History
Lamictal, known by its generic name as lamotrigine, was originally designed by GlaxoSmithKline (GSK) and marketed to the United Kingdom in 1991 with the brand name Lamictal. GSK began marketing Lamictal in the United States in 1994, which is the same year the drug was approved by the U.S. Food and Drug Administration (FDA) to treat the symptoms of epileptic seizures in adults and children over two years old. Lamictal became a common prescription after its introduction to the United States for both the treatment of epileptic patients as well as maintenance treatment for adults with bipolar disorder. At the height of its popularity in 2018, Lamictal was the 68th most commonly prescribed drug to the American people.
Brand names for lamotrigine include Lamictal, Lamictal CD, Lamictal ODT, and Lamictal XR.
How it works
Like many other mood stabilizers, Lamictal was initially developed primarily as an anticonvulsant drug to reduce the severity and frequency of seizures in people suffering from epilepsy. It is a member of the sodium blocking channels type of antiepileptic drugs, and functions by suppressing glutamate and aspartate in the user’s brain. In theory, slowing down these chemicals and electric signals to the brain will reduce the likelihood of a seizure in the user.
Lamotrigine is also approved by the FDA as a mood stabilizer medication used to prevent mood episodes in adults with bipolar disorder. The medication works in mood management by delaying the time between mood changes and depressive states in those suffering from bipolar disorder. This works by decreasing the intensity of irregular electrical activity in a person’s brain. Because bipolar disorder is often characterized by relapsing mood changes, lamotrigine works as maintenance treatment in reducing the risk of relapses by delaying the mood recurrences. As with any other medication, the effects of Lamictal for mood stabilization vary for each patient.
Common uses
Lamictal is not only known for treatment of epilepsy in children and adults, but it has also gained popularity as a maintenance treatment in adults with bipolar disorder. In people suffering from mild bipolar disorders, Lamictal is prescribed to aid in delaying the occurrence of various mood changes such as depression, mania, and hypomania. Additionally, Lamictal has been used in what is referred to as off-label uses, often with mixed success. Although the medication has only been designed and FDA-approved for epilepsy and mood maintenance for bipolar disorder, some medical providers have prescribed Lamictal for treatment of off-label conditions which are not approved by the FDA. These off-label uses include anxiety, migraines, posttraumatic stress disorder (PTSD), binge eating disorder, and panic disorder.
Associated complications
Lamictal has, at times, been linked to an adverse reaction known as Stevens-Johnson Syndrome (SJS). Some of the side effects of Lamictal are common to many anticonvulsive drugs such as nausea, headaches, dizziness, and rash. Stevens-Johnson Syndrome is an especially severe rash caused by a hypersensitivity reaction by the body. It is possible that Lamictal use has been linked with SJS reactions, especially under certain circumstances. Sudden increases in dosages of Lamictal or using the drug in conjunction with other anticonvulsive medications has been shown to increase the risk of SJS. Stevens-Johnson Syndrome is more dangerous than an average rash, with some effects including fever, lesions, and organ damage. During a premarketing clinical trial of epilepsy, 11 out of 3,348 (0.3%) of adults suffering from epilepsy who received Lamictal developed a serious rash that led to hospitalization. The rate of serious rash for the bipolar and other mood disorder clinical trials was 0.08% (1 of 1,233) of adult patients.
Lamictal can also cause a rare but serious reaction that activates the body’s immune system, causing severe inflammation throughout the body. This is a very serious condition that can lead to hospitalization and death. In April 2018, the FDA released a safety announcement that Lamictal can cause this serious immune system reaction known as Hemophagocytic Lymphohistiocytosis (HLH). HLH causes uncontrolled response by the immune system. This reaction typically presents as a persistent fever which can quickly lead to more serious problems affecting the liver, kidneys, and lungs. HLH may be confused with Drug Reaction with Eosinophilia and Systemic Symptoms (DRESS), another serious adverse drug-induced reaction associated with Lamictal use. DRESS syndrome is similar to HLH and the two are often confused as they are both potentially life-threatening reactions sometimes associated with Lamictal use. DRESS is characterized by fever, rash, hematologic abnormalities, and internal organ involvement.
In addition to HLH and DRESS syndrome, lamotrigine can cause a number of other serious reactions which are already included in the drug label. These adverse reactions include:
- Rashes, both mild and severe
- Serious allergic reactions that may cause problems to blood, liver, and other organs
- Mood or behavior changes, such as depression, suicidal thoughts, anxiety and hostility
- Aseptic meningitis
- Less serious side effects such as dizziness, sleepiness, headaches, double vision, nausea
