Overview Of Lamotrigine
(Lamictal) Therapy In Bipolar Disorder
(Feb. 6, 2004) --
Lamotrigine has been shown to be an effective maintenance therapy for
patients with bipolar I disorder, and is approved in the United States for
the treatment of adults to delay the time to occurrence of mood episodes in
patients treated by standard therapy for acute mood episodes.
In a recent publication, David R. Goldsmith and colleagues of Adis
International Limited in Auckland, New Zealand, performed an overview of
lamotrigine (Lamictal®), a well-established
anticonvulsant agent, and its
application in cases of bipolar disorder.
Early studies in patients with epilepsy who were treated with lamotrigine
indicated a propensity for improved mood, leading to clinical trials in
patients with bipolar disorder. Although lamotrigine's mechanism of action
in bipolar patients is undetermined, it may be related to the inhibition of
sodium and calcium channels in presynaptic neurons and subsequent neuronal
membrane stabilisation.
Compared to placebo, lamotrigine monotherapy has been demonstrated to
significantly delay time to intervention with additional pharmacotherapy or
electroconvulsive therapy for any new mood episode, as well as prolong time
to intervention for depression.
Furthermore, lamotrigine appears superior to lithium at prolonging time
to intervention for a
depressive mood episode. While lamotrigine has also
been found to significantly delayed time to intervention for a
manic/hypomanic
episode, it does not appear effective in the treatment of acute mania.
In 2 maintenance trials, lamotrigine monotherapy was generally well
tolerated, with common adverse events being headache (19%), nausea (14%),
infection (13%), and insomnia (10%). After 52-weeks of treatment,
lamotrigine did not appear to cause an increase in body weight.
Approximately 0.1% of study participants receiving lamotrigine developed
a serious rash, including 1 case of mild Stevens-Johnson syndrome.
Subsequently, the dosage of lamotrigine is titrated over a 6-week period to
200 mg/day to minimise the incidence of serious rash.
Dosages over 200 mg/day are not recommended, and no formal
recommendations exist for
lamotrigine maintenance therapy duration in
bipolar I disorder.
Source: CNS Drugs 2004;18:1:63-67. "Spotlight on lamotrigine in bipolar disorder"
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