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Lamotrigine 1

Lamotrigine

Lamotrigine

Systematic (IUPAC) name

6-(2,3-dichlorophenyl)-1,2,4-triazine-3,5-diamineClinical data

Trade names Lamictal

AHFS/Drugs.com monograph[1]

MedlinePlus a695007[2]

Licence data US FDA:link[3]

Pregnancy cat. D (AU) C (US)

Legal status Prescription Only (S4) (AU) €-only (CA) POM (UK) €-only (US)

Routes Oral

Pharmacokinetic data

Bioavailability 98%

Protein binding 55%

Metabolism Hepatic (mostly UGT1A4-mediated)

Half-life 29 hours

Excretion Urine (65%), faeces (2%)

Identifiers

CAS number 84057-84-1 [4] 

ATC code N03AX09[5]

PubChem CID 3878[6]

IUPHAR ligand 2622[7]

DrugBank DB00555[8]

ChemSpider 3741[9]

 

UNII U3H27498KS[10]

 

KEGG D00354[11]

 

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Lamotrigine 2

ChEBI CHEBI:6367[12]

 

ChEMBL CHEMBL741[13]

 

Chemical data

Formula C9H

7Cl

2N

5

Mol. mass 256.091 g/mol

  (what is this?) (verify)[14]

Lamotrigine, marketed in the US and most of Europe as Lamictal  /l•‚mƒkt•l/ by GlaxoSmithKline, is an

anticonvulsant drug used in the treatment of epilepsy and bipolar disorder. It is also used off-label as an adjunct in

treating clinical depression. For epilepsy, it is used to treat focal seizures, primary and secondary tonic-clonicseizures, and seizures associated with Lennox-Gastaut syndrome. Like many  other anticonvulsant medications,

lamotrigine also seems to act as an effective mood stabiliser, and has been the first US Food and Drug

Administration (FDA)-approved drug for this purpose since lithium, a drug approved almost 30 years earlier. It is

approved for the maintenance treatment of bipolar type I. Chemically unrelated to other anticonvulsants (due tolamotrigine's being a phenyltriazine), lamotrigine has many possible side-effects. Lamotrigine is generally accepted

to be a member of the sodium channel blocking class of antiepileptic drugs, but it could have additional actions sinceit has a broader spectrum of action than other sodium channel antiepileptic drugs such as phenytoin and

carbamazepine and is effective in the treatment of the depressed phase of bipolar disorder, whereas other sodiumchannel blocking antiepileptic drugs are not. In addition, lamotrigine shares few side-effects with other, unrelated

anticonvulsants known to inhibit sodium channels, which further emphasises its unique properties. Lamotrigine is

inactivated by hepatic glucuronidation.

Medical uses

Epilepsy and seizures

Lamotrigine is approved in the US for the treatment of partial seizures. It is considered a first-line drug for primary

generalised tonic-clonic (includes simple partial, complex partial and secondarily generalised seizures), and as an

adjuvant therapy in partial seizures (focal onset tonic-clonic, atypical absence,myoclonic, Lennox Gastautsyndrome). As well, it is used as an alternative drug for absence seizure and atypical absence, myoclonic, atonic.

Lamotrigine is one of a small number of FDA-approved therapies for seizures associated with Lennox-Gastautsyndrome, a severe form of epilepsy. Typically developing before four years of age, LGS is associated with

developmental delays. There is no cure, treatment is often complicated, and complete recovery is rare. Symptoms

include the atonic seizure (also known as a "drop attack"), during which brief loss of muscle tone and consciousnesscause abrupt falls. Lamotrigine significantly reduces the frequency of LGS seizures, and is one of two medications

known to decrease the severity of drop attacks. Combination with valproate is common, but this increases the risk of 

lamotrigine-induced rash, and necessitates reduced dosing due to the interaction of these drugs.

Bipolar disorder

Lamotrigine is approved in the US for maintenance treatment of Bipolar I disorder. While traditional anticonvulsant

drugs are predominantly antimanics, lamotrigine is most effective for preventing the recurrent depressive episodes of bipolar disorder. The drug seems ineffective in the maintenance of current rapid-cycling, mania, or depression

bipolar disorder; however, it is effective at prophylaxis or delaying the mania, depressive, or rapid cycle. According

to studies in 2007, lamotrigine may treat bipolar depression without triggering mania, hypomania, mixed states, orrapid-cycling.

