Lamical

Antiepileptic, anticonvulsant drug Lamiktal on the modern pharmaceutical market is produced by the Polish company Glaxo Smith Klein Pharmaceuticals SA.

"Herculean disease", "divine disease", "falling" - as soon as they did not call epilepsy for centuries, but it remained a problem. It interferes with the life of a person, closing the door to some professions, reducing the quality of life. But, nevertheless, today pharmacological companies with their products allow, if not to heal the patient, then significantly improve his condition, and the preventive reception of anticonvulsant medication, for example, Lamyctal, is sufficiently effective to prevent an impending attack. Be more attentive to your health. And if you have a history of this disease, do not give up, modern medicine is ready to help. It is only necessary to remember that such medicines should be prescribed only by an experienced qualified specialist.

Indications Lamical

Due to the peculiarities of the pharmacodynamics of the active active substance lamotrigine, indications for the use of the medicament Lamictal are stipulated:

1. As a medicine for monotherapy epilepsy (with minor attacks).
2. Suppression of partial and generalized seizures.
3. As a remedy for the complex treatment of epilepsy (with a more severe pathological manifestation of the disease).
4. Bipolar disorders.
5. Prevention of violations of the emotional state of the patient.
6. Treatment of typical absences (short generalized epileptic seizures with sudden rapid onset and completion).
7. Depression in bipolar disorder of the psyche.

[1], [2]

Release form

Medicinal anticonvulsant Lamiktal, is released on the market of medical medicines in the form of tablets of round or rectangular type. Tablets - this is the main form of release of the drug in question.

The tablets of this medication may have a white color or a yellowish brown tinge. Form and color determine a different dosage of the main active substance lamotrigine. The tabletted unit of the drug may contain 5, 25, 50 or 100 mg of said active chemical compound.

Each tablet has its own fruity aroma and taste (for example, black currant).
Additional chemical compounds that make up Lamictal: hydroxypropyl cellulose, povidone K30, calcium carbonate, sodium glycolate, magnesium stearate, sodium saccharin and fruit flavor flavor.

[3]

Pharmacodynamics

Lamyctal was created by the manufacturer company as an oral antiepileptic, anticonvulsant drug, hence the pharmacodynamics of the drug in question.

The active chemical compound of the drug is lamotrigine (INN-lamotriginum). It is he who sets the direction of pharmacological properties of tablets.

The active active substance of the drug in question has a depressing effect on the potential of dependent sodium channels, blocking their work. Lamotrigine effectively balances the functional instability of neuronal membranes. Reduces the rate of release of glutamic acid, which dominates the process of provoking epilepsy.

[4], [5], [6]

Pharmacokinetics

But for the effective treatment is not only important pharmacodynamics of the drug, the doctor who is treating needs to know and the parameters of the medicine in the light of the rate of absorption and the quality of removing it from the patient's body. Therefore, before taking any medication, the expert evaluates the pharmacokinetics of Lamycal.

In this case, Lamictal has a high rate of complete absorption of the mucosa of the digestive tract.

The maximum amount of the active active component of the drug in the blood plasma is observed after two and a half hours after oral administration. Bioavailability of Lamyctal is estimated at 55%. Lamotrigine in the patient almost completely transformed into its metabolites, the main of which is N-glucuronide.

The volumes that distribute the body are quite individual, but averaged within the range of 0.92 to 1.22 l / kg.

On average, the adult half-life (T _1/2 ) lasts up to 29 hours. Lamictal is excreted from the body in the form of metabolites and insignificant amount in an unchanged form (less than ten percent), mainly through the kidneys together with urine and only about 2% with the calves. The reception of food is lengthened T _1/2. This indicator has no influence on the level of adsorption.

In adults, creatinine clearance approximately ranges from 25 to 53 ml / min. The rate of creatinine clearance and half-life is directly dependent on the dosage administered. There are no differences in these indicators in young people and people of advanced age.

In small patients, creatinine clearance is tied at dosage and body weight. The highest given index is determined in children up to the age of five. The half-life in small patients is slightly less than in adults.

The creatinine clearance differs from the average for people with chronic kidney dysfunction and those who are on hemodialysis. The averaged values, respectively, show 0.42 ml / min per kilogram of weight and 0.33 ml / min per kilogram of weight (between the extracellular blood purification) or 1.57 ml / min per kilogram of weight (directly during the hemodialysis procedure) .

Accordingly, the time T _1/2 changes which approximately corresponds to:

• For patients with chronic renal failure - 42 hours 55 minutes.
• For patients in the period between hemodialysis - 57 hours 25 minutes.
• For patients during the procedure of extrarenal blood purification - 13 hours.

Based on this knowledge, the specialist appoints a schedule and dosage of Lamectal.

The creatinine clearance varies in people suffering from impaired liver function, depending on the severity of the pathology.

• A slight degree of impairment - an average of about 0.31 ml / min per kilogram of weight.
• The average degree of pathology is about 0.24 ml / min per kilogram of body weight.
• Severe degree of pathological changes - only about 0.1 ml / min per kilogram of weight.

