Lamolep

Lamolep is an anticonvulsant drug.

Indications Lamolep

The drug is used in monotherapy, as well as in the complex treatment of generalized and focal seizures (this includes epileptic seizures of a myoclonic-astatic nature) in adolescents and adults.

Children aged 2-12 years should take the drug as an aid in suppressing convulsive syndrome.

Lamolep can be used for monotherapy only when control over the intensity and frequency of the seizures is achieved.

It is used in the treatment of typical forms of absences.

It helps to suppress depressive stages in adults suffering from bipolar disorders.

Release form

It is available in tablet form of 25, 50 and 100 mg.

Pharmacodynamics

The drug acts by blocking the activity of potential-dependent Na channels, and in addition to this, by stabilizing the walls of neurons and suppressing the processes of secretion of 2-aminopentanedioic acid, which is the most important participant in the processes of formation of epileptic seizures.

Pharmacokinetics

Intestinal absorption of lamotrigine is fairly rapid and complete. Maximum plasma levels are observed approximately 2.5 hours after oral administration of the tablet. The peak period is prolonged when taken with food, but the absorption rate is not affected.

Oral dosing up to 450 mg has linear pharmacokinetics. Intraplasmic protein synthesis is approximately 55%, and the distribution volume is 0.92-1.22 L/kg.

The substance is metabolized by the enzyme glucuronyl transferase. The pharmacokinetic parameters of other anticonvulsants are not related to lamotrigine. The average clearance rate of the substance in adults is 39±14 ml/minute.

During metabolism, the substance is broken down into glucuronides, which are excreted in the urine. Less than 10% of the unchanged substance is excreted in the urine, and another 2% in the feces. The half-life, as well as the clearance rate of the drug, do not depend on the dose of the substance ingested.

In children (especially under 5 years of age), the clearance of the drug relative to weight is higher. Compared to an adult, a child also has a shorter half-life of the drug.

The mean values of drug clearance coefficient in people with chronic renal failure and those undergoing hemodialysis procedures are 0.42 ml/minute/kg (in people with CRF), 0.33 ml/minute/kg (in case of use between hemodialysis sessions) and 1.57 ml/minute/kg (in people undergoing hemodialysis). In proportion to this, the mean values of half-life are 42.9/57.4/13 hours.

A 4-hour hemodialysis session allows about 20% of lamotrigine to be removed. Therefore, if a person has kidney disease, the initial dose of the drug is determined taking into account the standard scheme for using anticonvulsants. If severe kidney dysfunction is observed, the maintenance dose is reduced.

The average drug clearance coefficient values in people with liver dysfunction (Child-Pugh stages A, B or C) are 0.31/0.24/0.1 ml/minute/kg, respectively.

Dosing and administration

Lamolep should be taken without chewing, swallowing the tablet whole. Since the tablets are soluble, they can be washed down with a small amount of liquid.

When changing the dose size in a child under 12 years of age or in case of problems with the excretory function, that is, when the dose taken differs in size from the active component of the whole tablet, it is necessary to use the minimum effective portions of the drug.

Monotherapy for the treatment of epilepsy in adolescents and adults is performed according to the following scheme: in the initial 2 weeks of the course, take 25 mg of the drug once a day, and in the following 2 weeks - 50 mg in the same frequency. After this, the dosage is titrated until the maximum medicinally significant effect is achieved. Maintenance treatment is performed using dosages of 100-200 mg/day, and in some patients it can reach 500 mg.

When used in combination with sodium valproate during epileptic syndrome, a slight reduction in the dose of Lamolep is necessary. The drug should be taken during the initial 2 weeks at 25 mg every other day, and then daily at the same dosage for another 2 weeks. After this, the daily dose of the drug is increased by 25-50 mg, and taken until improvement begins. The stabilizing dose is 100-200 mg/day (the dose is divided into 2 uses).

Complex treatment of epileptic seizures, which, in addition to Lamolepa, includes drugs that stimulate the activity of liver enzymes, requires taking 50 mg of the drug every day during the initial 2 weeks. During the next 14 days, the portion size is doubled. A month after the start of the course, the daily dosage of the drug reaches 100 mg, which is taken in 2 doses. To maintain the medicinal effect, 200-400 mg of the drug is taken per day.