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Lamotrigine 3

There is less evidence of therapeutic benefit when lamotrigine is used to treat a current mood episode. It has not

demonstrated effectiveness in treating acute mania, and there is controversy regarding the drug „s effectiveness intreating acute bipolar depression. While the 2002 American Psychiatric Association (APA) guidelines recommend

lamotrigine as a first-line treatment for acute depression in Bipolar II disorder, the APA„s website notes that theguidelines, being more than five years old, …can no longer be assumed to be current." A paper written in 2008 by

Nasser et al. reviewed evidence from trials that were unpublished and not referenced in the 2002 APA guidelines,

and it concludes that lamotrigine has "very limited, if any, efficacy in the treatment of acute bipolar depression." A2008 paper by Calabrese et al. examined much of the same data, and found that in five placebo controlled studies,

lamotrigine did not significantly differ from placebo in the treatment of bipolar depression. However, in a

meta-analysis of these studies conducted in 2008, Calabrese found that lamotrigine was effective in individuals withbipolar depression, with a number needed to treat (NNT) of 11, or 7 in severe depression. A recent review about

lamotrigine concluded that it is recommended in bipolar maintenance when depression is prominent and that more

research is needed in regards to its role in the treatment of acute bipolar depression and unipolar depression. As well,no information to recommend its use in other psychiatric disorders was found

Other usesOff-label uses include the treatment of peripheral neuropathy, trigeminal neuralgia, cluster headaches, migraines, andreducing neuropathic pain. Off-label psychiatric usage includes the treatment of depersonalization disorder,

hallucinogen persisting perception disorder, schizoaffective disorder, borderline personality disorder, andpost-traumatic stress disorder. Lamotrigine has been studied as an adjunctive therapy for treatment of refractory

unipolar depression, attaining efficacy on the secondary metric for treatment outcomes (Clinical Global

Impressions), but not the primary metrics (Montgomery-•sberg Depression Rating Scale and Hamilton Rating Scalefor Depression).

Pharmacology

Lamotrigine, 150 mg tablet.

Lamotrigine is a member of the sodium channel blocking class of antiepileptic drugs. It is a triazine derivate that inhibits

voltage-sensitive sodium channels, leading to stabilization of neuronal

membranes. It also blocks L-, N-, and P-type calcium channels and hasweak 5-hydroxytryptamine-3 (5-HT3) receptor inhibition. These

actions are thought to inhibit release of glutamate at cortical

projections in the ventral striatum limbic areas, and it has been pointedout this neuroprotective and antiglutamatergic effects as promising

contributors to its mood stabilizing activity. Observations that

lamotrigine reduced ‚-aminobutyric acid (GABA) A receptor-mediatedneurotransmission in rat amygdala, suggest that a GABAergic mechanism may also be involved, although this

concept is not without controversy.

Lamotrigine does not have pronounced effects on any of the usual neurotransmitter receptors (adrenergic, dopamine

D1 and D2, muscarinic, GABA, histaminergic H1, serotonin 5-HT2, and N-methyl-D-asparate). Inhibitory effects on

5-HT, norepinephrine, and dopamine transporters are weak. Lamotrigine is a weak inhibitor of dihydrofolatereductase, but whether this effect is sufficient to contribute to a mechanism of action or increases risk to the fetus

during pregnancy is not known. Early studies of lamotrigine's mechanism of action examined its effects on therelease of endogenous amino acids from rat cerebral cortex slices in vitro. As is the case for antiepileptic drugs that

act on voltage-dependent sodium channels, lamotrigine inhibited the release of glutamate and aspartate evoked by

the sodium-channel activator veratrine and was less effective in the inhibition of acetylcholine or GABA release. Athigh concentrations, it had no effect on spontaneous or potassium evoked amino acid release [citation needed ]. These

