Lamitor - Instructions For Use, Price, Reviews, Analogs Of Tablets

2024 Author: Rachel Wainwright | [email protected]. Last modified: 2023-12-15 07:39

Lamitor

Lamitor: instructions for use and reviews

1. 1. Release form and composition
2. 2. Pharmacological properties
3. 3. Indications for use
4. 4. Contraindications
5. 5. Method of application and dosage
6. 6. Side effects
7. 7. Overdose
8. 8. Special instructions
9. 9. Application during pregnancy and lactation
10. 10. Use in childhood
11. 11. In case of impaired renal function
12. 12. For violations of liver function
13. 13. Use in the elderly
14. 14. Drug interactions
15. 15. Analogs
16. 16. Terms and conditions of storage
17. 17. Terms of dispensing from pharmacies
18. 18. Reviews
19. 19. Price in pharmacies

Latin name: Lamitor

ATX code: N03AX09

Active ingredient: lamotrigine (Lamotrigine)

Manufacturer: Torrent Pharmaceuticals, Ltd. (Torrent Pharmaceuticals, Ltd.) (India)

Description and photo updated: 30.11.2018

Prices in pharmacies: from 311 rubles.

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Lamitor is an antiepileptic drug.

Release form and composition

Dosage form - tablets: round, flat, light yellow, with a risk on one side (10 pcs. In blisters, in a cardboard box of 3 or 5 blisters and instructions for the use of Lamitor).

Composition of 1 tablet:

• active substance: lamotrigine - 25, 50 or 100 mg;
• auxiliary components: sodium carboxymethyl starch, povidone-K30, microcrystalline cellulose, lactose monohydrate, magnesium stearate, talc, colloidal silicon dioxide, iron dye yellow oxide.

Pharmacological properties

Pharmacodynamics

Lamotrigine - Lamitor's active ingredient, has a blocking effect on voltage-gated sodium channels of the presynaptic membranes of neurons. This mechanism is due to the ability of the drug to suppress the excessive release of glutamic acid (a neurotransmitter that plays an important role in the development of epileptic seizures) and the associated spread of effector impulses.

Pharmacokinetics

Lamotrigine is rapidly and completely absorbed from the intestine. Almost does not undergo first pass metabolism through the liver. The maximum plasma concentration (Cmax) reaches approximately within 2.5 hours. Food intake may slightly increase the time to reach Cmax, but the degree of drug absorption does not change.

In an equilibrium state, significant fluctuations in Cmax are observed in different patients, however, in one patient, these fluctuations are rare.

Plasma proteins bind about 55%. The volume of distribution is 0.92-1.22 l / kg.

Lamotrigine is metabolized with the participation of the enzyme UDPGT (uridine diphosphate glucuronyl transferase). The drug substance has a dose-dependent ability to slightly increase its own metabolism. In the equilibrium state, the clearance of lamotrigine in adult patients averages 39 ± 14 ml / min. It is biotransformed to glucuronides, which are excreted mainly by the kidneys, about 2% through the intestines. In unchanged form, no more than 10% of the dose of the drug is eliminated in the urine.

The clearance of lamotrigine and its half-life (T _1/2) are independent of the dose. T _1/2 in adults - 24-35 hours. In Gilbert's syndrome, the clearance of the drug decreases by 32%, but this decrease does not go beyond the normal range for the general population. The duration of T _1/2 can vary significantly under the influence of other drugs used in combination with Lamitor.

Lamotrigine passes into breast milk in concentrations of 40-60% of plasma levels. In some infants, the plasma levels of the drug can reach therapeutic concentrations.

Based on body weight, the clearance of lamotrigine in children (especially under 5 years of age) is higher than in adults, and T _{1/2 is} usually shorter. With the simultaneous use of drugs that induce glucuronidation, T _1/2 is 7 hours, in the case of joint administration of valproic acid, it rises to 45-50 hours.

