How do bipolar medications affect weight. What are the different types of bipolar medications. Which bipolar medications are more likely to cause weight gain. How can weight gain from bipolar medications be managed.

Types of Medications Used to Treat Bipolar Disorder

Bipolar disorder is a complex mental health condition that requires careful management through medication. The primary categories of medications used to treat bipolar disorder include:

• Mood stabilizers
• Antipsychotics
• Antidepressants
• Combination medications

Each of these medication types works differently to help manage the symptoms of bipolar disorder, such as manic episodes, depressive episodes, and mood swings. However, it’s important to note that the effectiveness and side effects can vary significantly from person to person.

Mood Stabilizers and Their Impact on Weight

Mood stabilizers are a cornerstone in the treatment of bipolar disorder. They help to even out the extreme highs and lows characteristic of the condition. Common mood stabilizers include:

• Lithium (Lithobid)
• Valproic acid (Depakene)
• Divalproex sodium (Depakote)
• Carbamazepine (Tegretol, Equetro)
• Lamotrigine (Lamictal)

Among these, lamotrigine stands out as it is not typically associated with weight gain. The others, however, are known to increase the risk of weight gain in many patients.

Does lamotrigine cause weight loss?

While lamotrigine (Lamictal) does not typically cause weight gain, it’s also not associated with significant weight loss. It’s considered more weight-neutral compared to other mood stabilizers. If you’re concerned about weight changes while taking lamotrigine, it’s essential to discuss this with your healthcare provider.

Antipsychotics and Weight Fluctuations

Antipsychotics are another class of medications commonly prescribed for bipolar disorder. They can be particularly effective in managing manic episodes and psychotic symptoms. Some commonly prescribed antipsychotics include:

• Olanzapine (Zyprexa)
• Risperidone (Risperdal)
• Quetiapine (Seroquel)
• Aripiprazole (Abilify)
• Ziprasidone (Geodon)
• Lurasidone (Latuda)
• Cariprazine (Vraylar)
• Asenapine (Saphris)

When it comes to weight changes, not all antipsychotics are created equal. Aripiprazole, ziprasidone, lurasidone, and cariprazine are generally considered more weight-neutral options. However, individual responses can vary, and what works well for one person may not be ideal for another.

Which antipsychotics are least likely to cause weight gain?

Based on current research and clinical observations, the antipsychotics least likely to cause significant weight gain are:

1. Aripiprazole (Abilify)
2. Ziprasidone (Geodon)
3. Lurasidone (Latuda)
4. Cariprazine (Vraylar)

However, it’s crucial to remember that individual responses can vary, and the most suitable medication should be determined in consultation with a healthcare professional.

The Role of Antidepressants in Bipolar Treatment

Antidepressants are sometimes used in combination with mood stabilizers or antipsychotics to treat bipolar disorder, particularly during depressive episodes. However, their use in bipolar disorder is controversial, as they can potentially trigger manic episodes or rapid cycling in some individuals.

The impact of antidepressants on weight can vary widely depending on the specific medication and the individual. Some antidepressants may be more likely to cause weight gain than others, but this can differ from person to person.

Can antidepressants be used alone to treat bipolar disorder?

Antidepressants are generally not recommended as a standalone treatment for bipolar disorder. Using antidepressants alone could potentially trigger manic episodes or rapid cycling in individuals with bipolar disorder. This is why they are typically prescribed in combination with mood stabilizers or antipsychotics when used to treat bipolar depression.

Combination Medications: A Double-Edged Sword

In some cases, combination medications that include both an antidepressant and an antipsychotic may be prescribed. One such medication is Symbyax, which combines the antidepressant fluoxetine with the antipsychotic olanzapine. While this combination can be effective in managing bipolar symptoms, it’s also associated with a higher risk of weight gain.

Why are combination medications used in bipolar treatment?

Combination medications are used in bipolar treatment to address multiple symptoms simultaneously. For instance, Symbyax targets both depressive symptoms (through the antidepressant component) and manic symptoms (through the antipsychotic component). This can be particularly helpful for individuals who experience mixed episodes or rapid cycling. However, the potential for increased side effects, including weight gain, must be carefully considered.

Managing Weight Gain from Bipolar Medications

While weight gain can be a challenging side effect of many bipolar medications, it’s important not to discontinue or change your medication regimen without consulting your healthcare provider. There are several strategies that can help manage weight gain:

• Healthy eating habits
• Regular physical activity
• Psychological counseling (psychotherapy)
• Regular monitoring of weight and metabolic parameters
• Discussing medication adjustments with your healthcare provider

Remember, finding the right balance between effective symptom control and manageable side effects often requires patience and collaboration with your healthcare team.

How can I prevent weight gain while taking bipolar medications?

While it may not always be possible to completely prevent weight gain, you can take steps to minimize it:

1. Maintain a balanced, nutritious diet
2. Engage in regular physical activity
3. Monitor your weight and report significant changes to your doctor
4. Stay hydrated and limit high-calorie beverages
5. Get adequate sleep
6. Manage stress through techniques like meditation or yoga
7. Work with a nutritionist or dietitian for personalized advice

Always consult with your healthcare provider before making any significant changes to your diet or exercise routine.

The Importance of Individualized Treatment Plans

When it comes to treating bipolar disorder, there’s no one-size-fits-all approach. What works well for one person may not be effective for another, and the side effects experienced can vary widely. This is why finding the right medication or combination of medications often involves a process of trial and error.

Factors that can influence the choice of medication include:

• The specific type of bipolar disorder (I, II, or cyclothymia)
• The predominant symptoms (manic, depressive, or mixed)
• The patient’s medical history and other health conditions
• Potential drug interactions
• The patient’s response to previous treatments
• Individual tolerability of side effects

How long does it take to find the right medication for bipolar disorder?

Finding the right medication or combination of medications for bipolar disorder can be a process that takes several weeks to months. It often requires patience and close collaboration with your healthcare provider. Each medication needs time to take effect, usually 4-6 weeks, and adjustments may be necessary. During this time, it’s crucial to keep your doctor informed about your symptoms and any side effects you experience.

The Role of Lifestyle Factors in Bipolar Management

While medication is a crucial component in managing bipolar disorder, lifestyle factors play a significant role as well. Incorporating healthy habits can not only help manage weight gain but also contribute to overall mood stability. Some key lifestyle factors to consider include:

• Maintaining a consistent sleep schedule
• Engaging in regular exercise
• Practicing stress-reduction techniques
• Avoiding alcohol and recreational drugs
• Building a strong support network
• Sticking to a routine

These lifestyle modifications, when combined with appropriate medication, can significantly improve the management of bipolar disorder and overall quality of life.

How does exercise help in managing bipolar disorder?

Exercise can be a powerful tool in managing bipolar disorder:

1. It helps regulate mood by releasing endorphins, the body’s natural “feel-good” chemicals
2. Regular physical activity can improve sleep quality, which is crucial for mood stability
3. Exercise can help manage weight gain, a common side effect of many bipolar medications
4. It provides a healthy outlet for excess energy during manic or hypomanic episodes
5. Physical activity can boost self-esteem and reduce stress and anxiety

Always consult with your healthcare provider before starting a new exercise regimen, especially if you have any other health conditions.

The Future of Bipolar Treatment: Emerging Therapies and Research

As our understanding of bipolar disorder continues to evolve, researchers are exploring new treatment options that may offer better symptom control with fewer side effects. Some areas of ongoing research include:

• Novel mood stabilizers with improved side effect profiles
• Targeted therapies based on genetic markers
• Non-pharmacological treatments such as transcranial magnetic stimulation (TMS)
• Digital health interventions for mood monitoring and early intervention
• Personalized medicine approaches to tailor treatments to individual patients

While these emerging therapies offer hope for improved treatments in the future, it’s important to work closely with your current healthcare team to manage your bipolar disorder effectively with the treatments available today.

What are some promising new treatments for bipolar disorder?

Several innovative treatments for bipolar disorder are currently being researched:

1. Ketamine and esketamine: Rapid-acting treatments for bipolar depression
2. NMDA receptor antagonists: A new class of drugs targeting glutamate signaling
3. Gene therapy: Targeting specific genes associated with bipolar disorder
4. Chronotherapy: Manipulating sleep-wake cycles to stabilize mood
5. Precision psychiatry: Using biomarkers to predict treatment response

While these treatments show promise, many are still in experimental stages and require further research before becoming widely available.

Bipolar medications and weight gain

Bipolar disorder can be treated with a number of medications. Some of these medications can increase your appetite or cause changes in metabolism leading to weight gain.

Whether a certain medication will cause weight gain or other side effects varies from person to person. Also, how well the medication works to treat bipolar disorder symptoms differs among individuals. Because of this, finding the medications that best treat your symptoms may require some trial and error.

Medications for bipolar disorder include mood stabilizers, antipsychotics and antidepressants.