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Lamotrigine 4

studies suggested that lamotrigine acts presynaptically on voltage-gated sodium channels to decrease glutamate

release. Several electrophysiological studies have investigated the effects of lamotrigine on voltage-dependentsodium channels. For example, lamotrigine blocked sustained repetitive firing in cultured mouse spinal cord neurons

in a concentration-dependent manner, at concentrations that are therapeutically relevant in the treatment of humanseizures. In cultured hippocampal neurons, lamotrigine reduced sodium currents in a voltage-dependent manner, and

at depolarised potentials showed a small frequency-dependent inhibition. These and a variety of other results indicate

that the antiepileptic effect of lamotrigine, like that of phenytoin and carbamazepine, is at least in part due to use-and voltage-dependent modulation of fast voltage-dependent sodium currents. However, lamotrigine has a broader

clinical spectrum of activity than phenytoin and carbamazepine and is recognised to be protective against generalised

absence epilepsy and other generalised epilepsy syndromes, including primary generalised tonic † clonic seizures, juvenile myoclonic epilepsy, and Lennox-Gastaut syndrome. The basis for the broader spectrum of activity of 

lamotrigine is unknown, but could relate to actions of the drug on voltage-activated calcium channels. Lamotrigine

blocks T-type calcium channels weakly, if at all. However, it does inhibit native and recombinanthigh-voltage † activated calcium channels (N- and P/Q/R-types) at therapeutic concentrations. Whether this activity

on calcium channels accounts for lamotrigine's broader clinical spectrum of activity in comparison with phenytoin

and carbamazepine remains to be determined.It antagonises the following receptors with the following IC

50values:

ƒ 5-HT3, IC

50=18„M

ƒ … receptors, IC50

=145„M

Pharmacokinetics

The pharmacokinetics of lamotrigine follow first-order kinetics, with a half-life of 13.5 hours and volume of distribution of 1.36 L/kg. Lamotrigine is rapidly and completely absorbed after oral administration. Its absolute

bioavailability is 98% and its plasma Cmax occurs from 1.4 to 4.8 hours. Available data indicate that its

bioavailability is not affected by food. Estimate of the mean apparent volume of distribution of lamotrigine followingoral administration ranges from 0.9 to 1.3 L/kg. This is independent of dose and is similar following single and

multiple doses in both patients with epilepsy and in healthy volunteers.

Lamotrigine is metabolised predominantly by glucuronic acid conjugation. Its major metabolite is an inactive

2-n-glucuronide conjugate. Lamotrigine has fewer drug interactions than many anticonvulsant drugs, althoughpharmacokinetic interactions with carbamazepine, phenytoin and other hepatic enzyme inducing medications may

shorten half-life. Dose adjustments should be made on clinical response, but monitoring may be of benefit in

assessing compliance.(CITATION NEEDED)

Side Effects

Lamotrigine prescribing information has a black box warning about life-threatening skin reactions, including

Stevens † Johnson syndrome, DRESS syndrome and toxic epidermal necrolysis. The manufacturer states that nearly

all cases appear in the first 2 to 8 weeks of therapy and if medication is suddenly stopped then resumed at the normaldosage. Patients should seek medical attention for any unexpected skin rash, as its presence is an indication of a

possible serious or even deadly side-effect of the drug. Not all rashes that occur while taking lamotrigine progress toSJS or TEN. Between 5 to 10% of patients will develop a rash, but only one in a thousand patients will develop a

serious rash. Rash and other skin reactions are more common in children, so this medication is often reserved for

adults.

There is also an increased incidence of these eruptions in patients who are currently on, or recently discontinued a

valproate-type anticonvulsant drug, as these medications interact in such a way that the clearance of both isdecreased and the effective dose of lamotrigine is increased.

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Lamotrigine 5

As of December 2010, lamotrigine carries an FDA black box warning for aseptic meningitis. [15]

Side-effects such as rash, fever, and fatigue are very serious, as they may indicate incipient Stevens † Johnson

syndrome, toxic epidermal necrolysis, DRESS syndrome or aseptic meningitis.

Other side-effects include loss of balance or coordination, double vision, crossed eyes, pupil constriction, blurred

vision, dizziness and lack of coordination, drowsiness, insomnia, anxiety, vivid dreams or nightmares, dry mouth,

mouth ulcers, memory and cognitive problems, mood changes, runny nose, cough, nausea, indigestion, abdominalpain, weight loss, missed or painful menstrual periods, and vaginitis. The side-effect profile is different for different

patient populations.