In older people, there are no significant differences in the clearance of lamotrigine.

In severe renal impairment, moderate and severe renal failure, a dose reduction of Lamitor may be required.

Indications for use

• epilepsy (partial and generalized seizures, including tonic-clonic seizures; seizures in Lennox-Gastaut syndrome) - as monotherapy or as part of complex treatment in adults and children over 12 years old, as an additional therapy in children 3–12 years old;
• typical absences - as monotherapy;
• bipolar disorder - to prevent mood disorders in adults (mania, hypomania, depression, mixed episodes).

Contraindications

• lactase deficiency, lactose intolerance, glucose-galactose malabsorption;
• age up to 3 years - with combination therapy for epilepsy;
• age up to 12 years - with monotherapy for epilepsy;
• age up to 18 years - with bipolar disorders;
• hypersensitivity to any component of the drug.

Only after a thorough assessment of the benefits and risks of Lamitor tablets are used with caution in renal failure, as well as during pregnancy and lactation.

Lamitor, instructions for use: method and dosage

Lamitor is indicated for oral administration.

The doctor selects the optimal dose. If the calculated dose cannot be divided by the whole number of Lamitor tablets at a lower dosage (for example, when administered to patients with liver dysfunction or children), then the dose is prescribed that corresponds to the closest value of the whole Lamitor tablet at a lower dosage.

It is not recommended to exceed the indicated starting doses, as in this case there is a risk of developing a rash.

If concomitant antiepileptic drugs are discontinued, the patient is transferred to Lamitor, or other anticonvulsant / other drugs are added to lamotrigine, it is necessary to take into account the possibility of the influence of the listed situations on the pharmacokinetics of lamotrigine.

If, for some reason, taking the drug was interrupted, when resuming therapy, the doctor should evaluate the feasibility of increasing the maintenance dose, since when using high initial doses and exceeding the recommended doses, there is a risk of developing a severe rash. The longer the break in taking Lamitor, the more care should be taken to increase the dose to maintenance, especially in cases where the duration of the break exceeds 5 half-lives of lamotrigine.

If Lamitor has been canceled due to the occurrence of a rash, it is not recommended to resume taking it, unless the expected benefit is definitely higher than the possible risks.

Epilepsy treatment

As a monotherapy for epilepsy for adults and children over 12 years of age, Lamitor is prescribed according to the following scheme: 1-2 weeks - 25 mg once a day, 3-4 weeks - 50 mg once a day, the maintenance daily dose - 100-200 mg in 1-2 doses, in some cases - 500 mg per day. For optimal achievement of the therapeutic effect, the dose can be increased by 50–100 mg every 1–2 weeks.

As part of the combination therapy of epilepsy for adults and children from 12 years of age, Lamitor is prescribed according to the following schemes, depending on the use of concomitant drugs:

• valproic acid (regardless of other concomitant therapy): 1-2 weeks - 25 mg every other day, 3-4 weeks - 25 mg 1 time per day, maintenance daily dose - 100-200 mg in 1– 2 receptions. For optimal achievement of the therapeutic effect, the dose can be increased by 25-50 mg every 1-2 weeks;
• lamotrigine glucuronidation inducers (phenobarbital, carbamazepine, primidone, rifampicin, phenytoin, lopinavir / ritonavir): 1-2 weeks - 50 mg once a day, 3-4 weeks - 50 mg twice a day, dose - 100-200 mg 2 times a day, in some cases - up to 700 mg per day. For optimal achievement of the therapeutic effect, the dose is increased by 100 mg every 1-2 weeks;
• drugs that have little effect on the glucuronidation of lamotrigine: 1-2 weeks - 25 mg once a day, 3-4 weeks - 50 mg once a day, the maintenance daily dose is 100-200 mg in 1– 2 receptions. For optimal achievement of the therapeutic effect, the dose can be increased by 50–100 mg every 1–2 weeks;
• drugs, the interaction of which with lamotrigine has not yet been established: use the regimen recommended for combination therapy with valproic acid.

