The Tolerability of Lamotrigine in Elderly Patients With Epilepsy

Abstract

Lamotrigine, used in the currently prescribed adult dosage regimen, was well tolerated in elderly patients with epilepsy.

Lamotrigine therapy in elderly patients with epilepsy, bipolar disorder or dementia

“…In epilepsy and bipolar studies, elderly patients receiving lamotrigine were less likely to discontinue prematurely. Rates of adverse effects appeared to be similar to that reported for younger patients (Giorgi et al, 2001;Robillard and Conn, 2002;Sajatovic et al, 2005).…”

“…Significantly fewer patients withdrew due to rash (3% vs 19% for lamotrigine vs carbamazepine, respectively). Giorgi et al (2001) examined pooled data from 13 clinical trials conducted in elderly patients. The incidences of drug-related adverse events were 49% (72/146) for lamotrigine, 72% (38/53) for carbamazepine, and 89% (8/9) for phenytoin.…”

An International Multicenter Randomized Double‐Blind Controlled Trial of Lamotrigine and Sustained‐Release Carbamazepine in the Treatment of Newly Diagnosed Epilepsy in the Elderly

“…In a study of 222 patients aged >65 years started on LTG, the mean dose in the 132 subjects that completed oneyear treatment was 72 mg/day and the initial target dose of 50 mg/day was maintained in 52% of these patients (Mauri Llerda et al, 2005). In a pooled analysis of 146 elderly patients included in LTG trials, the median daily LTG dosage in monotherapy was 100 mg/day (Giorgi et al, 2001), which was also the median dose in completers of the U.K. trial and our trial. In the U.S. study, the median LTG dose in completers was 152 mg/day, suggesting that the chosen target dosage was tolerated better for LTG than for CBZ (Rowan et al, 2005).…”

“…Third, CBZ was given as a sustained-release formulation, which on a b.i.d regimen is better tolerated than immediate-release CBZ (Canger et al, 1990;Eeg-Olofsson et al, 1990). Fourth, initial target dosages were lower, and CBZ titration rate was slower, than in the U.S. trial, and replicated dosing regimens found to be optimal in earlier studies (Brodie et al, 1999;Giorgi et al, 2001;Mauri Llerda et al, 2005;Mohanraj and Brodie, 2005a). Since the bioavailability of sustained-release CBZ is 15-35% lower than that of the conventional formulation (Eeg-Olofsson et al, 1990;Bialer, 1992;Revankar et al, 1999), its use is also likely to have resulted in lower serum drug levels than in previous studies.…”

Epilepsy and Dementia in the Elderly

“…Lamotrigine has a positive neuropsychological profile [90,91] , but its major adverse effect is the development of rashes that require a progressive increase in dosage. Few data are available concerning topiramate in the elderly; however, the reductions in measures of attention and word fluency described in adults, as well as weight loss, suggest that it should be used with caution [92,93] .…”