Lamotrigine has been associated with a decrease in white blood cell count (leukopenia). Lamotrigine does not

prolong QT/QTc in TQT studies in healthy subjects [16]

Cases of lamotrigine-induced neuroleptic malignant syndrome (NMS  ‡ a condition characterised by muscle

rigidity, tremors, autonomic dysregulation [tachycardia (high heart rate), hypertension (high blood pressure),

diarrhoea, diaphoresis (profuse sweating), etc.], mental status change [e.g. hallucinations, agitation, delusions,stupor, coma, etc.] and hyperthermia [elevated body temperature]; in patients that had been stabilised on atypical

antipsychotics for several months without NMS symptoms) have been reported.

Effects in women

In clinical trials women were more likely than men to have side-effects [citation needed ]. This is the opposite of most

other anticonvulsants.

There is evidence showing interactions between lamotrigine and female hormones, which can be of particular

concern for women on estrogen-containing hormonal contraceptives. Ethinyl estradiol, the ingredient of suchcontraceptives, has been shown to decrease serum levels of lamotrigine. Women starting an estrogen-containing oral

contraceptive may need to increase the dosage of lamotrigine to maintain its level of efficacy. Likewise, women may

experience an increase in lamotrigine side-effects upon discontinuation of the pill. This may include the "pill free"

week where lamotrigine serum levels have been shown to increase twofold. Another study showed a significantincrease in follicle stimulating hormone (FSH) and luteinizing hormone (LH) in women taking lamotrigine with oral

contraceptive compared to women taking oral contraceptives alone. However, these increases were not inconjunction with increased progesterone, indicating that oral contraceptives maintained suppression of ovulation.

Pregnancy and breastfeeding

Lamotrigine is rated Pregnancy Category Risk C. Use during pregnancy is recommended only if benefits outweighpotential risks. In September 2006, the FDA issued a warning stating that taking lamotrigine during the first trimester

of pregnancy may increase the risk for cleft lip and palate malformation in newborns.[17] Since then, review studieshave found that overall rates of congenital malformations in infants exposed to lamotrigine in utero are relatively

low (1-4%). This compares to a typical 3% rate in the untreated population. A prospective study on cognition in

children (mean age = 4.2 years) exposed to lamotrigine in utero did not indicate any adverse effects.

Lamotrigine is found in breast milk; the manufacturer does not recommend breastfeeding during treatment. In

"Medications and Mothers' Milk," a frequently updated review of scientific literature, lamotrigine is rated as L3:moderately safe.

http://en.wikipedia.org/w/index.php?title=Breastfeedinghttp://en.wikipedia.org/w/index.php?title=Breast_milkhttp://en.wikipedia.org/w/index.php?title=Cleft_lip_and_palatehttp://en.wikipedia.org/w/index.php?title=Luteinizing_hormonehttp://en.wikipedia.org/w/index.php?title=Follicle_stimulating_hormonehttp://en.wikipedia.org/w/index.php?title=Ethinyl_estradiolhttp://en.wikipedia.org/w/index.php?title=Hormonal_contraceptiveshttp://en.wikipedia.org/w/index.php?title=Anticonvulsanthttp://en.wikipedia.org/wiki/Citation_neededhttp://en.wikipedia.org/w/index.php?title=Atypical_antipsychoticshttp://en.wikipedia.org/w/index.php?title=Atypical_antipsychoticshttp://en.wikipedia.org/w/index.php?title=Neuroleptic_malignant_syndromehttp://en.wikipedia.org/w/index.php?title=Leukopeniahttp://en.wikipedia.org/w/index.php?title=Vaginitishttp://en.wikipedia.org/w/index.php?title=Menstrual_periodhttp://en.wikipedia.org/w/index.php?title=Nauseahttp://en.wikipedia.org/w/index.php?title=Memoryhttp://en.wikipedia.org/w/index.php?title=Dry_mouthhttp://en.wikipedia.org/w/index.php?title=Nightmarehttp://en.wikipedia.org/w/index.php?title=Insomniahttp://en.wikipedia.org/w/index.php?title=Dizzinesshttp://en.wikipedia.org/w/index.php?title=Strabismushttp://en.wikipedia.org/w/index.php?title=Diplopiahttp://en.wikipedia.org/w/index.php?title=Aseptic_meningitis

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Lamotrigine 6

Other types of effects

Lamotrigine binds to melanin-containing tissues such as the iris of the eye. The long-term consequences of this are

unknown.