As a monotherapy for typical absences for children 3–12 years old, Lamitor is prescribed according to the following scheme: 1–2 weeks - 0.3 mg / kg / day in 1–2 doses, 3-4 weeks - 0.6 mg each / kg / essence in 1–2 doses, the maintenance daily dose is 1–10 mg / kg in 1–2 doses, in some cases - up to 15 mg / kg per day. For optimal achievement of the therapeutic effect, the dose is increased by no more than 0.6 mg / kg every 1–2 weeks.

As part of the combination therapy of typical absences for children 3-12 years old, Lamitor is prescribed according to the following schemes, depending on the use of concomitant drugs:

• valproic acid (regardless of other concomitant therapy): 1-2 weeks - 0.15 mg / kg once a day, 3-4 weeks - 0.3 mg / kg once a day, supporting daily dose - 1–5 mg / kg in 1–2 doses, but not more than 200 mg per day. For optimal achievement of the therapeutic effect, the dose is increased by no more than 0.3 mg / kg every 1–2 weeks;
• inducers of glucuronidation of lamotrigine (phenobarbital, carbamazepine, primidone, rifampicin, phenytoin, lopinavir / ritonavir): 1-2 weeks - 0.6 mg / kg / day in 2 divided doses, 3-4 weeks - 1.2 each mg / kg / day in 2 divided doses, maintenance daily dose is 5-15 mg / kg in 1-2 doses, but not more than 400 mg per day. For optimal achievement of the therapeutic effect, the dose is increased by no more than 1.2 mg / kg every 1–2 weeks;
• drugs that have little effect on the glucuronidation of lamotrigine: 1–2 weeks - 0.3 mg / kg / day in 1–2 doses, 3–4 weeks - 0.6 mg / kg / day in 1– 2 doses, maintenance daily dose - 1-10 mg / kg in 1-2 doses, but not more than 200 mg per day. For optimal achievement of the therapeutic effect, the dose is increased by no more than 0.6 mg / kg every 1–2 weeks.

If the calculated daily dose of lamotrigine in children is less than 25 mg, Lamitor should not be prescribed. Other medicines containing lower doses of lamotrigine should be used.

After it is possible to achieve control of epilepsy during combination therapy, you can cancel the concomitant antiepileptic drugs and continue taking Lamitor as a monotherapy.

To ensure that the drug is taken in the optimal dosage, it is necessary to periodically monitor the child's body weight and adjust the dose when it changes. Most likely, children 3–6 years old will require the highest maintenance doses.

Treatment of bipolar disorders in patients over 18 years of age

In bipolar disorders, the Lamitor dose is increased gradually over 6 weeks to a maintenance (target) stabilization dose of lamotrigine, in accordance with the recommendations below, depending on the use of concomitant medications:

• monotherapy or combination therapy without glucuronidation inducers lamotrigine and valproic acid: 1-2 weeks - 25 mg once a day, 3-4 weeks - 50 mg in 1-2 doses, 5th week - 100 mg in 1-2 doses, the target stabilizing dose (CSD) per day from the 6th week of treatment - 100-400 mg in 1-2 doses;
• combination therapy with valproic acid: 1-2 weeks - 12.5 mg once a day (25 mg every other day), 3-4 weeks - 25 mg once a day, 5 weeks - 50 mg in 1–2 doses, daily CSD - 100 mg in 1–2 doses (in some cases - 200 mg per day in 1–2 doses);
• combination therapy with inducers of glucuronidation of lamotrigine (such as phenobarbital, carbamazepine, primidone, rifampicin, phenytoin, lopinavir / ritonavir): 1-2 weeks - 50 mg once a day, 3-4 weeks - 50 mg 2 times a day, 5th week - 100 mg 2 times a day, CSD - 150 mg 2 times a day, in some cases from the 7th week, it is possible to increase the dose to 200 mg 2 times a day;
• drugs, the interaction of which with lamotrigine has not yet been established: use the regimen recommended for combination therapy with valproic acid.

