Interaction of lamotrigine with sodium valproate

Panayiotopoulos, C. P.; Ferrie, C. D.; Knott, Christine; Robinson, Richard O.

doi:10.1016/0140-6736(93)93048-6

Cited by 107 publications

(43 citation statements)

References 5 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…complex partial seizures when the two drugs were used together, as compared to the isolated use of each one of them and this same synergic effect was seen in other seizures types 9,10 . The mechanism of action behind this association seems to be due to an inhibitory effect of VPA in the hepatic metabolization of LMT, thus reducing its clearance and elevating its serum levels 4,7,8 .…”

Section: Dr Isac Bruck -Rua Floriano Essenfelder 81 -80060-270 Curitmentioning

confidence: 72%

“…Adverse events ocurred in 4 (11%) patients: two of them (5.5%) presented with tremors, 1 (3%) had irritability and 1 (3%) had gastrointestinal symptoms (Table 3). None of the subjects developed a skin rash during the course of treatment and the adverse effects were not considered severe to the patient health, so that they did not warrant interruption of the medication DISCUSSION recent studies have shown that the concomitant administration of LMT and VPA might be a reasonable option in order to obtain a better seizure control in refractory epilepsy 4,8,9 . Thomé et al 4 reported the results of the first exclusive pediatric group.…”

Section: Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Association of lamotrigine and valproate in refractory epilepsies of children and adolescents

Karen

Bruck

Antoniuk

et al. 2008

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

-Objective: To evaluate the efficacy or eventual side-effects of the association of lamotrigine and sodium valproate in the control of refractory epilepsies. Method: A retrospective analysis of 37 children with a mean age of 12 years taking exclusivelly lamotrigine and sodium valproate. Efficacy of seizure control was considered satisfactory if there was a reduction in seizures ≥50% or total control. Results: The association of lamotrigine and sodium valproate was considered satisfactory in 65% of the studied children, independent of seizure type. Total seizure control was obtained in 33% and 35% had an unsatisfactory response or remained unchanged. Primary generalized tonic clonic seizures were the most common type with 84% of day-time seizures having a good response to treatment. Side-effects were seen in 11% of patients and the most common was tremor. Conclusion: Total or satisfactory control of seizures was seen in the majority of patients and sideeffects were uncommon.KEy wordS: epilepsy, refractory, valproate, lamotrigine, childhood. Associação de lamotrigina e valproato de sódio no tratamento de epilepsia refratária em crianças e adolescentesResumo -Objetivo: Avaliar a eficácia ou eventuais efeitos colaterais da associação de lamotrigina e valproato de sódio no controle de epilepsia refrataria. Método: Análise retrospectiva de 37 crianças e adolescentes com idade média de 12 anos tratadas exclusivamente com lamotrigina e valproato de sódio. A eficácia do controle de crises foi considerada satisfatória se o controle das crises foi ≥50% ou total. Resultados: A associação de lamotrigina e valproato de sódio foi considerada satisfatória em 65%, independente do tipo de crise. o controle total de crises foi obtido em 33% e em 35% a resposta foi insatisfatória ou permaneceu inalterada. Crise generalizada primaria tônico clonica foi o mais comum, com 84% das crises ocorrendo durante o dia, com boa resposta ao tratamento. Efeitos colaterais foram vistos em 11% dos pacientes, sendo tremor o mais freqüente. Conclusão: Controle total ou satisfatório das crises ocorreu na maioria dos pacientes, sendo pouco freqüente os efeitos colaterais.

show abstract

Section: Dr Isac Bruck -Rua Floriano Essenfelder 81 -80060-270 Curitmentioning

confidence: 72%

Section: Resultsmentioning

confidence: 99%

Association of lamotrigine and valproate in refractory epilepsies of children and adolescents

Karen

Bruck

Antoniuk

et al. 2008

Arq. Neuro-Psiquiatr.

View full text Add to dashboard Cite

show abstract

“…There is evidence that some patients with epilepsy may show a particularly favorable therapeutic response when lamotrigine is combined with valproic acid (60)(61)(62)(63)(64)(65). On the other hand, there have been occasional reports of disabling tremor in patients given this combination (62,66).…”

Section: Lamotriginementioning

confidence: 99%

The Clinical Pharmacokinetics of the New Antiepileptic Drugs

Perucca

1999

Epilepsia

View full text Add to dashboard Cite

Summary: Because pharmacokinetics is a major determinant of the magnitude and duration of pharmacologic response, understanding the kinetic properties of the new antiepileptic drugs (AEDs) is essential for the correct use of these compounds in clinical practice. After oral administration, absorption is rapid and relatively efficient for the new AEDs, the most notable exception being gabapentin, whose bioavailability decreases with increasing dosage. None of the new AEDs is extensively bound to plasma proteins except for tiagabine, which is over 95% protein-bound. The route of elimination differs to an important extent from one compound to another, and elimination half-lives range from over 30 h for zonisamide to 5-7 h for gabapentin. For all drugs that are metabolized, half-life is shortened and clearance is increased when patients receive concomitant enzyme-inducing agents such as barbiturates, phenytoin, and carbamazepine. Lamotrigine metabolism is markedly inhibited by valproic acid, and felbamate may increase the serum levels of most other AEDs. Felbamate, topiramate, and oxcarbazepine may also reduce the efficacy of the contraceptive pill by stimulating its metabolism. Key Words: AntiepilepticsPharmacokinetics-Drug interactions.To exert their therapeutic effects, antiepileptic drugs CLINICAL PHARMACOKINETICS (AEDs) must be absorbed and reach their sites of action in the brain at concentrations sufficient to produce the desired pharmacologic response. The pharmacokinetic profile is a major determinant of the magnitude and duration of drug action and is one of the factors to be considered in determining the optimal number of daily doses and the minimal interval that should elapse between dosage adjustments. For any given drug, pharmacokinetics may vary markedly from one patient to another (in relation to genetic background, age, physiologic states such as pregnancy, associated disease, and concomitant treatments), resulting in altered dosage requirements. Therefore, full understanding of the pharmacokinetic properties of individual compounds, and the factors affecting them, is essential for correct use of AEDs in clinical practice. Over the past decade, several new AEDs (felbamate, gabapentin, lamotrigine, oxcarbazepine, tiagabine, topiramate, vigabatrin, and zonisamide) have been introduced into routine clinical practice in a number of counThe pharmacokinetics of the new AEDs have been evaluated in healthy volunteers and in patients with epilepsy receiving a variety of concomitant treatments. For vigabatrin and for monohydroxycarbazepine (the active metabolite of oxcarbazepine), evaluation of pharmacokinetic properties is complicated by the presence of an asymmetric carbon in the molecule, which determines the existence of two different stereoisomers. Although vigabatrin is administered as a racemic mixture of the (R)-and (S)-isomers, only the (S)-form is pharmacologically active, and pharmacokinetic data for vigabatrin quoted in' this review refer to the (S)-enantiomer. In the case of monohydroxycarbazepine...

show abstract

“…In the treatment of myoclonic-astatic epilepsy, ketogenic diet is rather efficient. Administration of valproic acid and lamotrigine or topiramate in combination are important treatment options (50). Carbamazepine, phenytoin and vigabatrine which are known to increase myoclonic seizures should be avoided.…”

Section: Myoclonic-astatic Epilepsy: Doose Syndromementioning

confidence: 99%