who have taken recreational drugs or have a family history of epilepsy or family history or personal history of psychiatric disorder history of febrile seizures those people have more difficult to control seizures the first treatment generally works in about 50% of the cases second treatment add-on treatment often times an additional 12 plus percent have improved control third drug adds only about 4% extra and then each additional drug only adds one or two percent now there are multiple generic brands of lamictal available and there's sometimes a quality control problem so if you are taking the generic it's a good idea to take the same brand all the time when you change brand there might be a problem so there was recently a case where the TV and didn't seem to work very well well yes we're talking about studies controlling bipolar disorder there was an interesting study that looked at seroquel and lamictal together or just seroquel and those people were given either folic acid or they weren't given folic acid now a lot of people are taking folic acid a lot of people like to take vitamins and supplements so what happens when you take some of these supplements well interestingly remember I said it interfered with the mechanism of folic acid metabolism the dye hydrophobic acid reductase enzyme well it seems that if you take the seroquel and the lamictal it's going to be much better to control your bipolar disorder then if you just take the seroquel but if you take the combination with folic acid it erases any benefit so it's important that you discuss in depth any kind of supplement that you happen to take when you see your doctor how much does all this cost well the mcdu is very inexpensive you can buy thirty of the hundred milligram tablets for cash less than thirty dollars unless you go to Walgreens or CVS where it's around eighty dollars if you have a coupon most stores will sell until you've heard three to thirteen dollars but again if you go to CVS or Walgreens it's going to be considerably more but not nearly as much as if you get the brand-name if you pay cash for the brand-name it's gonna cost you almost six hundred ninety dollars if you have a coupon it's gonna cost you five hundred fifty dollars that's why chances are you're going to take a generic brand so there you have it we have lamictal it's good drugs but it's not a great drug for epilepsy it can interfere with a variety of other drugs as far as the metabolism is concerned so you do have to be a a bit careful we have the problem with the rash and it doesn't treat either the depression or the mania of bipolar disorder but it can help extend the time between the episodes if you have any questions about some of these other drugs well you can watch my videos about them anyway thanks for watching I'm dr. ken landau [Music] [Music] [Music] [Music]

Channel: wellnowdoctor

Views: 15,341

Rating: 4.8639455 out of 5

Keywords: Lamictal, Lamotrigine, Bipolar disorder, Mania, Depression, Partial seizures, Epilepsy, GABA, Tegretol, Carbamazepine, Dilantin, Phenytoin, Valproate, Depakote

Id: TEI7gMIEs80

Length: 18min 31sec (1111 seconds)

Published: Wed Jun 19 2019