The daily dose that maintains the target values of the pharmacodynamic index varies depending on the clinical effect.

After reaching the CSP, in the presence of indications, concomitant drugs can be canceled according to the following schemes:

• valproic acid: if the daily CSD of lamotrigine is 100 mg, in the 1st week after discontinuation - 200 mg, in the 2nd week and then * - 200 mg in 2 divided doses; if the daily CSD of lamotrigine is 200 mg, in the 1st week after discontinuation - 300 mg, in the 2nd week and further * - 400 mg;
• lamotrigine glucuronidation inducers (such as phenobarbital, carbamazepine, primidone, rifampicin, phenytoin, lopinavir / ritonavir): the current daily CSD of lamotrigine is 400 mg, the 1st week after withdrawal is 400 mg, the 2nd week is 300 mg, the 3rd week and beyond * - 200 mg; current daily CSD of lamotrigine - 300 mg, 1st week after withdrawal - 300 mg, 2nd week - 225 mg, 3rd week and beyond * - 150 mg; current daily CSD of lamotrigine - 200 mg, 1st week after withdrawal - 200 mg, 2nd week - 150 mg, 3rd week and beyond * - 100 mg;
• drugs that have little effect on the glucuronidation of lamotrigine: it is necessary to maintain the daily CDP achieved during the dose increase period (100–400 mg, on average 200 mg);
• drugs, the interaction of which with lamotrigine has not yet been established: a dosage regimen is recommended, as with the abolition of valproic acid.

* If necessary, from the 4th week, the daily dose of Lamitor can be increased to 400 mg.

There is no clinical experience in adjusting daily doses of lamotrigine with the addition of other agents in patients with bipolar disorder. However, based on drug interaction studies, the following recommendations can be made depending on the added drugs:

• valproic acid (regardless of other concomitant therapy): the current daily CSD of lamotrigine is 200 mg, the 1st week after the addition is 100 mg, the 2nd week and beyond - the daily dose of 100 mg is maintained; the current daily CSD of lamotrigine is 300 mg, the 1st week after the addition is 150 mg, the 2nd week and beyond - the daily dose of 150 mg is maintained; the current daily CSD of lamotrigine is 400 mg, the 1st week after the addition is 200 mg, the 2nd week and beyond - the daily dose of 200 mg is maintained;
• lamotrigine glucuronidation inducers (such as phenobarbital, carbamazepine, primidone, rifampicin, phenytoin, lopinavir / ritonavir): current daily CSD of lamotrigine is 200 mg, week 1 after addition is 200 mg, week 2 is 300 mg, week and then - 400 mg; current daily CSD of lamotrigine - 150 mg, 1st week after addition - 150 mg, 2nd week - 225 mg, 3rd week and further - 300 mg; current daily CSD of lamotrigine - 100 mg, 1st week after addition - 100 mg, 2nd week - 150 mg, 3rd week and further - 200 mg;
• other drugs that have little effect on the glucuronidation of lamotrigine: it is necessary to maintain the daily CDP achieved during the dose increase period (100-400 mg, on average 200 mg);
• drugs, the interaction of which with lamotrigine has not yet been established: a dosing regimen is recommended, as with the addition of valproic acid.

In bipolar disorders, if necessary, Lamitor can be canceled abruptly, without a gradual dose reduction.

General recommendations for dosing in special patient categories

Women taking oral hormonal contraceptives when prescribing Lamitor should be guided by the general instructions for the dosage regimen. Special regimens for combined use have not been developed, despite the fact that hormonal contraceptives increase the clearance of lamotrigine.

If oral contraceptives are prescribed in a maintenance dose to patients who are already taking Lamitor and not receiving lamotrigine glucuronidation inducers, an increase in the Lamitor dose by 50–100 mg every week is usually required, but no more than 2 times. When the anticonvulsant effect remains at the required level, there is no need to adjust the dose of the drug.

