Insomnia lamotrigine

Lamotrigine Modulate sodium channels Loading dose Not recommended due to increased risk of rash Maintenance dose 1 50-800 mg/day in 2-3 divided doses. Doses should be initiated and titrated according to the manufacturer s recommendations to reduce the risk of rash Half-life Not established Monotherapy 24 hours Concurrent enzyme inducers 12-15 hours Concurrent enzyme inhibitors 55-60 hours Apparent volume of distribution 1.1 L/kg Protein binding 55% Primary elimination route Hepatic Ataxia, drowsiness, headache, insomnia, sedation Rash... 

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. 

Irritability and aggressive behavior occur occasionally, and mentally retarded patients are possibly at greater risk (SEDA-22, 88). Rare central nervous system effects include insomnia, psychosis (SEDA-20, 63), downbeat nystagmus (SEDA-22, 89), movement disorders (SEDA-21, 72), and a Tourette-like syndrome. Lamotrigine can increase seizure frequency and severity in children with severe myoclonic epilepsy (SEDA-21, 72). 

Sadler M. Lamotrigine associated with insomnia. Epilepsia 1999 40(3) 322-5. 

Lamotrigine is reported to be generally well tolerated in maintenance studies, with the most common adverse events being headache, nausea, insomnia, and, to a lesser extent, tremor. Incidences of diarrhea and tremor are lower with lamotrigine than with litbium. 

Psychiatric In a retrospective review, nine children, mean age 5 years, were identified who had had neurobehavioral adverse reactions to lamotrigine (range of doses 0.7-14 mg/kg/day) [185" ]. Five developed self-injurious and violent behaviors and two developed severe insomnia. One patient had threatening visual and auditory hallucinations and insomnia. In all cases there was dramatic improvement and/or resolution of the adverse neurobehavioral effects after withdrawal of lamotrigine or dosage reduction. 

Placebo-controUed studies In a 16-week, double-blind, placebo-controlled, flexible-dose study of lamotrigine in binge-eating disorder associated with obesity, 51 outpatients were randomized to either lamotrigine (n = 26) or placebo (n = 25) [146 ]. Four patients withdrew because of adverse events (lamotrigine, n = 3 placebo, n = 1), the most common of which were headache (35% versus 28%), insomnia (35% versus 20%), somnolence (27% versus 8%), rash (15% versus 12%), and dry mouth (15% versus 0%). 

A 65-year-old woman with multiple sclerosis, spastic paraparesis, and chronic pain, who had previously taken gabapentin, lamotrigine, and amitriptyline, with partial pain relief, was given pregabalin 75 mg/day after 3 days she developed slurred speech, delusions, and insomnia. Pregabalin was withdrawn, and she recovered her normal cognitive function. 

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