Dizziness lamotrigine

Lamotrigine Diplopia Dizziness Unsteadiness Headache Rash Not established... 

Severe skin rashes appear to be the major concern with lamotrigine use. The incidence of rash is greater in children than in adults. Other adverse effects are similar to those of drugs with the same mechanism of action, such as cerebellovestibular changes leading to dizziness, diplopia, ataxia, and blurred vision. Disseminated intravascular coagulation has been reported. 

Nervous system effects were among the most frequent adverse effects reported in patients receiving lamotrigine as adjunctive therapy in controlled clinical trials (Matsuo et ah, 1993). The frequency of dizziness and ataxia and the rate of discontinuance of lamotrigine because of these adverse effects were dose related in clinical trials in a dose-response study, dizziness occurred in 31% and 27% of patients receiving lamotrigine at 500 mg/day, and 300 mg/day (Rambeck et ah, 1996). 

Lamotrigine is well tolerated and is not associated with hepatotox-icity, weight gain, or significant sedation. Common early side effects include headache, dizziness, gastrointestinal distress, and blurred or double vision. The most serious potential side effect is rash (described in the following subsection). 

Side effects. The most common side effects are headache, nausea and vomiting, diplopia, dizziness, ataxia and tremor. There are also reports that lamotrigine can cause such psychiatric side effects as aggression, agitation, confusion, hallucinations and psychosis, some of these effects possibly being associated with a reduction in the glutamatergic system. Rashes are a frequent side effect, occurring in up to 5% of patients. Usually rashes are mild but occasionally can be severe and amount to a Stevens-Johnson syndrome. The severe rash occurs more commonly in children. 

A 36-year-old woman with rapid-cycling bipolar II disorder and premenstrual mood exacerbation was treated as an out-patient with lamotrigine 400 mg/day, clonazepam 0.5 mg tds, and quetiapine 100 mg/day. She gained 9 kg in 6 months and was advised to reduce the dose of quetiapine to 50 mg/day. After 1 day, she reported nausea, dizziness, headache, and anxiety severe enough to preclude normal daily activities. She was instructed to take quetiapine 75 mg/day, but her symptoms continued and only resolved when she took 100 mg/day. Slower reduction in the dose of quetiapine (by 12.5 mg/day every 5 days) with an antiemetic, ondansetron, also failed. On a third attempt, prochlorperazine successfully reduced her withdrawal symptoms, although moderate nausea persisted for 2 days after complete withdrawal. 

Lamotrigine has been nsed as maintenance monotherapy for rapid-cycling bipolar disorder in 324 patients (open label) and 182 patients (donble-bUnd) with rapidcycling bipolar disorder (5). In aU, 265 patients reported adverse events during the open phase. The most common adverse events (over 10%) were headache, infection, influenza, nausea, abnormal dreams, dizziness, and rash. During the donble-bUnd phase 122 patients reported adverse events, eqnaUy with lamotrigine and placebo. 

In 126 patients with carbamazepine-resistant or valproate-resistant epilepsy given lamotrigine, 50% during add-on therapy and 53% during lamotrigine monotherapy had at least 50% reduction in total seizures (15). There were adverse events in 49 patients, including respiratory tract infections n — 11), dizziness (n — 8), headache (n = 7), diplopia (n = 5), tremor (n = 5), somnolence (n — 4), insomnia (n = 4), nausea (n — 4), and weakness (n = 3). Treatment was discontinued in nine patients because of adverse events, in five cases because of rash. 

The most common adverse effects of lamotrigine include dizziness, weakness, headache, diplopia, ataxia, blurred vision, and somnolence (SEDA-18, 65) (SEDA-20, 63) (19). These effects resemble those seen with carbamaze-pine and can result from an adverse pharmacodynamic interaction. Tolerability is better when lamotrigine is given as monotherapy or with drugs other than carbama-zepine however, tremor develops in some patients taking valproate in combinations (SEDA-18, 66). During monotherapy, serum lamotrigine concentrations associated with intolerable adverse effects (mostly headache, dizziness, and ataxia) were 0.4-18.5 qg/ml and overlapped widely with those tolerated in other patients (20). 

Dizziness, ataxia, diplopia, blurred vision, nausea, and vomiting are signs of toxicity that occur when the blood level exceeds 10 Ug/mL. A chromatographic method for analysis of lamotrigine has been reported. ... 

TOXICITY Common adverse effects when lamotrigine is added to another antiseizure drug are dizziness, ataxia, blurred or double vision, nausea, vomiting, and rash. A few cases of Stevens-Johnson syndrome and disseminated intravascular coagulation have been reported. The incidence of serious rash in children (-0.8%) is higher than in adults (0.3%). 

Lamotrigine 22-36 h 200-500 mg Lethargy, dizziness, ataxia, stupor, nystagmus, hypertonia, seizures QRS prolongation nausea and vomiting hypokalemia hypersensitivity fever, rash (Stevens-Johnson syndrome) hepatitis, renal failure. 

A 35-year-old man, who had been taking clozapine for 3 years, became dizzy and sedated about one month after starting to take lamotrigine. His plasma clozapine levels were found to have increased to... 

Nervous system The effects of levetiracetam ( = 38), lamotrigine (n = 29), and phenobar-bital (n = 28) have been evaluated in patients with seizures and Alzheimer s disease in a prospective, randomized, three-arm parallel-group, case-control study with a 4-week dosage adjustment and a 12-month evaluation period [199. The adverse reactions were somnolence (5.7%), dizziness (2.8%), headache (2.8%), and weakness (5.7%). Neuropsychological examination showed improvement in attention, shortterm memory, and oral fluency in patients randomized to levetiracetam. 

Observational studies Lamotrigine has been evaluated in a study that included an open, 1-week screening phase, a 20-week escalation phase, and a 12-week maintenance phase in 54 children aged under 13 years who had newly diagnosed absence epilepsy and had not previously been treated with antiepileptic drugs [138 ]. Rash was reported in six patients (11%), urticaria in one patient (2%), and pruritus in two patients (4%). None of these events was serious or resulted in premature withdrawal. Three patients had adverse events that led to premature withdrawal increased seizure activity in one, tremor in one, and vomiting and dizziness in one patient. 

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