lRENAL IMPAIRMENTCaution in renal failure; metabolite
may accumulate.
Dose adjustmentsConsider reducing maintenance dose in
significant impairment.
lTREATMENT CESSATIONAvoid abrupt withdrawal (taper off
over 2 weeks or longer) unless serious skin reaction occurs.
lPRESCRIBING AND DISPENSING INFORMATIONPatients
being treated for epilepsy may need to be maintained on a
specific manufacturer’s branded or generic lamotrigine
product.
Switching between formulationsCare should be taken when
switching between oral formulations in the treatment of
epilepsy. The need for continued supply of a particular
manufacturer’s product should be based on clinical
judgement and consultation with the patient or their
carer, taking into account factors such as seizure
frequency and treatment history.
lPATIENT AND CARER ADVICE
Skin reactionsWarn patients and carers to see their doctor
immediately if rash or signs or symptoms of
hypersensitivity syndrome develop.
Blood disordersPatients and their carers should be alert for
symptoms and signs suggestive of bone-marrow failure,
such as anaemia, bruising, or infection. Aplastic anaemia,
bone-marrow depression, and pancytopenia have been
associated rarely with lamotrigine.
Medicines for Children leaflet: Lamotrigine for preventing
seizureswww.medicinesforchildren.org.uk/lamotrigine-for-
preventing-seizures
lMEDICINAL FORMS
There can be variation in the licensing of different medicines
containing the same drug. Forms available from special-order
manufacturers include: oral suspension, oral solution
Dispersible tablet
CAUTIONARY AND ADVISORY LABELS8, 13
▶Lamotrigine (Non-proprietary)
Lamotrigine 5 mgLamotrigine 5 mg dispersible tablets sugar free
sugar-free| 28 tabletP£ 15. 00 DT = £ 7. 09
Lamotrigine 25 mgLamotrigine 25 mg dispersible tablets sugar free
sugar-free| 56 tabletP£ 20. 41 DT = £ 1. 86
Lamotrigine 100 mgLamotrigine 100 mg dispersible tablets sugar
free sugar-free| 56 tabletP£ 58. 68 DT = £ 3. 93
▶Lamictal(GlaxoSmithKline UK Ltd)
Lamotrigine 2 mgLamictal 2 mg dispersible tablets sugar-free|
30 tabletP£ 18. 81 DT = £ 18. 81
Lamotrigine 5 mgLamictal 5 mg dispersible tablets sugar-free|
28 tabletP£ 9. 38 DT = £ 7. 09
Lamotrigine 25 mgLamictal 25 mg dispersible tablets sugar-free|
56 tabletP£ 23. 53 DT = £ 1. 86
Lamotrigine 100 mgLamictal 100 mg dispersible tablets sugar-free
| 56 tabletP£ 69. 04 DT = £ 3. 93
Tablet
CAUTIONARY AND ADVISORY LABELS 8
▶Lamotrigine (Non-proprietary)
Lamotrigine 25 mgLamotrigine 25 mg tablets| 56 tabletP
£ 20. 41 DT = £ 1. 08
Lamotrigine 50 mgLamotrigine 50 mg tablets| 56 tabletP
£ 8. 00 DT = £ 1. 22
Lamotrigine 100 mgLamotrigine 100 mg tablets| 56 tabletP
£ 62. 14 DT = £ 1. 76
Lamotrigine 200 mgLamotrigine 200 mg tablets| 56 tabletP
£ 105. 62 DT = £ 2. 55
▶Lamictal(GlaxoSmithKline UK Ltd)
Lamotrigine 25 mgLamictal 25 mg tablets| 56 tabletP£ 23. 53
DT = £ 1. 08
Lamotrigine 50 mgLamictal 50 mg tablets| 56 tabletP£ 40. 02
DT = £ 1. 22
Lamotrigine 100 mgLamictal 100 mg tablets| 56 tabletP
£ 69. 04 DT = £ 1. 76
Lamotrigine 200 mgLamictal 200 mg tablets| 56 tabletP
£ 117. 35 DT = £ 2. 55
Levetiracetam 03-Apr-2018
lINDICATIONS AND DOSE
Monotherapy of focal seizures with or without secondary
generalisation
▶BY MOUTH, OR BY INTRAVENOUS INFUSION
▶Child 16–17 years:Initially 250 mg once daily for 1 week,
then increased to 250 mg twice daily, then increased in
steps of 250 mg twice daily (max. per dose 1. 5 g twice
daily), adjusted according to response, dose to be
increased every 2 weeks
Adjunctive therapy of focal seizures with or without
secondary generalisation
▶BY MOUTH
▶Child 1–5 months:Initially 7 mg/kg once daily, then
increased in steps of up to 7 mg/kg twice daily (max.
per dose 21 mg/kg twice daily), dose to be increased
every 2 weeks
▶Child 6 months–17 years (body-weight up to 50 kg):
Initially 10 mg/kg once daily, then increased in steps of
up to 10 mg/kg twice daily (max. per dose 30 mg/kg
twice daily), dose to be increased every 2 weeks
▶Child 12–17 years (body-weight 50 kg and above):Initially
250 mg twice daily, then increased in steps of 500 mg
twice daily (max. per dose 1. 5 g twice daily), dose to be
increased every 2 – 4 weeks
▶BY INTRAVENOUS INFUSION
▶Child 4–17 years (body-weight up to 50 kg):Initially
10 mg/kg once daily, then increased in steps of up to
10 mg/kg twice daily (max. per dose 30 mg/kg twice
daily), dose to be increased every 2 weeks
▶Child 12–17 years (body-weight 50 kg and above):Initially
250 mg twice daily, then increased in steps of 500 mg
twice daily (max. per dose 1. 5 g twice daily), dose to be
increased every 2 weeks
Adjunctive therapy of myoclonic seizures and tonic-clonic
seizures
▶BY MOUTH, OR BY INTRAVENOUS INFUSION
▶Child 12–17 years (body-weight up to 50 kg):Initially
10 mg/kg once daily, then increased in steps of up to
10 mg/kg twice daily (max. per dose 30 mg/kg twice
daily), dose to be increased every 2 weeks
▶Child 12–17 years (body-weight 50 kg and above):Initially
250 mg twice daily, then increased in steps of 500 mg
twice daily (max. per dose 1. 5 g twice daily), dose to be
increased every 2 weekslUNLICENSED USEgInitial dosing recommendations for
levetiracetamlin BNF Publications differ from product
licence. Manufacturer advisesgranulesnot licensed for use
in children under 6 years, for initial treatment in children
with body-weight less than 25 kg, or for the administration
of doses below 250 mg—oral solution should be used.
lINTERACTIONS→Appendix 1 : antiepileptics
lSIDE-EFFECTS
▶Common or very commonAnxiety.appetite decreased.
asthenia.behaviour abnormal.cough.depression.
diarrhoea.dizziness.drowsiness.gastrointestinal
discomfort.headache.increased risk of infection.
insomnia.mood altered.movement disorders.nausea.
skin reactions.vertigo.vomiting
▶UncommonAlopecia.concentration impaired.confusion.
hallucination.leucopenia.muscle weakness.myalgia.
paraesthesia.psychotic disorder.suicidal tendencies.
thrombocytopenia.vision disorders.weight changes
▶Rare or very rareAcute kidney injury.agranulocytosis.
hepatic disorders.hyponatraemia.neutropenia.
pancreatitis.pancytopenia.personality disorder.
rhabdomyolysis.severe cutaneous adverse reactions
(SCARs).thinking abnormalBNFC 2018 – 2019 Epilepsy and other seizure disorders 203
Nervous system4