In case of discontinuation of hormonal contraceptives in patients who are already receiving Lamitor in a maintenance dose and do not take lamitrigine glucuronidation inducers, a 2-fold reduction in the Lamitor dose is usually required: by 50-100 mg every week (no more than 25% of the daily dose) for 3 weeks …

In patients with a significant decrease in renal function, the maintenance dose is reduced if necessary.

In case of moderate hepatic insufficiency (severity class B according to the Child - Turcott - Pugh classification), the initial, increasing and maintenance doses of Lamitor are reduced by 50%, with severe hepatic insufficiency (severity class C according to the Child - Turcott - Pugh classification) - by 75% … The increasing and maintenance doses are adjusted depending on the clinical effect.

Elderly patients do not need to adjust the Lamitor dose.

Side effects

The information is divided into side effects in patients with epilepsy and adverse reactions in patients with bipolar disorder. However, when considering the overall safety profile of lamotrigine, the information presented in both sections should be considered.

The described phenomena are classified as follows: very often - ≥ 1/10, often - from ≥ 1/100 to <1/10, infrequently - from ≥ 1/1000 to <1/100, rarely - from ≥ 1/10 000 to < 1/1000, very rarely - <1/10 000, including isolated cases.

Side effects in patients with epilepsy:

• on the part of the psyche: often - irritability, hostility; very rarely - confusion, hallucinations, tics;
• from the nervous system during monotherapy: very often - headache; often - insomnia / drowsiness, tremors, vertigo; infrequently - ataxia; rarely - nystagmus;
• from the nervous system in other types of clinical use: very often - dizziness, headache, ataxia, drowsiness; often - tremor, nystagmus, insomnia; very rarely - increased frequency of seizures, worsening symptoms of Parkinson's disease (extrapyramidal disorders), movement disorders, gait instability, choreoathetosis, extrapyramidal disorders, agitation, aseptic meningitis;
• from the liver and biliary tract: very rarely - increased activity of liver enzymes, liver functional disorders, liver failure;
• from the gastrointestinal tract with monotherapy: often - diarrhea, nausea / vomiting;
• from the gastrointestinal tract in other types of clinical use: very often - nausea / vomiting; often - diarrhea;
• from the musculoskeletal and connective tissue: very rarely - lupus-like syndrome;
• on the part of the organ of vision during monotherapy: infrequently - blurred vision, diplopia;
• on the part of the organ of vision for other types of clinical use: very often - blurred vision, diplopia; rarely - conjunctivitis;
• on the part of the hematopoietic and lymphatic system: very rarely - lymphadenopathy and hematological disorders (thrombocytopenia, anemia, aplastic anemia, pancytopenia, leukopenia, neutropenia, agranulocytosis), in some cases associated with hypersensitivity syndrome;
• on the part of the immune system: very rarely - hypersensitivity syndrome (may manifest itself with symptoms such as fever, facial swelling, disseminated intravascular coagulation syndrome, lymphadenopathy, abnormalities in the blood and liver function, multiple organ failure);
• on the part of the skin and subcutaneous fat: very often - a skin rash (usually maculopalular in nature); rarely - Stevens-Johnson syndrome; very rarely - Lyell's syndrome (toxic epidermal necrolysis);
• others: often - fatigue.

Side effects in people with bipolar disorder:

• from the nervous system: very often - headache; often - drowsiness, agitation, dizziness;
• from the musculoskeletal and connective tissue: often - arthralgia;
• from the digestive system: often - dryness of the oral mucosa;
• on the part of the skin and subcutaneous fat: very often - skin rashes; rarely - Stevens-Johnson syndrome;
• others: often - pain syndrome, including back pain.

Overdose

There are reports of single doses of lamotrigine 10–20 times higher than the maximum therapeutic dose. Overdose manifested itself with various symptoms, including ataxia, nystagmus, impaired consciousness and coma.

