Safety and Efficacy of Lamotrigine in Older Adults with Epilepsy and Co-Morbid Depressive Symptoms

Abstract

Lamotrigine is an oral well absorbed antiepileptic medication (AED) from the phenyltriazine class approved by the FDA in 1994 for the treatment of epilepsy and in 2003 for the treatment of bipolar disorder. For epilepsy it is used to treat partial seizures, primary and secondary tonic-clonic seizures, and seizures associated with Lennox-Gastaut syndrome. Lamotrigine is the only AED that treats the depressive as well as the maniac phases of bipolar disorders. It is important to consider lamotrigine adverse reactions and drug-drug interactions such as with other AED's, psychiatric medications, estrogens, and complementary-alternative medicines. Lamotrigine induces skin reactions as part of the hypersensitivity response (HSR), the actual incidence of skin rash is low (1.8%) providing slow escalation regimens are used when introducing this medication. An especially appealing indication for lamotrigine treatment is elderly epilepsy with depression. The main advantage of lamotrigine for the treatment of this indication in the elderly lies in its favorable and predictive adverse event profile and drug-drug interactions in comparison to other AEDs. Lamotrigine can serve in the elderly as both an antiepileptic and an antidepressant drug with a relatively favorable profile.

Lamotrigine-Related Severe Cutaneous Adverse Reaction in Patient with Epilepsy

“…However, studies reported 10% of patients may develop skin rash to LTG which might be severe and life-threatening [10]. The incidence of skin rash with LTG therapy in this study was 7.48%, which is lower than the reported rate, probably because of the low doses and slow titration.…”

“…The incidence of skin rash with LTG therapy in this study was 7.48%, which is lower than the reported rate, probably because of the low doses and slow titration. The incidence of skin rash with LTG is doseand titration-dependent [10,14]. In this study, 6 males and 5 females developed CADR.…”

“…Furthermore, LTG has rare adverse severe skin reactions such as: Stevens-Johnson syndrome (SJS), toxic epidermal necrolysis (TEN), drug rash with eosinophilia and systemic symptoms (DRESS), and anticonvulsant hypersensitivity syndrome, which may lead to terminating LTG treatment [9][10][11]. Slow introduction and titration of LTG dosage may reduce or eliminate these adverse symptoms [9].…”

“…Additionally, LTG was also used to treat bipolar I disorder and as adjunctive therapy for the management of seizures associated with Lennox-Gastaut syndrome [9][10][11].…”

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“…In particular, it is used to treat partial seizures and tonic-clonic convulsions. [10] It also acts as a mood stabilizer. Chemically unrelated to other anticonvulsants, it has relatively few side-effects and does not require therapeutic drug monitoring.…”