Based on this, depending on the severity of the disorders, the administered dosage should be adjusted: reduced to 50% at mild and moderate and up to 75% in severe disorders.

[7], [8]

Dosing and administration

Any medication, including Lamycatal, is prescribed and prescribed only by a qualified experienced specialist. Pharmacologists of the manufacturer have proposed only the recommended method of administration and dose, and a more specific schedule of administration and dosage adjustment remains with the treating specialist.

The tablet before swallowing should not be chewed, squeezed with a sufficient amount of water.

The drug in question can be used as a single drug in the therapy of epilepsy. Patients of adolescence (over 12 years) and adults are offered this schedule of admission:

1. The initial 14 days - to 0,025 g once a day, every day.
2. The next 14 days - 0.05 g once a day, every day.
3. Further gradual titration of the dosage until the necessary clinical efficacy is obtained.

On average, the maintenance amount of Lamectal administered reaches doses of 100 to 200 mg. Some patients receive the necessary result at a dosage of 500 mg.

 If we talk about the protocol of complex treatment (for example, with the preparation of sodium valproate), then it is necessary to reduce the amount of lamotrigine taken. Such a reception schedule may look like this:

1. The initial 14 days - to 0,025 g once a day, every other day.
2. The next 14 days - to 0,025 g once a day, every day.
3. Subsequently, the daily dosage is increased by 0.025-0.05 g, bringing the administered volumes up to the moment of obtaining the medicamentous effect and regress of the pathological symptomatology.

On average, the maintenance daily dosage is from 100 to 200 mg, separated by two daily doses.

If the protocol of therapy includes not two, but more drugs, at least one of which stimulates the liver enzymes, it is recommended:

1. The starting dose of Lamictal is prescribed - 0.05 g daily. The duration of such a reception is two weeks.
2. The next two weeks - 0.1 g, taken daily, but separated into two doses.
3. In order to maintain the achieved effect, the daily amount of the drug in question is advantageously administered in the range of 0.2 to 0.4 g.

With antiepileptic therapy for small patients, whose age falls within the age range of two to twelve years, against the background of the introduction of sodium valproate, the schedule for taking and dosage of the antiepileptic drug under consideration is recommended:

1. The initial daily dose, during the first 14 days is 0.15 mg per kilogram of the weight of the small patient.
2. The next 14 days this indicator increases and is 0.3 mg per kilogram of the patient's weight.
3. In the future, every subsequent day, the base dosage is increased by 0.3 mg per kilogram of weight, eventually bringing it to a value of 1-1.5 mg per kilogram of weight, separated by two daily doses.

In this case, it is necessary to ensure that the calculated amount of the drug does not exceed 0.2 g daily.

If the protocol of therapy includes not two, but more drugs, at least one of which stimulates the liver enzymes, for children from 2 to 12 years is recommended:

1. The initial daily dose, during the first 14 days is 0.6 mg per kilogram of the weight of the small patient.
2. The next 14 days this indicator increases and is 1.2 mg per kilogram of the patient's weight.
3. Further gradual titration of the dosage until the necessary clinical effectiveness is obtained.

When diagnosing a patient with bipolar disorder, against the background of taking anticonvulsants, the schedule for Lamectal injection is recommended:

1. The initial 14 days - to 0,025 g once a day, every other day.
2. The next 14 days - to 0,025 g once a day, every day.
3. The maintenance daily dosage is 0.1 g.

It should be ensured that the maximum amount of lamotrigine administered does not exceed 0.2 g daily.

Particular caution should be exercised in such clinical cases:

1. If the patient suffers from serious impairment of the excretory system (kidneys, ureters, etc.).
2. If the patient has a history of liver failure, the amount of Lamectal administered is reduced by half. If this pathology is referred to a severe degree, the dose can be reduced by 75%.
3.  To avoid the development of withdrawal syndrome, do not stop taking the antiepileptic drug abruptly. Gradual reduction of dosage usually takes a couple of weeks. An exception is the threat to the life of the patient.
4. Do not enter the drug in the protocol of treatment, if you already have a drug containing lamotrigine.

With Lamectal therapy, you should not drive vehicles and / or work on complex mechanisms that require increased attention.

[12], [13]

Use Lamical during pregnancy

When a woman is in an "interesting position" or in the postpartum period, she feeds the newborn baby with breast milk, she tries as little as possible and in smaller quantities to take any medications. This is due to her fear of harming the fetus or the already born baby. Use during pregnancy of antiepileptic, anticonvulsant drug Lamiktal was not determined. This is due to the fact that there are no data, and there are no results of similar clinical studies.

Theoretically, physicians can assume a high possibility of Lamyctal to influence fetal development, causing congenital anomalies. This conclusion is based on the ability of lamotrigine to inhibit the synthesis of the enzyme dihydrofolate reductase.

There is no evidence of Lamyctal's ability to penetrate into mother's milk.