Some patients have reported experiencing a loss of concentration, even with very small doses. Lamotrigine has been

implicated in the apoptotic neurodegeneration of the developing brain. GlaxoSmithKline investigated lamotrigine for

the treatment of ADHD with inconclusive results. No detrimental effects on cognitive function were observed;however, the only statistical improvement in core ADHD symptoms was an improvement on a test, PASAT (Paced

Auditory Serial Addition Test), that measures auditory processing speed and calculation ability.

Lamotrigine is known to affect sleep. Studies with small numbers (10-15) of patients reported that lamotrigine

increases sleep stability (increases the duration of REM sleep, decreases the number of phase shifts and decreases the

duration of slow-wave sleep), and that there was no effect on vigilance, and daytime somnolence and cognitivefunction. However, a retrospective study of 109 patients' medical records found that 6.7% of patients experienced an

'alerting effect' resulting in intolerable insomnia, for which the treatment had to be discontinued.

Lamotrigine can induce a type of seizure known as a myoclonic jerk, which tends to happen soon after the use of the

medication.

[18]

When used in the treatment of myoclonic epilepsies such as juvenile myoclonic epilepsy, lower doses(and lower plasma levels) are usually needed, as even moderate doses of this drug can lead to induction of seizures,including tonic-clonic seizures, which can develop into status epilepticus, which is a medical emergency. It can also

cause myoclonic status epilepticus.[citation needed ]

In overdose, lamotrigine can cause uncontrolled seizures in most people.

History

ƒ December 1994 ‡ Lamotrigine was approved for the treatment of partial seizures.

ƒ August 1998 ‡ for use as adjunctive treatment of Lennox-Gastaut syndrome in pediatric and adult patients, newdosage form: chewable dispersible tablets.

ƒ December 1998 ‡ for use as monotherapy for treatment of partial seizures in adult patients when convertingfrom a single enzyme-inducing anti-epileptic drug (EIAED).

ƒ January 2003 ‡ for use as adjunctive therapy for partial seizures in pediatric patients as young as two years of 

age.ƒ June 2003 ‡ approved for maintenance treatment of Bipolar I disorder; the first such medication since lithium. []

ƒ January 2004 ‡ for use as monotherapy for treatment of partial seizures in adult patients when converting from

the anti-epileptic drug valproate (including valproic acid (Depakene); sodium valproate (Epilim) and divalproexsodium (Depakote)).

Availability

Lamictal 200 mg tablets

GlaxoSmithKline's trademarked brand of lamotrigine, Lamictal, ismanufactured in scored tablets (25 mg, 50 mg, 100 mg, 150 mg

and 200 mg) and chewable dispersible tablets (2 mg, 5 mg and

25 mg). Five-week sample kits are also available; these includetitration [19]  instructions and scored tablets (25 mg for patients

taking valproate, 25 mg and 100 mg for patients not takingvalproate). Lamotrigine is also available in un-scored tablet form.

In 2005, Teva Pharmaceutical Industries Ltd. began selling generic

lamotrigine in the United States, but only in 5 mg and 25 mg

http://en.wikipedia.org/w/index.php?title=Teva_Pharmaceutical_Industrieshttp://en.wikipedia.org/w/index.php?title=File%3ALamictal200mgTablet.pnghttp://en.wikipedia.org/w/index.php?title=Lithium_pharmacologyhttp://en.wikipedia.org/w/index.php?title=Bipolar_I_disorderhttp://en.wikipedia.org/wiki/Citation_neededhttp://en.wikipedia.org/w/index.php?title=Status_epilepticushttp://en.wikipedia.org/w/index.php?title=Juvenile_myoclonic_epilepsyhttp://en.wikipedia.org/w/index.php?title=Myoclonic_jerkhttp://en.wikipedia.org/w/index.php?title=Rapid_eye_movement_sleephttp://en.wikipedia.org/w/index.php?title=Cognitionhttp://en.wikipedia.org/w/index.php?title=ADHDhttp://en.wikipedia.org/w/index.php?title=GlaxoSmithKlinehttp://en.wikipedia.org/w/index.php?title=Melanin

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Lamotrigine 7

chewable dispersible tablets. On 23 July 2008 Teva began offering the full line of generic lamotrigine in the US. [20]

Lamotrigine is also available in generic form in the United States, the United Kingdom, Canada and Australia. Itshould be noted that brand name Lamictal is not available in 200 mg tablets in Canada, at all registered pharmacies

(while 25, 100, and 150 mg are all offered). Starter kits are also not available in Canada.