• Mood stabilizers used to treat bipolar disorder include lithium (Lithobid), valproic acid (Depakene), divalproex sodium (Depakote), carbamazepine (Tegretol, Equetro, others) and lamotrigine (Lamictal). All of these medications are known to increase the risk of weight gain except lamotrigine.
• Antipsychotics prescribed for bipolar disorder include olanzapine (Zyprexa), risperidone (Risperdal), quetiapine (Seroquel), aripiprazole (Abilify), ziprasidone (Geodon), lurasidone (Latuda), cariprazine (Vraylar) and asenapine (Saphris). It appears that aripiprazole, ziprasidone, lurasidone and cariprazine are more weight neutral than the others, but that can vary from person to person.
• Antidepressants along with a mood stabilizer or antipsychotic may be used in treating bipolar disorder, though antidepressants alone could cause mania or rapid cycling in people with bipolar disorder. Some antidepressants may be more likely to cause weight gain than others, but this can vary from person to person. Talk with your psychiatric care professional if you have concerns.
• Antidepressant-antipsychotic combination medication works as a depression treatment and a mood stabilizer. The medication Symbyax combines the antidepressant fluoxetine and the antipsychotic olanzapine and is associated with weight gain.

Some of these medications may be less likely to cause weight gain when taken alone, but many people need more than one medication to control bipolar symptoms. Some weight gain may be inevitable when taking medications for bipolar disorder.

If weight gain is an issue, ask your psychiatric care professional for advice on strategies to manage it. Healthy eating, keeping physically active and getting psychological counseling (psychotherapy) can all help.

Continue to work with your psychiatric care professional to find the best way to keep your bipolar symptoms and your weight under control.

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• Bipolar treatment: I vs. II

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Show references

1. Post RM. Bipolar disorder in adults: Choosing maintenance treatment. https://www.uptodate.com/contents/search. Accessed Dec. 11, 2017.
2. Kemp DE. Managing the side effects associated with commonly used treatments for bipolar depression. Journal of Affective Disorders. 2014;169(suppl 1):S34.
3. Nierenberg AA, et al. Improving outcomes in patients with bipolar depression: A comprehensive review. Journal of Clinical Psychiatry. 2015;2:1.
4. Dent R, et al. Changes in body weight and psychotropic drugs: A systematic synthesis of the literature. PLOS One. 2012;7:e36889. http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0036889. Accessed Dec. 11, 2017.
5. Frank E, et al. An integrated risk reduction intervention can reduce body mass index in individuals being treated for bipolar 1 disorder: Results from a randomized trial. Bipolar Disorders. 2015;17:424.
6. Hasnain M, et al. Weight considerations in psychotropic drug prescribing and switching. Postgraduate Medicine. 2013;125:117.
7. Bobo WV, et al. Bipolar disorder in adults: Treating major depression with antidepressants. https://www.uptodate.com/contents/search. Accessed Dec. 16, 2017.
8. Krieger CA (expert opinion). Mayo Clinic, Rochester, Minn. Dec. 22, 2017.

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Lamotrigine: medicine to treat epilepsy and bipolar disorder

Like all medicines, lamotrigine can cause side effects, although not everyone gets them.

Skin rashes

It’s common to get a skin rash with lamotrigine. Most skin rashes are not serious.

But if you develop a skin rash or redness, tell a doctor straight away, as this can develop into a life-threatening skin condition called Stevens-Johnson syndrome.

Stevens-Johnson syndrome is a rare side effect of lamotrigine. It causes flu-like symptoms, followed by a red or purple rash that spreads and forms blisters. The affected skin eventually dies and peels off.

It’s more likely to happen in the first 8 weeks of starting lamotrigine, or when the dose is increased too quickly.

It can also happen if lamotrigine is stopped suddenly for a few days and then restarted at the same dose as before, without reducing the dose and then increasing it slowly again.

Stevens-Johnson syndrome is more common in:

• children
• people who developed a rash with a different epilepsy medicine in the past
• people who are allergic to an antibiotic called trimethoprim
• people also taking a medicine called sodium valproate

To help prevent the chance of you getting a rash that could be confused with Stevens-Johnson syndrome, it’s best to not start any new medicines, foods or products during the first 3 months of treatment with lamotrigine.

It’s also best to not start lamotrigine within 2 weeks of a viral infection, vaccination or rash caused by something else.

Other common side effects

These common side effects may happen in more than 1 in 100 people. They’re usually mild and go away by themselves.

Keep taking the medicine, but talk to your doctor if these side effects bother you or do not go away:

• headaches
• feeling drowsy, sleepy or dizzy
• aggression, or feeling irritable or agitated
• shaking or tremors
• difficulty sleeping
• diarrhoea
• feeling or being sick (nausea or vomiting)

Other serious side effects

Very few people taking lamotrigine have serious problems.

Tell a doctor straight away if you have a serious side effect, including:

• thoughts of harming or killing yourself – a small number of people taking lamotrigine for bipolar disorder have had suicidal thoughts, and this can happen after only a few weeks of treatment
• worsening seizures (if you take lamotrigine for epilepsy)
• unexpected bruising or bleeding, a high temperature or sore throat – these could be warning signs of a blood disorder
• a stiff neck, headaches, feeling or being sick, a high temperature and extreme sensitivity to bright light – these could be signs of meningitis

Serious allergic reaction

In rare cases, it’s possible to have a serious allergic reaction (anaphylaxis) to lamotrigine.

These are not all the side effects of lamotrigine. For a full list, see the leaflet inside your medicines packet.

Psychiatric Uses of Lamotrigine

Lamotrigine (Brand names: Lamictal, Lamictal CD, Lamictal ODT, Lamictal XR)

Like other mood stabilizers, lamotrigine was originally developed as an anticonvulsant to treat seizures and is often used with other medications in the treatment of bipolar (manic-depressive) disorder. For the latest information on the use of lamotrigine, Psycom spoke with Joseph Goldberg, MD, Clinical Professor of Psychiatry at the Icahn School of Medicine at Mount Sinai in New York, and co-author of Managing the Side Effects of Psychotropic Medications, 2nd Ed, a textbook published by American Psychiatric Association Publishing and Christopher Aiken, MD, the director of the Mood Treatment Center in North Carolina.

Lamotrigine is the only mood stabilizer that calms mood swings by lifting the depression rather than suppressing the mania, says Dr. Aiken. “That makes it a great choice for the bipolar spectrum, where the depressive symptoms usually outweigh the manic ones. Its greatest benefit is in prevention. It can prevent both the depressive and manic side, but its benefits are much stronger for depression and it does not treat active mania or hypomania.”

Dr. Aiken adds that part of the reason patients prefer lamotrigine is that it’s generally free of side effects. “In the original research studies people reported more side effects on the placebo than on lamotrigine. That may sound impossible, but it’s likely that lamotrigine helped them feel better physically by treating their depression,” explains the mood disorder expert adding that lamotrigine is also largely free of the “medicated” feelings that people dislike with mood stabilizers. “People don’t tend to feel dull, flat, or groggy on it.”

In some research studies comparing a placebo to the medicine, the results were exceptional. “Lamotrigine is the only medicine we know of where patients were unable to tell they were taking the medication,” he explains. “It didn’t make them feel medicated, and its benefits built up very gradually. After 2 years, people taking lamotrigine had half as many days of depression as those who did not take it.”

Which conditions are treated with lamotrigine?

Although lamotrigine is not considered an antidepressant, it is used as a maintenance treatment for bipolar I disorder to help stabilize mood changes. (Bipolar I disorder is characterized by manic episodes.) ^1,2

“The drug manufacturer’s original studies of lamotrigine in bipolar depression found that improvements were stronger in bipolar 1 than bipolar II disorder,” Dr. Goldberg recalls. (Bipolar II disorder is characterized by longer episodes and more frequent occurrence of major depression and hypomania.) Newer research suggests, however, that lamotrigine may be even more effective as a mood stabilizer in preventing relapses in treating bipolar II disorder.²

There are also conditions lamotrigine treats off-label including borderline personality disorder, schizoaffective disorder, and obsessive-compulsive disorder (OCD), Dr. Aiken says.

How does lamotrigine work?

 Lamotrigine delays the time between mood changes and manic or depressive states in people with bipolar disorder by decreasing the intensity of irregular electrical activity in the brain. People with bipolar disorder are at high risk of experiencing recurrent and relapsing episodes of mood change. Maintenance treatment with lamotrigine helps reduce the risk by preventing or delaying these recurrences and relapses.

“Many clinicians think that lamotrigine helps achieve and sustain even moods over time by virtue of its antidepressant properties, rather than anti-manic (mood-stabilizing) properties,” says Dr. Goldberg. “It works with mood stabilizers like lithium and Divalproex, but it’s not interchangeable with these drugs and cannot be used in their place.”

Lamotrigine is used over time as a preventative medication. Clinical trials that looked at lamotrigine’s potential for treating acute (in-the-moment) episodes of mania found no difference between the medication and placebo. ²

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Is there a typical dose of lamotrigine?

