Epileptal

Epileptal is a subgroup of medications used for epilepsy therapy. Its active ingredient is lamotrigine.

The component lamotrigine has a pronounced anticonvulsant effect. It can be used not only as a monotherapy, but also in combination with other anticonvulsants. The drug blocks excessive release of neurotransmitters, mainly glutamic acid, which is a key element in the development of epileptic seizures. [ 1 ]

Indications Epileptal

It is used for therapy in the following cases:

• as a monotherapy for epilepsy;
• additional treatment of epilepsy - for example, tonic-clonic, generalized or partial seizures, as well as seizures caused by LGS;
• monotherapy for typical forms of minor epilepsy;
• in adults in case of bipolar disorders.

In addition, it is prescribed to prevent the development of emotional disorders (mania, depression, hypomania, mixed states) in people with bipolar disorders.

Release form

The therapeutic substance is produced in the form of tablets of 0.025, 0.05, 0.1 g, 30 pieces per blister pack.

Pharmacodynamics

Lamotrigine is able to block the activity of potential-dependent Na channels, which are located inside the nerve presynaptic walls. The neuronal walls are at a stage during which slow inactivation occurs.

In addition, a volumetric release of glutamic acid exceeds normal levels. [ 2 ]

Pharmacokinetics

When taken orally, the drug is fully absorbed in the gastrointestinal tract at high speed. The plasma Cmax level is noted after approximately 2.5 hours. The term of its achievement may increase after eating (the degree of absorption does not change). When using up to 0.45 g of the substance, the pharmacokinetic characteristics remain linear.

Protein synthesis – approximately 55%. Distribution volume indicators – within 0.92-1.22 l/kg. [ 3 ]

Intrahepatic metabolic processes occur with the help of the enzyme glucuronyl transferase with the formation of N-glucuronide. In adults, the average clearance values are 39±14 ml per minute. The substance is excreted in breast milk in a concentration of 40-60% of the plasma values.

The half-life is 29 hours regardless of the dose size. Excretion is mainly in the form of glucuronides; some of the substance is excreted unchanged in the urine (<10%). Another 2% is excreted in the feces.

Dosing and administration

Epileptal tablets should be taken with plain water. The portion size is selected and changed by the attending physician, taking into account the progress of the pathology. The doctor also determines the form of treatment - mono- or combination therapy. The tablet, if necessary, can be divided into halves.

Adolescents over 12 years of age and adults are often prescribed a dose of 25 mg, taken once a day, for a period of 14 days. Then the dosage is increased to 50 mg, taken for another 14 days. Then the dose is increased at 1-2-week intervals until the desired medicinal effect is achieved. The average maintenance dose is 0.1-0.2 g per day (taken in 1-2 applications). No more than 0.5 g of the drug is allowed per day.

For a child aged 2-12 years, the dose is selected in the proportion of 0.3 mg/kg per day. The dosage is increased by doubling at 2-week intervals. The dose is increased by 0.6 mg/kg. It should be consumed in 1-2 applications. The maintenance dose is within 1-15 mg/kg per day. The dose can be increased if necessary.

In case of combined treatment, the initial dose used in monotherapy is used, but during the first 2 weeks it is taken every other day. Then the use is continued as in monotherapy - daily intake of 25 mg. The dose should be increased by 25 mg at 2-week intervals, reaching maintenance rates of 0.1-0.2 g per day, which are used in 1-2 doses.

When using other anticonvulsants or other drugs that induce lamotrigine secretion, the dose can be increased to 50 mg per day; with a gradual increase, the dosage can reach a maximum of 0.7 g per day.

For individuals using oxcarbazepine (without any other inhibitors or inducers of lamotrigine glucuronidation), the initial dose is 25 mg once daily for 14 days; then 50 mg once daily for the next 2 weeks. The dosage is then increased (by a maximum of 0.05-0.1 g per day) at 1-2-week intervals until the optimal medicinal effect is achieved. The standard maintenance dose is 0.1-0.2 g per day in 1-2 applications.

• Application for children

The medicine can be used by people over 2 years of age.

Use Epileptal during pregnancy

Epileptal is not prescribed during pregnancy.

If it is necessary to use the medication during lactation, breastfeeding should be discontinued during the treatment period.

Contraindications

Contraindicated for use in cases of severe hypersensitivity to any of the components of the medication.

Side effects Epileptal

Main side effects:

• epidermal rashes, TEN, SSD;
• hematological disorders, including thrombocyto-, leuko-, pancyto- or neutropenia, agranulocytosis and anemia (also aplastic);
• lymphadenopathy, fever, liver dysfunction, changes in blood counts, facial swelling, DIC syndrome and multiple organ failure;
• irritability, confusion, aggression, hallucinations and tics;
• dizziness, ataxia, loss of balance, tremor, cephalgia, movement disorders, insomnia, nystagmus, choreoathetosis, anxiety, increased frequency of attacks, extrapyramidal signs and exacerbation of shaking palsy;
• "veil" over the eyes, diplopia, conjunctivitis;
• diarrhea, nausea and vomiting;
• liver failure;
• arthralgia, fatigue, back pain.

Overdose

In case of poisoning, nystagmus, ataxia, coma and impaired consciousness may be observed.

It is necessary to perform gastric lavage, prescribe sorbents, monitor the patient's condition and, if necessary, carry out standard symptomatic procedures.

Interactions with other drugs

Valproic acid substances reduce the rate of metabolic processes of Epileptal, increasing its half-life to 45-55 hours in a child and 70 hours in an adult.

Carbamazepine, primidone, phenytoin, phenobarbital and paracetamol increase the rate of drug metabolism, reducing its half-life by half.

Use together with carbamazepine increases the incidence of certain side effects (ataxia, blurred vision, dizziness, nausea, diplopia). They disappear when the dosage of carbamazepine is reduced.

Storage conditions

Epileptal should be stored in a place out of reach of children and moisture. Temperature indicators – no more than 25°C.

Shelf life

Epileptal can be used within 36 months from the date of production of the therapeutic substance.

Analogues

Analogues of the drug are Lamictal with Lamotrine, as well as Latrigil with Lamitril.