The initial dosage of the drug for children aged 2-12 years in combination with sodium valproate or other anticonvulsants is 0.15 mg/kg per day. The drug is taken in such portions for 14 days. During the next 14 days, it is necessary to take 0.3 mg/kg/day. Then the dosage of the drug is increased every day by 0.3 mg/kg until improvements are noted. In this case, the size of the maintenance portions reaches 1-1.5 mg/kg/day with 2-time administration. For this category of patients, the maximum daily dose should not exceed 200 mg.

When combining the drug with other anticonvulsants (including stimulators of liver enzyme activity), children aged 2-12 years should first (for 14 days) take 0.6 mg/kg per day, and then, for another 14 days, 1.2 mg/kg per day. Then the dosage is titrated until a stable effect of the drug is achieved.

Combined treatment with Lamictal and anticonvulsant drugs (slowing down the activity of liver enzymes) for bipolar disorders for adolescents and adults begins with taking 25 mg of the drug every other day for 14 days. In the following 14 days, it is necessary to take the drug in the same dose, but every day. The stabilizing dose is 100 mg. It should not exceed the maximum daily dose, which is 200 mg.

When combining the drug with liver enzyme activators, its dose must be doubled (compared to combination therapy with drugs that inhibit liver proteases).

If the parameters of interaction between the drug and other prescribed anticonvulsants are not known, a treatment regimen similar to the monotherapeutic one should be used.

[ 1 ]

Use Lamolep during pregnancy

The test results show that with monotherapy in the 1st trimester, no increase in the overall probability of congenital anomalies was found, but individual sources demonstrate an increase in situations where anomalies in the oral cavity are observed. Because of this, Lamolep is allowed to be used during pregnancy only in cases where the probability of benefit to the woman is higher than the risk of negative effects on the fetus.

Variable levels of lamotrigine are found in breast milk, and the total level of the drug in the infant can sometimes reach up to 50% of the level of the substance in the mother's body, which is why the development of drug effects of the drug can be expected. In this regard, it is necessary to carefully evaluate the benefits of breastfeeding and the risk of adverse effects in the infant.

Contraindications

An absolute contraindication to the use of the drug is for people who suffer from intolerance to the components of the drug.

Lamolep should be used with caution in people with renal insufficiency.

Side effects Lamolep

Taking the medicine may cause certain side effects:

• skin lesions: allergic-type exanthemas may develop, sometimes leading to TEN or Stevens-Johnson syndrome;
• disorders of hematopoietic function: decrease in cellular content in hematopoietic germs;
• immune disorders: development of lymphadenopathy, and in addition to this, symptoms of HCT;
• CNS dysfunction: problems with vision, consciousness and balance. With abrupt discontinuation of the drug, withdrawal syndrome may be observed - in the form of increased frequency of seizures;
• problems with the gastrointestinal tract and hepatobiliary system: bowel disorders, manifestations of dyspepsia and decreased activity of liver enzymes.

When taking an insufficiently effective dose of the drug, sludge formation of blood cells inside the vessels and the development of rhabdomyolysis or MODS are possible.

Overdose

Poisoning with Lamolep can cause nausea with dizziness, problems with coordination or vision, cranialgia, and loss of consciousness.

To eliminate signs of overdose, it is necessary to perform detoxification procedures, including gastric lavage.

Interactions with other drugs

Due to competitive hepatic metabolism, use with sodium valproate reduces the rate of absorption of Lamolep.

The combination of the drug with carbamazepine increases the likelihood of side effects.

Anticonvulsants, hormonal contraceptives, and paracetamol double the rate of metabolism and excretion of Lamolepa.

[ 2 ], [ 3 ]

Storage conditions

Lamolep should be stored in a place closed to small children. Temperature level – no more than 30°C.

Shelf life

Lamolep is allowed to be used for a period of 3 years from the date of manufacture of the medicinal product.

Reviews

Lamolep has quite polar reviews, in which there is no clearly positive or negative opinion about the drug, its safety and effectiveness. This is due to the fact that the constituent component of the drug is lamotrigine, and such drugs must be selected individually - both the dose sizes and the drugs themselves.

People who found Lamolep suitable consider it to be quite an effective remedy. Among the negative aspects, negative reactions in the form of skin rashes are often noted, which usually go away on their own.