Your doctor will initially prescribe a low dose of lamotrigine and gradually increase your dose every week or two for several weeks, until you reach an effective dose level.

“Treatment guidelines for target blood levels of lamotrigine have not been established for conditions other than epilepsy,” Dr. Goldberg points out. “In relapse prevention studies conducted by its manufacturer, however, 200 mg/day was found to be a better target dose than 50 mg/day, while higher doses (400 mg/day) did not provide greater benefit against relapse.”

The dosing regimen of lamotrigine can depend on which other medications you are taking to treat bipolar disorder, and is adjusted when you wean off and discontinue other medications.

“Some medicines slow down the metabolism of lamotrigine (notably, Divalproex), requiring a slower rate of increase and a lower target dose,” notes Dr. Goldberg.  “Others speed up its metabolism (notably, carbamazepine), requiring a faster-than-usual dose increase and a higher-than-usual target dose.”

Lamotrigine comes in several forms for treating bipolar disorder: Tablets, chewable tablets, dissolving tablets. Your doctor may tell you to take tablets once a day, twice a day or every other day.

If you miss a dose of lamotrigine, take the missed dose as soon as you remember. If it is close to the time of your next dose, however, skip the missed dose and continue with your usual schedule. Never take a double dose of lamotrigine.

How long does it take to work?

In certain cases, the antidepressant and antimanic benefits of lamotrigine are noticed pretty early on in the treatment cycle, says Dr. Aiken. “For some other patients, though, effects are seen after about a month of being on lamotrigine treatment. But there will always be others that take a bit longer to experience the positive effects.”

Cost of Lamictal/Lamotrigine

When ordered in lots of 100 tablets, here is the breakdown in pricing for one tablet of the medication in the following doses (Note: pricing information generated April 2011):

• $4.83 for 25 mg tablet
• $5.43 for 100 mg tablet
• $5.93 for 150 mg tablet
• $6.67 for 200 mg tablet

Generic cost (lamotrigine) is as follows:

• $0.3 for 25 mg tablet
• $0.3 for 100 mg tablet
• $0.53 for 150 mg tablet
• $0.53 for 2000 mg tablet

Advantages of Lamotrigine

Dr. Aiken reports there are some major advantages of lamotrigine including:

• It’s effective in a majority of bipolar patients
  Almost two-thirds of patients who are suffering from bipolar mood disorders have responded extremely well to lamotrigine.
• It’s ideal for mixed states
  People who, due to mania switches during intense cycling, have not been able to rely on other antidepressants have responded well to lamotrigine when given in therapeutic doses.
• It’s good for patients who respond to nothing else
  Patients who fail to respond to any other mood stabilizers and lithium have shown good results when treated using lamotrigine.
• There are minimal side effects
  Lamotrigine has minimal side effects that usually fade away after some time.

Who can (and cannot) take lamotrigine for bipolar disorder?

Doctors may prescribe lamotrigine to adults or adolescents who are otherwise being treated for bipolar disorder or weaning off other medications used to treat bipolar disorder. Older adults may be more sensitive to the effects of lamotrigine and prescribed lower doses. “When people respond to lamotrigine, they often say they can see things in perspective better and are less reactive under stress. They usually still have days of depression, but these tend to be shorter and less frequent,” says Dr.  Aiken.

Children under age 18 are at higher risk of developing a skin rash from lamotrigine if dosed too rapidly. In spite of the potential side effects, however, Dr. Goldberg points out that many studies support the use of lamotrigine for treating bipolar disorder in youth.

Definitive information about the safety of lamotrigine in pregnancy is not available, but according to Dr. Goldberg, many doctors perceive it to be among the safer options when treatment is required, especially in women who are more prone to depression than mania.  Like many psychotropic drugs, lamotrigine is secreted into breast milk, so women are advised to discuss with their doctors the risk and benefits of breastfeeding while taking lamotrigine.

Lamotrigine Side Effects 

Some people who take lamotrigine may experience adverse reactions or side effects. In approximately 8 in 10,000 people, lamotrigine can cause severe, life-threatening rashes and other skin disorders, typically between the second and eighth weeks of treatment. The risk of rash increases with higher starting doses, higher escalating doses and use of lamotrigine in combination with valproate.  Early clinical trials and follow-up research showed that the overall incidence of any skin disorders was 11 to 12% in both bipolar I and bipolar II patients treated with lamotrigine. ²

“Most of these skin issues are benign,” Dr. Goldberg emphasizes. “Serious rashes from lamotrigine are not due to an allergy, but rather, a systemic reaction that also usually includes fever, sore throat, swollen glands, and other physical symptoms.”

But as with any medication, Dr. Goldberg adds, allergic reactions to lamotrigine can occur. Get immediate emergency help if you show any signs of an allergic reaction, such as hives, facial or throat swelling, or difficulty breathing. Notify your doctor if you develop a skin rash, especially if it occurs within your mouth or on soft body tissue such as eyelids or around nasal openings, and if it is blistering, peeling, painful, burning, or involves a fever or sore throat. Be sure to report all medications you are taking to medical staff.

Serious side effects that should be reported immediately to your doctor include:

• Any skin rash, blistering or peeling of skin
• Painful (burning) sores in or around the mouth, eyes or genitals
• Jaundice (yellowish skin or eyes)
• Swollen gland, fever, severe muscle pain
• Weakness, drowsiness, confusion
• Stiff neck, headache
• Increased sensitivity to light
• Mood or behavior changes, such as depression, anxiety, agitation, hostility, restlessness, mental or physical hyperactivity, suicidal thoughts

Common side effects of lamotrigine that are not emergencies but should also be reported to your doctor include:

• Headache or dizziness
• Blurred or double vision
• Dry mouth
• Gastrointestinal distress such as nausea, vomiting, diarrhea or stomach pain
• Fever, sore throat, runny nose
• Drowsiness or fatigue
• Tremor
• Insomnia

Lamotrigine Rash

The biggest risk with lamotrigine is a rare allergic reaction called Stevens-Johnson Syndrome, which can be fatal if left untreated. Many medications can cause this reaction, including antibiotics like Bactrim and penicillin and over-the-counter medications like Tylenol and Motrin. The risk of getting the rash can be prevented if the following precautions are followed:

1. Dosing increases must be raised very slowly.
2. It should be stopped if any new rash or skin changes occur while you’re starting the medication. (After the first 3 months the risk of Stevens-Johnson Syndrome declines to almost zero).
3. To avoid false-alarm rash confusion, the use of new soaps, getting a sunburn, exposure to poison ivy and starting any other new medications should be avoided during the first 3 months of starting lamotrigine.

With those steps, the risk of this severe rash is about 1 in 3,000; without them, it’s more like 1 in 100. “Unfortunately, there is still a high risk of non-serious, benign rashes (10% chance), so many people have to stop lamotrigine to be on the safe side,” Dr. Aiken explains. “If you responded to lamotrigine but had to stop it because of a rash, it may be possible to restart at a lower dose.”

Does lamotrigine interact with any medications or other substances?

Certain other drugs can affect the way lamotrigine works in your body by decreasing its effectiveness or delaying its excretion from your body. These include hormonal birth control methods, hormone treatments, seizure medications such as phenobarbital, and valproic acid, which is also used to treat bipolar disorder.

Your doctor will carefully prescribe and monitor your dosage when lamotrigine is taken with other treatments. Avoid alcohol, cannabis, and other substances that can increase dizziness or drowsiness while taking lamotrigine. To rule out dangerous side effects, discuss all other medications or mind-altering substances you consume with your doctor before taking lamotrigine.

One recent British study found that folic acid supplements can cancel out lamotrigine’s benefits (Geddes et al. , 2016). “No one expected that result, as folic acid usually helps depression, and other medications, like valproate (a mood stabilizer approved for mania associated with bipolar disorder, seizures/epilepsy, and migraine headaches),” says Dr. Aiken. “More research is needed before we can fully trust this result, but until then, we recommend taking lamotrigine without any folic acid supplements, including those found in multivitamins. Once you’re doing well on lamotrigine, if you decided to add folic acid, watch out for a potential loss of benefits.”

Is it OK to suddenly stop taking lamotrigine?

Consult your doctor before stopping lamotrigine. If you do stop for more than a few days, DO NOT restart at your current dose. Call your doctor to review your dosing schedule.

Article Sources

1. MedlinePlus. Lamotrigine. Last revised January 15, 2019. Available at: https://medlineplus.gov/druginfo/meds/a695007.html. Accessed October 10, 2019.
2. Terao T, Ishida A, Kimura T, Yarita M, Hara T. Preventive effects of lamotrigine in bipolar II versus bipolar I disorder. The Journal of Clinical Psychiatry. September 1, 2017; 78(8): e1000-e1005. Available at:  www.psychiatrist.com/JCP/article/Pages/2017/v78n08/16m11404.aspx. Accessed October 10, 2019/

Last Updated: Oct 18, 2021

Side Effects of Lamictal (Lamotrigine), Warnings, Uses

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Lamictal 100 mg

hexagonal, peach, imprinted with LAMICTAL 100

Lamictal 150 mg

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Lamictal 200 mg

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Lamictal 25 mg

shield, white, imprinted with LAMICTAL 25

Lamotrigine 100 mg 009047008

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Lamotrigine 100 mg 690970149

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Lamotrigine 25 mg 690970148

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lamotrigine 300 mg XR 002281580

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Lamotrigine ER 100 mg 136680341

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oval, purple, imprinted with R419

Lamotrigine ER 50 mg 136680340

round, green, imprinted with 340, 50

Lamictal – Uses, Side Effects, Interactions

How does this medication work? What will it do for me?