In case of taking an excessive dose of Lamitor, the patient is hospitalized and provided with supportive therapy, the scheme of which is determined by the clinical picture or the recommendations of the national poison control center.

special instructions

Lamitor should not be taken by patients who are receiving other drugs containing lamotrigine without consulting a doctor.

Clinical deterioration and risk of suicide

Suicidal behavior and suicidal thoughts have been reported in patients who were taking antiepileptic drugs (AEDs) for several indications. In randomized placebo-controlled trials of AEDs (including lamotrigine), there was a slight increase in the risk of suicide. The mechanism of such an action of the drug has not been established, but the available data do not exclude the possibility of an increase in suicidal risk when using Lamitor. In this regard, during the period of therapy, patients should be closely monitored. The patients themselves and their caregivers should be informed about the need to consult a doctor in case of such disorders.

In bipolar disorders, it is possible to aggravate or develop suicidal ideation both with lamotrigine therapy and without treatment. For this reason, during the period of taking Lamitor, careful monitoring of the symptoms of possible clinical worsening (including the appearance of new symptoms) and probable suicidal signs is required, especially during the period of titration and dose changes. Persons from the risk group should be strictly controlled: patients with a history of suicidal thoughts / behavior, young people, as well as patients with suicidal intentions before starting treatment. The patients themselves and their guardians should be informed about the need to immediately consult a doctor in case of aggravation / development of disorders, including new ones.

In all cases described, the attending physician should assess the situation and make appropriate changes to the therapy regimen, if necessary, cancel Lamitor, especially in the event of new or severe symptoms with a sudden onset.

Skin reactions

There are reports of the development of skin reactions during therapy with lamotrigine. Most often they occurred during the first 8 weeks of taking Lamitor, in most cases they were mild and went away on their own. However, some patients experienced serious reactions (for example, Lyell's syndrome and Stevens-Johnson syndrome), which required hospitalization of the patient and discontinuation of therapy.

Severe skin reactions develop in about 1 in 500 patients with epilepsy. Stevens-Johnson syndrome has been diagnosed in about half of the cases. In patients with bipolar disorders, severe skin rashes occur with approximately a frequency of 1 ÷ 1000.

Children are at higher risk of developing severe skin rashes than adults. There is evidence that hospitalization of children with epilepsy was required in 1 case out of 100–300.

In pediatric patients, the first symptoms of skin reactions are usually a rash and fever, which can be mistaken for an infection. This should be taken into account in the first 8 weeks of therapy.

The overall risk of rash is largely associated with violations of the recommended dose titration regimen (prescribing a high initial dose of Lamitor and exceeding the intervals between dose increases), as well as with the simultaneous use of valproic acid preparations.

Caution should be exercised when prescribing Lamitor to patients with a history of the development of a rash or allergic reactions to other antiepileptic drugs, since their risk of rash is 3 times higher than in patients with an uncomplicated history.

If a rash is found on the body, you should immediately consult a doctor. Reception of Lamitor is stopped until it is reliably established that the reaction is not caused by lamotrigine. If the rash occurs during therapy, it is allowed to resume treatment with the drug only in exceptional cases when the expected benefit is clearly higher than the possible risks. The rash is also considered as part of the hypersensitivity syndrome, which can be expressed in various manifestations, including fever, facial swelling, lymphadenopathy, liver dysfunction, blood disorders, aseptic meningitis. The severity of symptoms of the syndrome varies widely.

In rare cases, hypersensitivity syndrome can lead to the development of multiple organ failure and disseminated intravascular coagulation syndrome. It should be noted that the early signs of hypersensitivity are fever and lymphadenopathy - they can be observed even without obvious signs of a rash.

If any of the described reactions occur, patients should immediately consult a doctor. Unless otherwise established, the Lamitor is canceled.

