This drug blocks sodium channels and decreases the release of glutamate, an excitatory neurotransmitter. Lamotrigine binds to sodium channels and prolongs inactivation to decrease high-frequency neuronal discharge. The decrease of neuronal excitability leads to a reduction of seizure activity.
As a sodium channel blocker, Lamotrigine decreases seizure activity. This drug is indicated to treat partial seizures, generalized tonic-clonic seizures, and absence seizures.
Long-term maintenance lamotrigine therapy decreases the manic and depressive symptoms associated with bipolar disorder. This drug acts as a mood stabilizer and delays relapses of depression. Important to note that if augmenting this medication with valproic acid for treatment resistant bipolar, use half dose of lamotrigine in the presence of valproate, as valproate can double lamotrigine levels.
Diplopia (double vision) and blurred vision are common side effects of lamotrigine. Instruct the patient to report sudden vision problems to the healthcare provider for a possible medication change.
Lamotrigine may causes life-threatening rashes, such as Stevens-Johnson Syndrome (SJS) and toxic epidermal necrolysis (TEN). Minimize the risk of developing a serious rash by initiating low doses and gradually increase to therapeutic levels. Immediately stop lamotrigine administration if a rash develops.
Headache and dizziness are common side effects of Lamotrigine. To minimize these neurological side effects, initiate therapy with low doses.
Although rare, aseptic meningitis is a serious complication associated with lamotrigine. Instruct the patient to contact the healthcare provider immediately if experiencing symptoms, such as headache, fever, stiff neck, vomiting, drowsiness, or confusion.
Lamotrigine may cause temporary nausea or vomiting and lead to a decrease in appetite. Consuming a snack prior to the medication may help prevent these side effects.
Patients receiving lamotrigine may experience suicidal thoughts and behaviors and should be screened for suicide risk. Monitor the patient for increased anxiety, agitation, hostility, depression, and mania. Use caution with lamotrigine alongside antidepressants such as TCAs, MAOIs, as these can destabilize mood in some patients, including induction of rapid cycling or suicidal ideation.
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