Lamotrigine belongs to a class of medications known as antiepileptics. It is used alone or in combination with other medications to manage seizures associated with epilepsy when other medications have not been effective or have been stopped. It is also used along with other medications to manage seizures associated with Lennox-Gastaut syndrome. Lamotrigine works by decreasing the chemicals in the brain that are believed to contribute to seizures.

This medication may be available under multiple brand names and/or in several different forms. Any specific brand name of this medication may not be available in all of the forms or approved for all of the conditions discussed here. As well, some forms of this medication may not be used for all of the conditions discussed here.

Your doctor may have suggested this medication for conditions other than those listed in these drug information articles. If you have not discussed this with your doctor or are not sure why you are taking this medication, speak to your doctor. Do not stop taking this medication without consulting your doctor.

Do not give this medication to anyone else, even if they have the same symptoms as you do. It can be harmful for people to take this medication if their doctor has not prescribed it.

What form(s) does this medication come in?

Chewable/Dispersible Tablets

2 mg
Each white, round tablet, engraved “LTG” over “2”, contains 2 mg of lamotrigine. Nonmedicinal ingredients: aluminum magnesium silicate, blackcurrant flavour, calcium carbonate, hydroxypropylcellulose, magnesium stearate, povidone, saccharin sodium, and sodium starch glycolate.

5 mg
Each white-to-off-white, elongated, and biconvex tablet, engraved “GS CL2” on one side and “5” on the other (initiation dose only), contains 5 mg of lamotrigine. Nonmedicinal ingredients: aluminum magnesium silicate, blackcurrant flavour, calcium carbonate, hydroxypropylcellulose, magnesium stearate, povidone, saccharin sodium, and sodium starch glycolate.

Tablets

25 mg
Each white, scored, shield-shaped tablet, engraved with “LAMICTAL” and “25”, contains 25 mg of lamotrigine. Nonmedicinal ingredients: cellulose, lactose, magnesium stearate, povidone, and sodium starch glycolate.

100 mg
Each peach, scored, shield-shaped tablet, engraved with “LAMICTAL” and “100”, contains 100 mg of lamotrigine. Nonmedicinal ingredients: cellulose, lactose, magnesium stearate, povidone, sunset yellow FCF Lake, and sodium starch glycolate.

150 mg
Each cream, scored, shield-shaped tablet, engraved with “LAMICTAL” and “150”, contains 150 mg of lamotrigine. Nonmedicinal ingredients: cellulose, ferric oxide (yellow), lactose, magnesium stearate, povidone, and sodium starch glycolate.

How should I use this medication?

The recommended dose of lamotrigine varies according to a person’s need and the other antiepileptic medications they are taking.  In adults, lamotrigine is started at a low dose, ranging from 25 mg every other day to 50 mg once a day. Over a number of weeks, the dose is gradually increased until a maintenance dose is reached. The maintenance dose ranges from 50 mg to 250 mg twice a day. For children, lamotrigine is given according to the weight of the child. It should not be used for children who weigh less than 9 kg.

Many things can affect the dose of a medication that a person needs, such as body weight, other medical conditions, and other medications. If your doctor has recommended a dose different from the ones listed here, do not change the way that you are taking the medication without consulting your doctor.

The regular tablets must be swallowed whole and not chewed or crushed. The chewable tablets may be swallowed whole, chewed, or dissolved in a teaspoonful of water or fruit juice. The tablets take about 1 minute to dissolve. Once dissolved, swirl the solution and drink the entire amount immediately. Add some water to the glass and drink that as well to make sure there is no medicine left in the glass.

Lamotrigine may be taken with or without food.

It is important that this medication be taken exactly as prescribed by your doctor. If you miss a dose, take it as soon as possible and continue with your regular schedule. If your next dose is less than 4 hours away, skip the missed dose and continue with your regular dosing schedule. Do not take a double dose to make up for a missed one. If you are not sure what to do after missing a dose, contact your doctor or pharmacist for advice. If you miss more than a few days of lamotrigine doses, talk to your doctor before restarting the medication. You may need to start taking the medication at a lower dose than you were taking previously.

Store this medication at room temperature, protect it from light and moisture, and keep it out of the reach of children.

Do not dispose of medications in wastewater (e. g. down the sink or in the toilet) or in household garbage. Ask your pharmacist how to dispose of medications that are no longer needed or have expired.

Who should NOT take this medication?

Do not take this medication if you are allergic to lamotrigine or any ingredients of the medication.

What side effects are possible with this medication?

Many medications can cause side effects. A side effect is an unwanted response to a medication when it is taken in normal doses. Side effects can be mild or severe, temporary or permanent.

The side effects listed below are not experienced by everyone who takes this medication. If you are concerned about side effects, discuss the risks and benefits of this medication with your doctor.

The following side effects have been reported by at least 1% of people taking this medication. Many of these side effects can be managed, and some may go away on their own over time.

Contact your doctor if you experience these side effects and they are severe or bothersome. Your pharmacist may be able to advise you on managing side effects.

• difficulty sleeping
• dizziness
• drowsiness
• headache
• nasal congestion
• nausea
• stomach upset
• vomiting
• weakness
• weight gain

Although most of the side effects listed below don’t happen very often, they could lead to serious problems if you do not seek medical attention.
Check with your doctor as soon as possible if any of the following side effects occur:

• blurred vision or other changes in vision
• clumsiness or unsteadiness
• confusion
• continuous, uncontrolled back-and-forth or rolling eye movements
• double vision
• flu-like symptoms (e.g., fever, chills, or sore throat)
• hallucinations (seeing or hearing things that aren’t there)
• itchy eyes, with discharge
• mood or mental changes (e. g., agitation, anxiety, aggression, irritability, or nervousness)
• neck, joint, or abdominal pain
• nightmares
• signs of anemia (low red blood cells; e.g., pale skin, unusual tiredness or weakness)
• signs of depression (e.g., poor concentration, changes in weight, changes in sleep, decreased interest in activities, thoughts of suicide)
• signs of liver problems (e.g., nausea, vomiting, diarrhea, loss of appetite, weight loss, yellowing of the skin or whites of the eyes, dark urine, pale stools)
• skin rash
• swollen glands in the armpit, neck, or groin, or facial swelling
• tremor
• uncontrollable muscle movements involving the face, eyes, neck, trunk, arms, or legs

Stop taking the medication and seek immediate medical attention if any of the following occur:

• increase in seizures
• signs of an allergic reaction (such as difficulty breathing; hives; or swelling of the face, tongue, or throat)
• signs of bleeding (such as easy bruising, bleeding gums, nosebleeds, vomiting blood, blood in the urine, dark tarry stools)
• signs of meningitis not caused by infection (e. g., headache [severe], throbbing, or with stiff neck or back)
• signs of a severe skin reaction such as blistering, peeling, a rash covering a large area of the body, a rash that spreads quickly, or a rash combined with fever or discomfort
• thoughts of suicide or harming yourself

Some people may experience side effects other than those listed. Check with your doctor if you notice any symptom that worries you while you are taking this medication.

Are there any other precautions or warnings for this medication?

Before you begin taking a medication, be sure to inform your doctor of any medical conditions or allergies you may have, any medications you are taking, whether you are pregnant or breast-feeding, and any other significant facts about your health. These factors may affect how you should take this medication.

Aseptic meningitis: Rarely, lamotrigine can cause symptoms of aseptic meningitis (inflammation or swelling of the membranes around the brain and spinal cord that is not caused by bacteria). If you have an autoimmune condition (e.g., systemic lupus erythematosus, mixed connective tissue disease), you are more at risk for developing this. If you experience symptoms such as stiff neck, severe headache, nausea, vomiting, fever, or changes in consciousness, stop taking this medication and get immediate medical attention.

Birth control pills/hormone replacement therapy: The dose of lamotrigine you take may need to be adjusted if you start or stop oral contraceptives or other female hormonal treatments, such as hormone replacement therapy.

According to some case reports, when lamotrigine was taken in combination with birth control pills or other hormone replacement, rarely seizures, unexpected pregnancies, and menstrual bleeding disorders (e.g., breakthrough bleeding) occurred.

Do not start or stop taking these medications without consulting your doctor. If you experience changes in your menstrual pattern such as breakthrough bleeding while taking lamotrigine with these medications, contact your doctor.