Therefore, if there is a question about the treatment of a pregnant woman with a medicine, this issue is decided individually based on the degree of medical necessity. During lactation, so as not to risk the health of the baby, it is better to stop breastfeeding and transfer the newborn to the adapted mixture.

Contraindications

Practically there is no medicine that would not have a contraindication to the use. There is a list for Lamyctal too. It is small, since the medicine in question is easily perceived and processed by the human body.

1. Increased individual intolerance of the patient's body to one or more of the component components of the drug in question.
2. And just as carefully, you should prescribe the medication itself and its dosage to patients with renal and / or liver failure.

[9], [10], [11]

Side effects Lamical

Incorrect dosage administration, deviation from the schedule of admission or not properly sustained dose, individual sensitivity to a particular chemical compound and side effects of Lamictal may appear.

According to the statistical processing of monitoring results, most often patients have to meet with such pathological symptoms:

1. On the skin can appear exanthemic wounds of allergic etiology, up to the development of Stevens-Jones syndrome or epidermal Nicolysis Lyell.
2. Development of lymphadenopathy (enlarged lymph nodes).
3. The manifestation of a delayed-type hypersensitivity reaction (GZZHT).
4. Intravascular shedding (smoothing of characteristics) of blood cell structures.
5. Reduction in the blood of the number of cellular structures of germs of hemopoiesis.
6. Deterioration of vision.
7. Increase of excitability of receptors of the central nervous system, down to loss of consciousness.
8. Development of the syndrome of multiple organ failure.
9. With a sharp discontinuation of Lamectal, withdrawal can occur, causing seizures.
10. There may be problems with defecation.
11. The enzymatic activity of the liver decreases.
12. Rhabdomyolysis - the destruction of cells of the muscle tissue and the manifestation of a number of other pathologies.

Overdose

If a person does not follow the schedule and dosage of the Lamictal drug prescribed in the protocol of therapy, and because of individual sensitivity to a particular chemical compound, the amount of chemical substance that has entered the body may be exceeded. Overdosing of the leading active chemical component lamotrigine can manifest itself with such pathological symptoms:

1. Dizziness.
2. Nausea.
3. Visual impairment.
4. Coordination of movements failed.
5. Loss of consciousness.
6. Cranialgia is a headache caused by problems in the cervical spine.

Cupping of such pathological symptoms is carried out by detoxification of the patient's body: gastric lavage, the introduction of adsorbent substances (for example, activated carbon).

[14], [15], [16], [17],

Interactions with other drugs

If the patient's state of health does not cause fear and treatment affects the problem of only epileptic seizures, then Lamyctal can be taken alone, then the patient needs only to monitor his condition and, in case of emergence of secondary symptoms, seek counseling from his treating doctor.

 But such a situation, as a rule, arises quite seldom, much more often sick people take simultaneously several medicines belonging to different pharmacological groups. Therefore, in order to obtain the expected result and not to harm the patient's body, the specialist who prescribes treatment should clearly represent what clinical picture can be obtained eventually with the joint work of two or more pharmacological agents. Here, knowledge of interaction with other Lamectal preparations is mandatory.

But enough extensive knowledge and research results in this issue so far.

It is only known that when a given anticonvulsant medication is administered together with a drug such as sodium valproate, the metabolite of the latter, obtained through the operation of liver enzymes, reduces the ability of the patient's body to absorb the constituent chemical compounds of Lamictal.

The joint work of the antiepileptic agent and carbamazepine can provoke the rapid development of secondary pathological symptoms.
As shown by clinical observations, the use of hormonal contraceptives is able to activate the process of lamotrigine metabolism and its elimination from the body in half.

A similar result of tandem injection of Lamectal and paracetamol, as well as drugs of its (antiepileptic) pharmacological group.

[18], [19], [20]

Storage conditions

In order for the treatment to have the maximum therapeutic effect, in addition to fulfilling all the recommendations of the doctor leading the disease, it is necessary to get acquainted with the instruction and learn the storage conditions of Lamectal. If its content is incorrect, the active active lamotrigine can lose or significantly reduce its pharmacodynamic characteristics. Therefore, before proceeding to therapeutic treatment, you should carefully read the instructions attached to any pharmacological product. 

If all the recommendations were followed, you can be sure that the level of pharmacodynamic activity of an anticonvulsant drug will remain high throughout the life-time allowed.

The content requirements are much in line with the set of recommendations that relate to the storage of most medicines:

1. The room where storage of the drug in question is supposed to be unavailable for direct rays of the solar spectrum.
2. The humidity of the room should be moderate.
3. Temperature storage should not be above +30 degrees.
4. Contain Lamectal should be in places that are not available for adolescents and small children.

Shelf life

Entering the pharmacy market, any product produced by the manufacturer corporation is necessarily equipped on the packaging material with date indicators when this anticonvulsant was produced. Another number is the end date, after which, the medication supplied with this instruction should not be used as an effective antiepileptic remedy.

In this case, the shelf life of the antiepileptic, anticonvulsant drug Lamictal is three years (or 36 months).

[21], [22]