Lamotrigine is marketed as Lamotrine in Egypt, Lamitrin in Bangladesh [21], Lamictin in South Africa, †‡'ˆ‰Š‹

(Lamogine) in Israel, and€•‚ in South Korea and generally named as Lamitor.

Lamictal XR

In 2009 GlaxoSmithKline received FDA Approval for an extended-release version of lamotrigine branded Lamictal

XR. Lamictal XR tablets are a novel preparation of lamotrigine, delivered in a tablet with an enteric coating that

GlaxoSmithKline has branded DiffCORE. The extended release formulation is analogous to the instant releaseversion, such that treatment may begin without titration or recalibration of the dosage.

Chemistry

Lamotrigine can be prepared from 2,3-dichlorobenzoyl cyanide.

References

[1] http:/   /  www. drugs.  com/  monograph/  lamotrigine.  html[2] http:/   /  www. nlm.nih.  gov/  medlineplus/  druginfo/  meds/  a695007.  html[3] http:/   /  www. accessdata. fda.  gov/  scripts/  cder/  drugsatfda/  index.  cfm?fuseaction=Search. SearchAction& SearchTerm=Lamotrigine&

SearchType=BasicSearch[4] http:/   /  www. nlm.nih.  gov/  cgi/  mesh/  2009/  MB_cgi?term=84057-84-1&  rn=1[5] http:/   /  www. whocc.  no/  atc_ddd_index/  ?code=N03AX09[6] http:/   /  pubchem.  ncbi.nlm.  nih.  gov/  summary/  summary. cgi?cid=3878[7] http:/   /  www. iuphar-db.  org/  DATABASE/  LigandDisplayForward?ligandId=2622[8] http:/   /  www. drugbank.  ca/  drugs/  DB00555[9] http:/   /  www. chemspider.  com/  Chemical-Structure. 3741

[10] http:/  

 /  

fdasis.nlm.nih. 

gov/  

srs/  

srsdirect. 

 jsp?regno=U3H27498KS[11] http:/   /  www. kegg.   jp/  entry/  D00354[12] https:/   /  www. ebi.  ac. uk/  chebi/  searchId. do?chebiId=CHEBI:6367[13] https:/   /  www. ebi.  ac. uk/  chembldb/  index. php/  compound/  inspect/  CHEMBL741[14] http:/   /  en.  wikipedia. org/  w/  index.  php?title=Special:ComparePages& rev1=420280917&  page2=Lamotrigine[15] http:/   /  www. drugs.  com/  monograph/  lamotrigine.  html[16] Lamotrigine does not prolong QTc in a thorough QT/QTc study in healthy subjects (http:/   /  www. richmondpharmacology.  com/  downloads/ 

Publications/  Lamotrigine does not prolong QTc in a thorough QTQTc study in healthy subjects.  pdf)[17] FDA: Safety Alerts: Lamotrigine (http:/   /  www. fda.  gov/  Safety/  MedWatch/  SafetyInformation/  SafetyAlertsforHumanMedicalProducts/ 

ucm150637.  htm)[18] http:/   /  www. ehealthme. com/  ds/  lamictal/  myoclonic+   jerks Retrieved August 19, 2010. Myoclonic Jerk in the use of Lamictal.[19][19] In medicine, titration is the process of gradually adjusting the dose of a medication until optimal results are reached.[20] http:/   /  www. tevapharm.  com/  pr/  2008/  pr_779.  asp[21] http:/   /  www. bddrugs.  com/  product5.  php?idn=244&  prev=99&  prev1=&  prev2=