Blood counts: This medication can decrease the number of neutrophils (a type of white blood cell that helps fight infection), red blood cells (which carry oxygen), and platelets (which help your blood to clot). Your doctor will do blood tests to monitor this. If you notice any signs of infection (e.g., fever, chills, or sore throat) or unusual bleeding or bruising, contact your doctor immediately.

Drowsiness/reduced alertness: If you have uncontrolled epilepsy, you should not drive or handle potentially dangerous machinery. Common side effects of lamotrigine include dizziness, problems with muscle coordination, drowsiness, double vision, and blurred vision. You should not undertake activities requiring mental alertness or physical coordination until you determine how lamotrigine affects you.

Heart disease: Lamotrigine can cause a change in the rhythm of the heart, particularly for people who already have certain heart conditions. If you have any heart condition, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Hypersensitivity reaction: Lamotrigine has occasionally caused a severe allergic reaction called hypersensitivity syndrome. This reaction involves a number of organs in the body and may be fatal if not treated quickly. Stop taking the medication and get immediate medical attention if you have symptoms of a severe allergic reaction, including fever, swollen glands, yellowing of the skin or eyes, or flu-like symptoms with skin rash or blistering.

Kidney function: Kidney disease or reduced kidney function may cause this medication to build up in the body, causing side effects. If you have reduced kidney function or kidney disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

Liver function: Liver disease or reduced liver function may cause this medication to build up in the body, causing side effects. If you have reduced liver function or liver disease, discuss with your doctor how this medication may affect your medical condition, how your medical condition may affect the dosing and effectiveness of this medication, and whether any special monitoring is needed.

This medication may also cause a decrease in liver function. If you experience symptoms of liver problems such as fatigue, feeling unwell, loss of appetite, nausea, yellowing of the skin or whites of the eyes, dark urine, pale stools, abdominal pain or swelling, and itchy skin, contact your doctor immediately.

Rashes: Severe skin rashes leading to hospitalization have been reported by people taking lamotrigine. This appears more likely to happen if the dose is increased too quickly. The risk of a serious rash is higher for children and may be higher for people who have experienced rashes when taking other medication for epilepsy. Nearly all cases of serious rashes associated with lamotrigine have occurred within 2 to 8 weeks of the start of treatment. If you notice a skin rash, fever, or swollen glands, seek medical attention immediately.

Stopping the medication: Suddenly stopping any antiepileptic medication may cause rebound seizures. In general, the medication should be stopped gradually, as directed by your doctor, to minimize this risk. Before stopping lamotrigine, contact your doctor for guidance.

Suicidal or agitated behaviour: People with epilepsy sometimes experience depression. If you have depression or bipolar disorder, you may be at an increased risk of feeling agitated (restless, anxious, aggressive, emotional, and feeling not like themselves), or wanting to hurt yourself or others. If you experience these side effects or notice them in a family member who is taking this medication, contact your doctor immediately.

Pregnancy: The use of lamotrigine during pregnancy has been associated with an increased number of cases of cleft palate, a birth defect. This medication should not be used during pregnancy unless the benefits outweigh the risks. If you become pregnant while taking this medication, contact your doctor immediately.

Do not stop taking the medication until you’ve consulted your doctor, since doing so can cause rebound seizures that may be harmful to the mother and unborn baby.

Breast-feeding: This medication passes into breast milk. If you are a breast-feeding mother and are taking lamotrigine, it may affect your baby. Talk to your doctor about whether you should continue breast-feeding. Generally, breast-feeding while taking lamotrigine is not recommended.

Children: The safety and effectiveness of using lamotrigine for children under 16 years of age, other than those with Lennox-Gastaut syndrome, have not been established. Lamotrigine should not be used in children who weigh less than 9 kg.

What other drugs could interact with this medication?

There may be an interaction between lamotrigine and any of the following:

• acetaminophen
• alcohol
• antihistamines (e. g., cetirizine, doxylamine, diphenhydramine, hydroxyzine, loratadine)
• antipsychotics (e.g., chlorpromazine, clozapine, haloperidol, olanzapine, quetiapine, risperidone)
• azelastine
• barbiturates (e.g., butalbital, phenobarbital)
• benzodiazepines (e.g., alprazolam, diazepam, lorazepam)
• birth control pills
• brimonidine
• buprenorphine
• buspirone
• cannabis
• chloral hydrate
• desmopressin
• dofetilide
• efavirenz
• entacapone
• estrogens (e.g., conjugated estrogen, estradiol, ethinyl estradiol)
• guanfacine
• HIV protease inhibitors (e.g., atazanavir, lopinavir, ritonavir)
• kava kava
• magnesium sulfate
• mefloquine
• metformin
• methotrexate
• mirtazapine
• muscle relaxants (e.g., baclofen, cyclobenzaprine, methocarbamol, orphenadrine)
• nabilone
• narcotic pain relievers (e. g., codeine, fentanyl, morphine, oxycodone)
• olopatadine
• orlistat
• pramipexole
• pregabalin
• procainamide
• progestins (e.g., dienogest, levonorgestrel, medroxyprogesterone, norethindrone)
• rifampin
• ropinirole
• rotigotine
• scopolamine
• other seizure medications (e.g., carbamazepine, divalproex, gabapentin, levetiracetam, phenytoin, primidone)
• selective serotonin reuptake inhibitors (SSRIs; e.g., citalopram, fluoxetine, paroxetine, sertraline)
• sodium oxybate
• tapentadol
• tetrabenazine
• thalidomide
• tolcapone
• tramadol
• tricyclic antidepressants (e.g., amitriptyline, clomipramine, desipramine, trimipramine)
• zolpidem
• zopiclone

If you are taking any of these medications, speak with your doctor or pharmacist. Depending on your specific circumstances, your doctor may want you to:

• stop taking one of the medications,
• change one of the medications to another,
• change how you are taking one or both of the medications, or
• leave everything as is.

An interaction between two medications does not always mean that you must stop taking one of them. Speak to your doctor about how any drug interactions are being managed or should be managed.

Medications other than those listed above may interact with this medication. Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications you are taking. Also tell them about any supplements you take. Since caffeine, alcohol, the nicotine from cigarettes, or street drugs can affect the action of many medications, you should let your prescriber know if you use them.

All material copyright MediResource Inc. 1996 – 2021. Terms and conditions of use. The contents herein are for informational purposes only. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a medical condition. Source: www.medbroadcast.com/drug/getdrug/Lamictal

What symptoms does Lamictal help with? – MVOrganizing

What symptoms does Lamictal help with?

Lamotrigine is a mood stabilizer medication that works in the brain. It is approved for the treatment of bipolar disorder (also known as manic depression) and certain types of seizure disorders. Bipolar disorder involves episodes of depression and/or mania.

Should I take Lamictal in the morning or at night?

It’s usual to take lamotrigine once or twice a day. You can take it with or without food. If you take it twice a day, try to space your doses evenly through the day. For example, first thing in the morning and in the evening.

Does Lamictal cause weight loss?

Low risk of weight gain: Lamotrigine (Lamictal) is most likely to cause weight loss. However, it can also cause weight gain. Other common side effects of this drug include: headache.

How often should Lamictal levels be checked?

Once the dosage is stable, serum levels should be monitored every 2 to 3 months for the first year, then annually or as clinically indicated.

What is a normal Lamictal blood level?

Therapeutic range: 3 – 14 mcg/mL. Comments: The proposed therapeutic range for seizure control is 3 – 14 μg/mL. Concentrations that exceed 15 μg/mL may contribute to adverse effects.

What is a good lamotrigine level?

An initial target range of 1.5 to 10 μg/mL is suggested, although higher levels, up to more than 20 μg/mL, are often tolerated and can lead to additional efficacy in refractory patients.

What is the normal blood level for Keppra?

The therapeutic range for levetiracetam is about 12.0 – 46.0 mcg/mL (mg/L). Levels above 46 mcg/mL are considered potentially toxic. However, ranges vary slightly from laboratory to laboratory, and toxic levels have not been well established.

How often should keppra level be checked?

Currently, little is known about the therapeutic range for blood levels for Keppra® . Therefore, levels may not routinely be checked. Dosing is usually based on patient tolerance and effectiveness in seizure control.

What is an alternative to Keppra?

Sodium valproate or lamotrigine are recommended for people with generalised tonic-clonic seizures, and levetiracetam is an alternative option.

What are the long term effects of Keppra?

In studies, non-psychotic behavioral symptoms (reported as aggression, agitation, anger, anxiety, apathy, depersonalization, depression, emotional lability, hostility, hyperkinesias, irritability, nervousness, neurosis, and personality disorder) were reported in 13% of adults and 38% of pediatric patients aged 4 to 16 …

Add-on topiramate reduces weight in overweight patients with affective disorders: a clinical case series | BMC Psychiatry

90,000 Does Lamictal cause weight gain or loss? | Health

If you are concerned that taking Lamictal (lamotrigine) may lead to weight gain, there is good news. It probably won’t affect your weight at all. Anyway, you have a better chance of

Contents:

If you are concerned that taking Lamictal (lamotrigine) may lead to weight gain, there is good news. It probably won’t affect your weight at all.Anyway, you are more likely to lose weight due to Lamictal than to gain weight, but in any case, the changes are likely to be quite small.

