Lamotrigine and topiramate

Acetazolamide Alcohol (ethanol) Contraceptives Dichlorphenamide Sertraline 

Drugs that can increase the serum levels/effects of lamotrigine or topiramate 

Drugs whose therapeutic effects were shown to be opposed by lamotrigine or topiramate 

Drugs whose serum levels/effects can be increased by 

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Epilepsy is a clinical disorder characterized by spontaneous, recurrent seizures arising from excessive electrical activity in certain parts of the brain [51]. Currently available drugs, such as phenytoin, carbamazepine, valproic acid, lamotrigine, and topiramate (for molecular structures see Fig. 6), provide symptomatic seizure suppression in only 60-70% of those receiving treatment [52-54]. These drugs are also associated with unwanted side... 

Controlled trials of combinations of mood stabilizers with single mood stabilizer, or of the newer anticonvulsants (e.g., lamotrigine and topiramate) are in process. Open trials have included add-on medications and heterogeneous samples. 

At least three drugs are effective against absence seizures. Two are nonsedating and therefore preferred ethosuximide and valproate. Clonazepam is also highly effective but has disadvantages of dose-related adverse effects and development of tolerance. Lamotrigine and topiramate may also be useful. 

Specific myoclonic syndromes are usually treated with valproate an intravenous formulation can be used acutely if needed. It is nonsedating and can be dramatically effective. Other patients respond to clonazepam, nitrazepam, or other benzodiazepines, although high doses may be necessary, with accompanying drowsiness. Zonisamide and levetiracetam may be useful. Another specific myoclonic syndrome, juvenile myoclonic epilepsy, can be aggravated by phenytoin or carbamazepine valproate is the drug of choice followed by lamotrigine and topiramate. 

Vigabactin is indicated for second-line use in patients with refractory partial epilepsy but, unlike lamotrigine and topiramate, it does not appear to be useful in generalized epilepsies. It is the drug of choice for infantile spasms. 

Outlook Among the newer antiepileptics, gabapentin, oxycarbazepine, lamotrigine, and topiramate are now endorsed as primary monotherapeutics for both partial and generalized seizures. Their pharmacokinetic characteristics are generally more desirable than those of the older drugs. 

The use of antiepileptic drugs (gabapentin, lamotrigine, and topiramate) as mood stabilizers has been... 

The anticonvulsant action of valproate may prevent ECT treatment from being effective by preventing seizure activity. This is also a theoretical/practical concern with carbamazepine, gabapentin, lamotrigine, and topiramate. As a rule of thumb, the co-administration of an anticonvulsant and ECT should be considered very cautiously ... 

Myoclonic seizures consist of sudden, very brief, jerking contractions that may involve the entire body or be confined to limited areas, such as the face and neck. The contractions may affect Individual muscles or groups, with simultaneous contraction of both extensor and flexor muscles. These seizures occur In all age groups, with symptoms ranging from rapid tremors to falling down. No loss of consciousness Is detectable because of the brief duration of the seizure. Myoclonic seizures often occur In combination with other seizure types. Valproate and clonazepam are used most often to treat myoclonic seizures lamotrigine and topiramate also have shown some efficacy. 

Clonazepam and valproate commonly are used to control myoclonic seizures. Studies suggest that lamotrigine and topiramate may be effective as well, although neither is approved by the U.S. FDA for this indication. 

Antiepileptic drug-induced encephalopathies have been reviewed [50 ]. These complications have been reported with phenytoin, carbamazepine, and valproate and less often with vigabatrin, lamotrigine, and topiramate. 

Anticonvulsants. Several antiseizure medicines have been studied in the treatment of PTSD, and some results have been encouraging. Open label studies, first with carbamazepine (800-1200 mg/day) and later with valproate (500-2000 mg/ day), demonstrated overall improvement in PTSD patients, though not for intrusive recollections per se. Recent open label studies of gabapentin, lamotrigine, tiagabine, and topiramate have suggested these anticonvulsants might also be helpful for some PTSD symptoms. 

Recently, other medications have been evaluated as mood stabilizers. This includes gabapentin (Neurontin), lamotrigine (Lamictal), and topiramate (Topamax). Only lamotrigine has been shown in controlled trials to be effective in the treatment... 

Curry, W.J. and Kulling, D.L. (1998) Newer antiepileptic drugs ga-bapentin, lamotrigine, felbamate, topiramate and fosphenytoin. Am Fam Physician 57 513-520. 

Another group of mood-stabilizing drugs that are also anticonvulsant agents have become more widely used than lithium. These include carbamazepine and valproic acid for the treatment of acute mania and for prevention of its recurrence. Lamotrigine is approved for prevention of recurrence. Gabapentin, oxcarbazepine, and topiramate are sometimes used to treat bipolar disorder but are not approved by FDA for this indication. Aripiprazole, chlorpromazine, olanzapine, quetiapine, risperidone, and ziprasidone are approved by FDA for the treatment of manic phase of bipolar disorder. Olanzapine plus fluoxetine in combination and quetiapine are approved for the treatment of bipolar depression. 

For maintenance treatment, failure of first-line mood stabilizers or second-line atypical antipsychotics to control symptoms adequately may lead to monotherapy trials with other anticonvulsants such as carbamazepine, lamotrigine, gabapentin, and topiramate (third-line monotherapy). 

To review the mechanism of action of lithium and five anticonvulsants used as mood stabilizers (valproic acid, carbamazepine, lamotrigine, gabapentin and topiramate). 

A 19-year-old man with focal epilepsy took carbamazepine 1000 mg/day and lamotrigine 300 mg/day. Because his seizures persisted topiramate was added up to 200 mg/day and the dose of carbamazepine was reduced to 300 mg/day. Behavioral problems started within a week and worsened over the following months. He finally developed obsessive-compulsive disorder. Citalopram was given in doses up to 60 mg/ day and topiramate was tapered within 2 weeks. The symptoms improved. 

Lhatoo SD, Wong IC, Polizzi G, Sander JW. Long-term retention rates of lamotrigine, gabapentin, and topiramate in chronic epilepsy. Epilepsia 2000 41(12) 1592-6. 

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