The risk of developing aseptic meningitis

There are known cases of the development of aseptic meningitis during therapy with lamotrigine. Patients should seek urgent medical attention if they develop any sign of meningitis. If another cause of its occurrence is not established, Lamitor is canceled and appropriate therapy is prescribed.

Resuming lamotrigine treatment in this case is not recommended, as there is a risk of reappearance of signs of meningitis.

Cancellation of therapy for epilepsy

Sudden discontinuation of Lamitor in patients with epilepsy may cause seizures to recur. If abrupt withdrawal of the drug is not a medical indication (for example, with the development of a rash), the dose of lamotrigine should be gradually reduced over 2 weeks. In the literature, there are reports of the occurrence of severe convulsive seizures (including up to the development of status epilepticus), which led to the syndrome of disseminated intravascular coagulation, rhabdomyolysis and multi-organ disorders, sometimes with a fatal outcome. Similar episodes are possible when taking Lamitor.

Influence on the ability to drive vehicles and complex mechanisms

While taking Lamitor, you should refrain from driving a car and performing potentially dangerous work that requires speed of reactions and increased attention.

Application during pregnancy and lactation

Physiological transformations in the female body during pregnancy can cause changes in the concentration and / or therapeutic effect of lamotrigine. There is evidence of a decrease in the content of the drug in the blood of pregnant women. A post-marketing study followed the pregnancies of about 200 women who received lamotrigine monotherapy during the first trimester. The information obtained does not confirm an increase in the overall risk of developing intrauterine anomalies, however, in some registries, an increase in the likelihood of the formation of oral defects was reported. In this regard, Lamitor is contraindicated during pregnancy, except in rare cases when the expected benefit from therapy is definitely higher than the potential risks.

There is evidence of the penetration of lamotrigine into breast milk. However, information on the practical use of the drug during lactation is limited. The benefits and risks should be weighed by the physician before prescribing Lamitor.

Pediatric use

Lamitor tablets are not used at the age of:

• up to 3 years - with combined therapy for epilepsy;
• up to 12 years - with monotherapy for epilepsy;
• under 18 years old - with bipolar disorders.

Do not prescribe the drug to children weighing less than 25 kg due to the lack of the possibility of its accurate dosage at the initial stage of treatment in accordance with medical recommendations.

In children and adolescents with mental disorders (including depression), treatment with antidepressants is associated with an increased risk of developing / worsening suicidal ideation. Therefore, they require careful monitoring.

With impaired renal function

With a single dose of lamotrigine in patients with end-stage renal failure, there were no significant changes in its concentration. However, the possibility of accumulation of the glucuronide metabolite cannot be completely ruled out with prolonged use of Lamitor. For this reason, patients with renal insufficiency are treated with caution. In the case of a significant decrease in renal function, if necessary, reduce the maintenance dose.

For violations of liver function

With hepatic insufficiency of moderate severity (severity class B according to the Child-Türcott-Pugh classification), the initial, increasing and maintenance doses of Lamitor are reduced by 50%. In severe hepatic impairment (severity class C according to the Child-Türcott-Pugh classification), the dosage is reduced by 75%. The increasing and maintenance doses are adjusted depending on the clinical effect.

Use in the elderly

There is no need to adjust the dose of Lamitor in elderly patients.

Drug interactions

The drug interaction of lamotrigine has been studied only in adult patients.

Interaction between lamotrigine and drugs that are metabolized by cytochrome P ₄₅₀ isoenzymes is unlikely.

Lamotrigine can induce its own metabolism, but this phenomenon is moderate and does not have significant clinical significance.

Lamotrigine does not have a significant effect on the pharmacokinetic parameters of risperidone, however, 12 out of 14 patients receiving combination therapy experienced drowsiness (when taking only risperidone - in 1 out of 20, when taking only lamotrigine - in no patient).

Clonazepam, bupropion, amitriptyline, lorazepam, haloperidol and fluoxetine, due to inhibition of the action of lamotrigine, have a minimal effect on the formation of its primary metabolite 2-N-glucuronide.