The effect of Lamictal on weight has been little studied and various clinical trials have shown minimal increases in exposure. In fact, some researchers have even looked at this medication as a possible obesity remedy and as a remedy for overeating.

This should reassure people with bipolar disorder, as many of the medications used to treat the condition can cause weight gain.

Lamictal and weight gain or loss

Lamictal is an anticonvulsant drug that can be used to treat seizure disorders such as epilepsy. It is also used as a mood stabilizer in bipolar disorder.

In the first clinical trials of the drug, 5% of adults with epilepsy lost weight while taking lamictal, while 1% to 5% of patients with bipolar I disorder gained weight while taking the drug.The researchers did not reveal how the patients gained or lost a lot of weight.

Meanwhile, a 2006 study comparing the effects of lamictal, lithium and placebo on weight found that obese patients who took lamictal lost an average of four pounds, while the weight of non-obese patients remained much the same. …

Weight Gain and Other Bipolar Drugs

Unfortunately, weight gain from drugs used to treat bipolar disorder is fairly common. Certain mood stabilizers commonly used for bipolar disorder, in particular lithium and depakote (valproate), carry a high risk of weight gain.

In addition, the atypical antipsychotics clozaril (clozapine) and zyprexa (olanzapine) tend to cause significant weight gain in people taking them. Finally, some antidepressants, notably Paxil (Paroxetine) and Remeron (Mirtazapine), cause weight gain.

Therefore, if you are already overweight, you and your psychiatrist may consider adding additional weight when determining your bipolar medication regimen.For this reason alone, Lamictal may be a good choice.

Lamictal for obesity

Lamictal has also been studied as a possible treatment for obesity in people without epilepsy or bipolar disorder.

In a small clinical study of 40 people conducted in 2006, researchers randomly assigned participants who received either lamictal or placebo for up to 26 weeks. All study participants had a body mass index (BMI) between 30 and 40, which ranged them from obesity to severe obesity.

Those taking Lamictal lost an average of just over 10 pounds. In the meantime, those taking the placebo lost about seven pounds, so while those taking Lamictal lost more weight, they didn’t lose much more.

Another study in 2009 looked at lamictal as a remedy for overeating. This study included 51 people with the condition: 26 of them received Lamictal and 25 received a placebo.

Those taking Lamictal lost more weight than those taking the placebo (about 2.5 pounds versus about one third of a pound), and they did have significant improvements in their blood sugar and cholesterol lab test results.However, Lamictal did not appear to have an impact on other aspects of their binge eating disorder compared to placebo.

A word from GroinStrong

While more research is needed to determine if Lamictal may be beneficial as a weight loss aid, current research suggests that this drug may not cause the significant weight loss that is common with some other bipolar drugs. Talk to your doctor about your concerns to determine if Lamictal is right for you.

90,000 Is there a link between lamotrigine and weight gain?

Lamotrigine is an anticonvulsant drug used primarily in the treatment of epilepsy. It can cause some mild side effects, however, it is usually well tolerated. There is no association between lamotrigine and weight gain.

This medication can also be used in the treatment of bipolar disorder to stabilize the mood of patients. Lamotrigine and weight gain are not associated when the drug is used to treat bipolar disorder or epilepsy.A small percentage of people in clinical trials actually reported weight loss while taking this medication.

Other side effects of lamotrigine include dizziness, drowsiness, and dizziness. Some people experience dry mouth, diarrhea, or upset stomach, which can lead to weight loss. On several occasions, people have experienced back pain and insomnia. Some people also experience pain in the abdomen, back, or joints. Most people taking this drug reported only minor side effects.

The most serious side effect in people taking lamotrigine is a rash on the chest. This is a relatively rare side effect, but it can be very dangerous. People with this chest rash should alert their doctor immediately. Other signs of a serious adverse reaction to lamotrigine include chest pain, seizures that are different or longer than previous episodes, swelling of the extremities, stiff neck, and sensitivity to light.

Certain antiepileptic drugs such as valproate can cause weight gain. However, there is no link between lamotrigine and weight gain, and the drug has few side effects. This makes lamotrigine a common choice for doctors who are treating epilepsy and bipolar disorder.

Lamotrigine has been tested in both adults and adolescents. None of the groups experienced weight gain with the drug. In both groups, side effects were usually mild and easily tolerated.Lamotrigine is safe for use in both adults and children with epilepsy, however, it has not been shown to be safe in children with bipolar disorder.

Discontinuation of lamotrigine dose may cause serious adverse reactions if done abruptly. If a person wants to stop taking medication, it is important to consult a doctor. The dose of lamotrigine should be tapered down gradually to avoid serious side effects from withdrawal. Avoiding lamotrigine will not lead to weight gain.

Antiepileptic drugs, such as lamotrigine, rarely increase suicidal ideation in patients. It is important to monitor the person taking lamotrigine for sudden and severe changes in mood or thinking. Even in such situations, it is dangerous to simply stop taking the medication. A person with these side effects should see a doctor immediately.

OTHER LANGUAGES

(PDF) Lamotrigine in the treatment of epilepsy and bipolar spectrum disorders: two main therapeutic targets

PSYCHIATRY AND PSYCHOPHARMACOTHERAPY Volume 20 # 2 2018 / PSYCHIATRY AND PSYCHOPHARMACOTHERAPY Vol.20, No. 2 2018

on and dopamine), as well as the weak inhibitory effect of

on the activity of monoamine oxidases A and B, which in total at

leads to an increase in the concentrations of all three monoamines

in the synaptic cleft and an increase in monoaminergic

neurotransmission K. Sariev, 1987; E. Southam, 1998;

M. Sagud et al., 2008; E. N. Yakusheva et al., 2015).

Due to its antiglutamatergic action

lamotrigine also protects neurons from the excitotoxic

action of glutamate and excess incoming current

calcium ions, i.e.That is, it has a neuroprotective effect. It is possible that its therapeutic effect at

BAR is also related to this, since with BAR, there is an increased glutamatergic activity, oxidative

and free radical stress and excitotoxic death of neurons from apoptosis ( A.K.Sariev et al.,

1999; S. Stahl, 2013). In addition, lamotrigine increases

the expression of BDNF and its concentration in cerebrospinal fluid, plasma

blood and brain tissue, which potentially leads to neuro-

trophic effects, inhibition of apoptosis and stimulation of neurogenesis

, prevention of hippo atrophy

campa and limbic with bipolar disorder (S.Stahl, 2013). It is possible that la-

motrigine has other, as yet unknown mechanisms of action

, which explain its effectiveness in bipolar disorder

(PA Baranov et al. , 2010).

Evidence base on the effectiveness of lamotrigine

in RHD

Lamotrigine is one of the most widely used

NTs in the treatment of bipolar disorder, especially with a predominance of

depressive or mixed-depressive phases (R. Weisler

et al., 2008). Both in the United States and in the European Union, lamotrigine

is officially approved for the prevention of affective

phases of both signs (depressive, manic and hypoma –

niacal and mixed) in patients with bipolar I and II types and

is especially recommended during the course of the disease with a predominance of depressive or mixed-depressive phases

(G. Goodwin et al., 2004). It is important to emphasize that lamot-

ridge is highly effective in the fast-cyclic

BAR flow (flow with frequent phase changes), i.e.That is, just

in the clinical form that is especially difficult

is treatable and in which the results of using

lithium or carbamazepine are often disappointing –

, and the use of blood pressure or typical AP can

aggravate rapid mood cycling ( K. Fountoula-

kis, E. Vieta, 2008; A. Sumegi, 2008; S. Stahl, 2013).

In a comparative study of the effectiveness and safety of lamotrigine in comparison with other AEDs, in

including the new generation, in the treatment of bipolar disorder it was shown that lamotrigine has a number of advantages

.In particular, the evidence base for its use in bipolar disorder is much more convincing than for topir

mat, levetiracetam, zonisamide, gabapentin, or pre

gabalin (S. Stahl, 2013). Its effectiveness in suppressing

depressive phases is higher than that of valproate or carbam-

zepin (M. Brodie, 1995; S. Stahl, 2013). It does not have an undesirable effect on body weight

(it does not increase, like

valproate or lithium, but also does not decrease, like topiramate and

zonisamide), the adverse effect on cognitive

functions, characteristic of many other NT, especially to –

pyramata, does not have a pronounced sedative effect

and behavioral toxicity, does not have organ toxicity –

toxicity (in particular, hepatotoxicity and hematotoxicity,

characteristic of carbamazepine and valproate, cardio, ti

rheo and lithium nephrotoxicity) [M. Brodie,

1995; S. Stahl, 2013]. Lamotrigine also does not have a negative effect on the condition of hair and nails, does not cause the appearance of acne

, does not worsen the course of psoriasis, which is rarely the case with the use of valproate or lithium

(S. Stahl, 2013).