http://www.bddrugs.com/product5.php?idn=244&prev=99&prev1=&prev2=http://www.tevapharm.com/pr/2008/pr_779.asphttp://www.ehealthme.com/ds/lamictal/myoclonic+jerkshttp://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm150637.htmhttp://www.fda.gov/Safety/MedWatch/SafetyInformation/SafetyAlertsforHumanMedicalProducts/ucm150637.htmhttp://www.richmondpharmacology.com/downloads/Publications/Lamotrigine%20does%20not%20prolong%20QTc%20in%20a%20thorough%20QTQTc%20study%20in%20healthy%20subjects.pdfhttp://www.richmondpharmacology.com/downloads/Publications/Lamotrigine%20does%20not%20prolong%20QTc%20in%20a%20thorough%20QTQTc%20study%20in%20healthy%20subjects.pdfhttp://www.drugs.com/monograph/lamotrigine.htmlhttp://en.wikipedia.org/w/index.php?title=Special:ComparePages&rev1=420280917&page2=Lamotriginehttps://www.ebi.ac.uk/chembldb/index.php/compound/inspect/CHEMBL741https://www.ebi.ac.uk/chebi/searchId.do?chebiId=CHEBI:6367http://www.kegg.jp/entry/D00354http://fdasis.nlm.nih.gov/srs/srsdirect.jsp?regno=U3H27498KShttp://www.chemspider.com/Chemical-Structure.3741http://www.drugbank.ca/drugs/DB00555http://www.iuphar-db.org/DATABASE/LigandDisplayForward?ligandId=2622http://pubchem.ncbi.nlm.nih.gov/summary/summary.cgi?cid=3878http://www.whocc.no/atc_ddd_index/?code=N03AX09http://www.nlm.nih.gov/cgi/mesh/2009/MB_cgi?term=84057-84-1&rn=1http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&SearchTerm=Lamotrigine&SearchType=BasicSearchhttp://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.SearchAction&SearchTerm=Lamotrigine&SearchType=BasicSearchhttp://www.nlm.nih.gov/medlineplus/druginfo/meds/a695007.htmlhttp://www.drugs.com/monograph/lamotrigine.htmlhttp://en.wikipedia.org/w/index.php?title=File:Lamotrigine_synth.pnghttp://en.wikipedia.org/w/index.php?title=Enteric_coatinghttp://en.wikipedia.org/w/index.php?title=South_Koreahttp://en.wikipedia.org/w/index.php?title=Israelhttp://en.wikipedia.org/w/index.php?title=South_Africahttp://www.bddrugs.com/product5.php?idn=244&prev=99&prev1=&prev2=http://en.wikipedia.org/w/index.php?title=Bangladeshhttp://en.wikipedia.org/w/index.php?title=Egypthttp://en.wikipedia.org/w/index.php?title=United_Kingdom

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Lamotrigine 8

External links

ƒ FAQ: Psychiatric Uses of Lamotrigine (Lamictal) (http:/   /  www. psycom. net/  depression. central. lamotrigine.html), by Ivan K. Goldberg, MD. Includes many references from the medical literature.

ƒ Center for Drug Evaluation and Research: Lamictal (http:/   /  www. accessdata. fda. gov/  scripts/  cder/  drugsatfda/ 

index. cfm?fuseaction=Search.Label_ApprovalHistory) ‡ documents related to the FDA approval process,

including medical reviews and correspondence letters.ƒ Epilepsy South Africa: MEDICATION FOR EPILEPSY (http:/   /  www. epilepsy. org. za/  faq. php) ‡ an

Epilepsy FAQ with a list of medicines for treatment thereof, includes Lamotrigine with South African trade

name Lamictin.

ƒ Adverse Reactions (http:/   /  www. druglib. com/  adverse-reactions_side-effects/  lamictal/  ) ‡ Reported adversereactions and side-effects.