The study of the metabolic process of bufuralol by liver microsomal enzymes isolated from humans suggests that lamotrigine does not affect the clearance of drugs that are eliminated mainly with the participation of CYP2D6 isoenzymes. In vitro studies also suggest that sertraline, trazodone, fluoxetine, risperidone, phenelzine, and clozapine are unlikely to affect the metabolism of lamotrigine.

Valproic acid is a potent inhibitor of lamotrigine glucuronidation.

Potent inducers of lamotrigine glucuronidation are lopinavir, ritonavir, primidone, carbamazepine, rifampicin, phenobarbital, atazanavir, ritonavir, phenytoin, and combination drugs containing ethinyl estradiol and levonorgestrel. The effect of other oral hormonal drugs has not been studied, however, it is assumed that they may have the same effect on the pharmacokinetics of lamotrigine.

Means that have little effect on the glucuronidation of lamotrigine are gabapentin, oxcarbazepine, zonisamide, levetiracetam, olanzapine, topiramate, lithium preparations, pregabalin, felbamate, bupropion.

Rifampicin increases the clearance of lamotrigine and decreases its half-life. For patients receiving rifampicin, Lamitor should be dosed according to the recommended regimen for concomitant use of drugs that induce glucuronidation of lamotrigine.

In vitro studies have shown that lamotrigine (but not its metabolite 2-N-glucuronide) is able to inhibit the transfer of organic cations more than cimetidine. With the simultaneous use of Lamitor can increase the concentration of drugs that are excreted by the kidneys (for example, varenicline, gabapentin, metformin). The clinical significance of this phenomenon has not been reliably established, however, caution is advised when prescribing such combinations.

As a weak inhibitor of dihydrofolate reductase, lamotrigine, with long-term use, can affect folate metabolism. However, it was found that Lamitor, when used for up to 1 year, did not cause significant changes in serum folate concentration, and when used for up to 5 years - in erythrocytes. In addition, the hemoglobin level and the average volume of erythrocytes did not change.

Analogs

Lamitor's analogs are Algerica, Valparin, Gabagamma, Difenin, Zeptol, Carbamazepine, Keppra, Konvalis, Konvulsan, Lamictal, Lyrica, Maxitopyr, Neurontin, Pregabalin, Seizar, Tirapol, Fiycompa, Ephenobarbital, others.

Terms and conditions of storage

Store at a temperature not exceeding 30 ° C, out of reach of children, protected from light, in a dry place.

The shelf life is 3 years.

Terms of dispensing from pharmacies

Dispensed by prescription.

Reviews about Lamitore

Reviews about Lamitore are few, but mostly positive. Most often, the drug is characterized by patients who have taken it as an antiepileptic drug. They are noted for their high efficiency, good tolerance and significantly lower cost compared to many popular analogues.

The price of Lamitor in pharmacies

Depending on the region of sale and the pharmacy chain, prices for Lamitor can be:

• 30 tablets of 50 mg each - 199–385 rubles;
• 50 tablets of 50 mg each - 350-598 rubles;
• 30 tablets of 100 mg - 543-619 rubles;
• 50 tablets of 100 mg - 795-960 rubles.

Lamitor: prices in online pharmacies

Drug name Price Pharmacy

Lamitor 50 mg tablets 30 pcs. RUB 311 Buy

Lamitor 50 mg tablets 50 pcs. RUB 517 Buy

Lamitor tab. 50mg No. 50 557 r Buy

Lamitor 100 mg tablets 30 pcs. 589 r Buy

Lamitor 100 mg tablets 50 pcs. 815 RUB Buy

Anna Kozlova Medical journalist About the author

Education: Rostov State Medical University, specialty "General Medicine".

Information about the drug is generalized, provided for informational purposes only and does not replace the official instructions. Self-medication is hazardous to health!