Lamotrigine is also effective in the prevention of af-

effective phases not only in bipolar I, but also in bipolar II (which

swarm is often characterized by the predominance of de-

pressures or mixed phases), as well as in the so-called

atypical bipolar disorder or RBD (for example, with depressions, which

rye outwardly look like “unipolar”, but have definite signs that cause suspicion of possible bipolarity, for example, “atypical”

tative signs, beginning at a young age, season-

character, occurrence of an activation reaction, anxiety, irritability or insomnia when trying to change blood pressure monotherapy

, family history of bipolar disorder, etc. n.)

[S. Stahl, 2013]. Also, lamotrigine is effective in cyclo-

thymia and fast-cyclic bipolar disorder, as well as in

short-term, but often recurrent, outwardly

“seemingly unipolar” depressions (U. Malt, T. Fladvad, 2001;

S. Stahl , 2013).

Due to good tolerance and a small number of problematic PEs, as well as high efficiency in suppressing depression, which subjectively

cause more suffering to patients than hypomanic

states, patients with bipolar disorder have on average

higher compliance with long-term use of lamotrigine

and less frequently drop it than other NT (S.Stahl, 2013).

Acute bipolar depression

Multiple studies suggest

that lamotrigine appears to have more acute antidepressant effects than carba-

mazepine or valproate and possibly even more pronounced

more than lithium (U. Malt, T. Fladvad, 2001; S. Stahl, 2013). At the same time,

, its acute anti-manic effect (which

should not be confused with the preventive normotimic

) is weak and unconvincing or is absent (U. Malt,

T. Fladvad, 2001; S. Stahl, 2013).

Previously it was believed that the acute antidepressant effect of lamotrigine in bipolar depression

occurs more slowly than with the use of blood pressure, in

, including due to the need for its slow increase in

shielding due to the risk itching or rash. However, according to

, recent research data show that with the correct

vigorous use, the antidepressant effect of lamot

regina does not occur much slower than with a

change in blood pressure, and that patients with bipolar depression,

having the opportunity of choice, they themselves often prefer

lamotrigine over blood pressure, since it is usually

better tolerated, does not cause, unlike SSRIs and

selective serotonin reuptake inhibitors,

on norepinephrine and sexual dysfunctions, does not give a difference in

weight gain from mirtazapine, etc.d.

(P. Phelps, 2018). In addition, the use of lamotrigine

, in contrast to the use of blood pressure, is not associated with the risk of

phase inversion into mania or hypomania, the development of a mixed state or a rapid cycle and the risk of long-term deterioration in the course of bipolar disorder, has a higher

What is the probability from the very beginning to have the “correct”

effect, i.e. to bring the patient into remission, bypassing the interim

horrible stages of “bumpy” phases or phase inversion

(P.Phelps, 2018).

In the same cases when, due to the severity of depressive state,

standing or suicidal risk in a patient with bipolar disorder

there is no opportunity and time to wait for the onset of the antide-

pressurizing effect of lamotrigine, it is more correct to consider from the use of lamotrigine in favor of

for the use of blood pressure, and the use, in parallel with lamotrid-

, of faster-acting drugs, such as

lithium, AAP (quetiapine or olanzapine), ketam infusion-

for or the use of electroconvulsive therapy

(P. Phelps, 2018).

RESEARCHER – TO THE PRACTICE

44

90,000 🎖 ▷ Why you don’t have to worry about weight gain with Lamictal

If you are concerned that taking Lamictal (lamotrigine) may lead to weight gain, there is good news. It probably won’t have a big effect on your weight. Anyway, you are more likely to lose weight due to Lamictal than to gain weight, but in any case, the changes are likely to be quite small.
The effect of Lamictal on weight has been little studied and various clinical trials have found minimal effect. In fact, some researchers have even looked at the drug as a possible remedy for obesity and as a remedy for overeating. This information should be reassuring for people with bipolar disorder, as many of the medications used to treat the condition can cause weight gain.

Conclusions on Lamictal and weight gain or loss
Lamictal is an anticonvulsant drug that can be used to treat seizures such as epilepsy.It is also used as a mood stabilizer in bipolar disorder.
In the first clinical trials with the drug, 5 percent of adults with epilepsy lost weight while taking Lamictal, while 1 to 5 percent of patients with bipolar I disorder gained weight while taking the drug. The researchers did not disclose how much weight the patients gained or lost.
Meanwhile, a 2006 study comparing the effects on weight of Lamictal, lithium, and placebo found that some patients who received Lamictal gained weight, some lost weight, and most remained at about the same weight.Weight changes are usually not many pounds anyway. Obese patients taking Lamictal lost an average of four pounds, while the weight of non-obese patients remained virtually unchanged.
Link between weight gain and other bipolar drugs
Weight gain from drugs used to treat bipolar disorder is unfortunately quite common. Certain mood stabilizers commonly used for bipolar disorder, especially lithium and Depakote (valproate), carry a high risk of weight gain.
In addition, the atypical antipsychotics Clozaril (clozapine) and Zyprexa (olanzapine) tend to cause significant weight gain in people taking them. Finally, some antidepressants, notably Paxil (paroxetine) and Remeron (mirtazapine), have been linked to weight gain.
Therefore, if you are already overweight, you and your psychiatrist may want to consider adding extra weight when determining your bipolar medication regimen.Based on this, Lamictal might be a good choice.
Lamictal as a possible treatment for obesity
Lamictal has also been studied as a possible treatment for obesity in people without epilepsy or bipolar disorder.
In a small clinical study of 40 people conducted in 2006, researchers randomly assigned participants to receive either lamictal or placebo for up to 26 weeks. Each participant in the study had a body mass index (BMI) between 30 and 40, which placed them in the obese to severely obese group.Those who took Lamictal lost an average of just over 10 pounds. Those taking the placebo lost about 7 pounds in the meantime, so while those taking Lamictal lost more weight, they didn’t lose all that much more.
Another study from 2009 looked at Lamictal as a remedy for overeating. This study involved 51 people with the condition that 26 of them received Lamictal and 25 received a placebo.
Those who took Lamictal lost more weight than those who took the placebo (about 2.5 pounds versus about one third of a pound), and they did have significant improvements in their blood sugar and cholesterol lab test results.However, Lamictal did not appear to affect other aspects of the eating disorder when compared to placebo.

90,000 Is it possible to withdraw drug therapy in patients with Crohn’s disease (CD) who have achieved remission?

Relevance

Crohn’s disease is a serious, chronic, inflammatory disease of the small and large intestine. Symptoms include abdominal pain, diarrhea, bleeding, and weight loss. When people with Crohn’s disease experience symptoms, the disease is “active.”When symptoms go away, the condition is called remission. When people in remission experience symptoms, it is called a “relapse. ” Immunosuppressants (such as azathioprine, 6-mercaptopurine, and methotrexate) and biologics (such as infliximab, adalimumab, vedolizumab, and ustekinumab) are usually used alone or in combination to treat Crohn’s disease. While they are effective in initially controlling the disease (i.e., causing remission), there are safety and cost concerns associated with long-term use of these drugs to prevent relapse in people with remission of Crohn’s disease.

Characteristics of research

We conducted a comprehensive literature review and identified six randomized controlled trials (an experiment in which participants are randomly assigned to receive two or more interventions and compare results) involving a total of 326 participants. In four of the six studies, patients receiving azathioprine alone were assigned to either continue or discontinue therapy (215 participants).In two of the six studies, patients who received azathioprine in addition to infliximab were assigned to continue therapy or to stop taking azathioprine (111 participants).

Main results

Clinical relapse occurred in 13% (14/104) of patients who continued azathioprine monotherapy, compared with 32% (36/111) of patients who discontinued azathioprine monotherapy. No differences were found for complications associated with Crohn’s disease, side effects, serious side effects, and withdrawal due to side effects.Common side effects were infections, mild white blood cell counts, abdominal symptoms, joint pain, headache, and increased liver enzyme activity. Among patients who continued combination therapy with azathioprine and infliximab, 48% (27/56) had a clinical relapse compared with 49% (27/55) of patients who stopped taking azathioprine but remained on infliximab. No differences were observed in side effects, serious side effects, or withdrawal due to side effects.Common side effects reported in combination therapy trials were infections, increased liver function tests, joint pain, and infusion reactions (biologic hypersensitivity reactions).

Quality of evidence

Overall, the quality of the evidence for each outcome was low because of the high risk of bias (bias) in the study and assessment of the small number of patients.