ƒ U.S. National Library of Medicine: Drug Information Portal ‡ Lamotrigine (http:/   /  druginfo.nlm.  nih.gov/ 

drugportal/  dpdirect.  jsp?name=Lamotrigine)

http://druginfo.nlm.nih.gov/drugportal/dpdirect.jsp?name=Lamotriginehttp://druginfo.nlm.nih.gov/drugportal/dpdirect.jsp?name=Lamotriginehttp://www.druglib.com/adverse-reactions_side-effects/lamictal/http://www.epilepsy.org.za/faq.phphttp://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Label_ApprovalHistoryhttp://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm?fuseaction=Search.Label_ApprovalHistoryhttp://www.psycom.net/depression.central.lamotrigine.htmlhttp://www.psycom.net/depression.central.lamotrigine.html

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Article Sources and Contributors 9

Article Sources and ContributorsLamotrigine  Source: http://en.wikipedia.org/w/index.php?oldid=591578305 Contributors: A876, ABCD, Abcb336, Aetheling, Agjchs, Akb4, Albmont, Alchemagenta, Alexrexpvt, Allens,Aneah, Ara6012, Arcadian, AssetBurned, Batamt, Beetstra, Bkell, Bllix, Bogwhistle, Bonhomie, Bradd, Bwilliams, Casforty, Casliber, Cfailde, Chemgirl131, Chowbok, Chronulator, Daevatgl,Dagrrl, Danhash, Darklilac, David Hedlund, Dcirovic, Deepwatership, Def lective, Deli nk, Dfogelso, Dfxoreilly, Dhatfield, Dixto, Download, Drphilharmonic, Ecwp2, Edgar181, Edward, Elvey,Enix150, Epicgenius, Epolk, FREvers, Facts707, Fortheloveofbacon, Fraggle81, Funandtrvl, Fuse809, Fvasconcellos, Gaius Cornelius, Gene Nygaard, Gigacephalus, GingerDemarque,Giorgiogp2, GngstrMNKY, GoingBatty, Golbez, Gprobins, Graeme Bartlett, Grec3000, Ground Zero, Hoffmeier, Hohohahaha, Hopkapi, Hurricane111, I dream of horses, IDX, Indon, InferiorOlive, Interestedperson, Ithacagorges, Jhaochen, Jimp, Jmh649, Joemorethanokman, Jonesey95, K-MUS, Karada, KaterGator, Katharine908, Katpra, Keziah, Khoikhoi, KirkCliff2, Koavf,

Kpstewart, Kwamikagami, Lada Guy, Lanulos, LeaMaimone, Letsgoridebikes, Levydav, Linberry, Lmatt, Loserduh, LuK3, Lucid, Lwnf360, Lyrl, Macaddct1984, Mailer diablo, Mandel, MarcelLavender, Mark D Hardy, Marnanel, Mc1998, Mcarrasco03, Memtgs, Metalhead94, Metaphoria, Mfourman, MichaK, Michael Ward, Mikael HŒggstrm, Milliemchi, Mogism, Mohsenkazempur,Motamot, Msvs, MusicNewz, Mykhal, Neonfuzz, NeuroGlossary, Ngubernator, Nihiltres, Nmg20, Nono64, Oaktree b, Oddity-, Ohnoitsjamie, OsamaBinLogin, PStrait, Panscient, Par hamr,Pashihiko, Patter lake, Patxi lurra, Pentagron, PharmerDan, Pigkeeper, Poindexter Propellerhead, P tavangar, Pztheron, Quale, RDBrown, Ramius, Rangoon11, Rckites, Rhombus, Riemann Zeta,Risssa, Rjwilmsi, Rmky87, Ruby Murray, Rushiagr, Rybkovich, RŽgis DŽcamps, Sandkicker10, SarahEmm, Sburke, Sduibek, SelfishSeahorse, Selket, S iafu, Some guy, Spylab, St3vo, Staciabb,SteveCrook, SteveLoughran, Stillwaterising, Substantiate, Sun Creator, Supbonkers, Superwawa66, Swelgemoed, Tatsundo h, Tea with toast, Testem, The Anome, TheDude2006, TimBuck2,Tmallard, Tobycat, TomCat4680, Tomas e, Tomwac, Tonyfaull, Torqueing, Tristanb, Ur0pl, Useight, Vanished user kjdioejh329io3rksdkj, Verloren Hoop, VernoWhitney, Vokesk, Vytal,W.F.Galway, Watermelon mang, Westewart, Wroughtirony, Xanzzibar, Xavierlives, Xwdl, Yandman, Yid, Ytcracker, €•‚ ƒ „…† ‡ ˆ ‰   , 276 anonymous edits

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