Conclusions

The effect of withdrawing immunosuppressive therapy in people with Crohn’s disease in remission is unclear.Low-quality evidence suggests that continued azathioprine monotherapy may be better than discontinuation of azathioprine to avoid clinical relapse in people with Crohn’s disease in remission. The low quality of the data suggests that discontinuation of the immunosuppressive drug (azathioprine) after combination therapy does not appear to affect the risk of relapse. It is unclear whether withdrawal of azathioprine, initially given alone or in combination, affects Crohn’s disease complications, side effects, serious side effects, or withdrawal from studies due to side effects.More research is needed in this area to better inform clinical practice, in particular high quality randomized controlled trials that investigate the outcomes of biological therapy withdrawal are needed.

instructions for use, dosage, composition, analogs, side effects / Pillintrip

Inside. Epilepsy: for adults and children over 12 years of age who did not receive sodium valproate, initial dose of 25 mg once a day for 2 weeks, then 50 mg once a day for 2 weeks, then the dose is increased by 50-100 mg every 1-2 weeks until the optimal therapeutic effect is achieved.The maintenance dose is 100-200 mg / day in 1 or 2 doses (some patients require a dose of 500 mg / day).

Scheme of increasing doses for monotherapy with lamotrigine in adults and children over 12 years old

For patients receiving sodium valproate, the initial dose is 25 mg every other day for 2 weeks, then 25 mg daily for the next 2 weeks, after which the dose is increased by a maximum of 25-50 mg / day every 1-2 weeks until the optimal therapeutic effect is achieved. The maintenance dose is 100-200 mg / day in 1 or 2 doses.

Patients taking antiepileptic drugs that induce liver enzymes in combination with other antiepileptic drugs or without them (except for sodium valproate), initial dose – 50 mg once a day for 2 weeks, then – 100 mg / day in 2 divided doses for 2 weeks. Then the dose is increased by a maximum of 100 mg every 1–2 weeks until the optimal therapeutic effect is achieved. The maintenance dose to achieve the optimal therapeutic effect is 200-400 mg / day in 2 divided doses.Some patients may need a dose of 700 mg / day to achieve the desired effect.

Scheme of increasing doses in combination therapy in adults and children over 12 years old

1–2 weeks , 5 or 25 mg every other day

Children from 2 to 12 years old receiving sodium valproate in combination with other antiepileptic drugs or without them, initial dose – 0. 15 mg / kg 1 time per day for 2 weeks; then – 0.3 mg / kg once a day for 2 weeks.Then the dose is increased by 0.3 mg / kg every 1–2 weeks until the optimal therapeutic effect is achieved. The maintenance dose is 1–5 mg / kg / day in 1 or 2 doses. The maximum daily dose is 200 mg.

For patients taking antiepileptic drugs that induce liver enzymes, in combination with or without other antiepileptic drugs (with the exception of sodium valproate), initial dose – 0.6 mg / kg / day in 2 divided doses for 2 weeks, further – 1.2 mg / kg / day in 2 doses for 2 weeks.Then the dose is increased by a maximum of 1.2 mg / kg every 1–2 weeks until the optimal therapeutic effect is achieved. The average maintenance dose to achieve the optimal therapeutic effect is 5-15 mg / kg / day in 2 divided doses. The maximum daily dose is 400 mg. To achieve the optimal effect in children, it is necessary to systematically monitor body weight in order to adjust the dose in accordance with changes in the child’s body weight.

Scheme of increasing doses in combination therapy in children from 2 to 12 years old

1–2 weeks , 15 mg / kg / day

Therapy	Doses
Lamictal and valproate in combination with or without other antiepileptic drugs
3-4 weeks	0.3 mg / kg / day
Maintenance dose	The dose is increased by 0.3 mg / kg every 1-2 weeks to maintenance 1 –5 mg / kg (in 1 or 2 doses), but not more than 200 mg / day
Lamictal and antiepileptic drugs that induce liver enzymes (phenytoin, carbamazepine, phenobarbital, primidone), in combination with other antiepileptic drugs or without them (excluding valproate)
1-2 weeks	0.6 mg / kg in 2 divided doses
3-4 weeks	1.2 mg / kg in 2 divided doses
Maintenance dose	The dose is increased by 1. 2 mg / kg every 1-2 weeks to a maintenance dose of 5-15 mg / kg (in 2 divided doses), but not more than 400 mg / day

Bipolar disorders ( in order to prevent the development of a depressive episode).Inside, chewing, dissolving in a small amount of water or swallowing whole with water.

Scheme of increasing doses to achieve a maintenance daily stabilizing dose in adults (over 18 years old) with bipolar disorders

1

904 09

Therapy	Doses
Lamictal in combination with antiepileptic drugs, inhibitors in liver enzymes4
1-2 weeks	12.5 mg (25 mg every other day)
3-4 weeks	25 mg / day
5 weeks	50 mg / day in 1-2 doses
Week 6 (stabilizing dose) *	100 mg / day in 1–2 doses (maximum dose 200 mg)
Lamictal in combination with antiepileptic drugs that induce liver enzymes
weeks	50 mg / day
3-4 weeks	100 mg / day in 2 divided doses
5 weeks	200 mg / day in 2 divided doses
6 weeks (stabilizing dose) *	300 mg
7 weeks	if necessary increase the dose to 400 mg in 2 divided doses
Lamictal in combination with antiepileptic drugs, the nature of the interaction of which is unknown. Monotherapy with Lamictal
1-2 weeks	25 mg / day
3-4 weeks	50 mg / day in 1-2 doses
5 weeks	100 mg / day in 1– 2 doses
6 weeks (stabilizing dose) *	200 mg / day in 1-2 doses

* The stabilizing dose varies depending on the clinical effect

Adults over 18 years old taking Lamictal in combination with antiepileptic drugs, liver enzyme inhibitors (incl.hours with sodium valproate), 25 mg every other day for 2 weeks, then 25 mg daily for 2 weeks, then 50 mg / day in 1 or 2 doses for 1 week; stabilizing dose – 100 mg / day in 1 or 2 doses (varies depending on the clinical effect). The maximum dose is 200 mg / day.

Lamictal therapy in combination with antiepileptic drugs that induce liver enzymes (carbamazepine, phenobarbital), without sodium valproate, initial dose – 50 mg 1 time per day for 2 weeks, then 100 mg / day in 2 doses for 2 weekThe dose is increased by 5 weeks to 200 mg / day in 2 divided doses and up to 300 mg / day by 6 weeks. To achieve the optimal therapeutic effect – 400 mg / day in 2 divided doses, starting from 7 weeks.

Therapy with Lamictal and drugs with unknown interactions (lithium drugs, bupropion). Monotherapy with Lamictal: initial dose – 25 mg / day for 2 weeks, then 50 mg / day in 1 or 2 doses for 2 weeks. The dose should be increased to 100 mg / day for 5 weeks. To achieve the optimal therapeutic effect, a dose of 200 mg / day is required in 1 or 2 doses.

As soon as the daily maintenance stabilizing dose is reached, other psychotropic drugs may be discontinued.

The daily dose of Lamiktal required to stabilize mood in bipolar disorders after discontinuation of concomitant psychotropic or antiepileptic drugs

2 weeks

Lamictal therapy after discontinuation of antiepileptic drugs, liver inhibitors. including sodium valproate): after the abolition of sodium valproate, the stabilizing dose is doubled, not exceeding 100 mg / week. For example, the stabilizing dose of 100 mg / day is increased in the first week to 200 mg / day, in the second, third week and then the dose is kept at 200 mg / day in 2 divided doses. If necessary, the dose can be increased to 400 mg / day.

Lamictal therapy after discontinuation of antiepileptic drugs that induce liver enzymes (carbamazepine), depending on the initial maintenance dose: Lamictal dose is gradually reduced over 3 weeks.

Therapy with Lamictal after the withdrawal of psychotropic drugs or other antiepileptic drugs, the nature of the interaction of which with lamotrigine is unknown (lithium preparations, bupropion): the same maintenance dose remains.

Lamotrigine dosing regimen for bipolar disorders after joining therapy with other drugs

904 Valproate addition

Attach antiepileptic drugs liver enzymes (sodium valproate), depending on the initial dose of lamotrigine: at a stabilizing dose of 200 mg / day, in the first week – reduce it to 100 mg / day, in the second, third week and further – keep 100 mg / day. At a dose of 300 mg / day, in the first week, reduce to 150 mg / day and then keep unchanged, at a dose of 400 mg / day, in the first week, reduce to 200 mg / day and then keep unchanged.

Addition of antiepileptic drugs that induce liver enzymes (carbamazepine) in patients not receiving sodium valproate, depending on the initial dose of lamotrigine: at a dose of 200 mg / day, keep it unchanged in the first week, and increase it to 300 in the second week mg / day, in the third and further – increase to 400 mg / day.

At a dose of 150 mg / day in the first week, keep it unchanged, in the second – increase to 225 mg / day, in the third and further – increase to 300 mg / day. At a dose of 100 mg / day, in the first week, keep it unchanged, in the second – increase to 150 mg / day, in the third and further – increase to 200 mg / day.

Attachment of other psychotropic or antiepileptic drugs, the nature of the interaction of which with lamotrigine is unknown: Maintain a maintenance dose of 200 mg / day in 2 divided doses (from 100 to 400 mg).