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> Frequently asked questions about LAMICTAL
> Treatment Considerations
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Treatment Considerations

 
There are now numerous options for antiepileptic drug (AED) therapy. As the range of options rapidly expands, so do the considerations you face in treating patients. Seizure control is clearly the most important concern in your treatment decisions, but beyond seizure control, there are additional factors to consider. Below is a checklist of some factors to consider before determining the appropriate AED for any given patient.

Questions to ask the patient and/or caregiver:
Do you feel that your seizures are adequately controlled?
Are you having difficulty thinking clearly? (For example, problems concentrating, communicating, or remembering things)
Are you bothered by changes in your physical appearance? (For example, changes in weight, hair loss or unusual hair growth, acne or rash, gum problems)
Are your feelings or moods out of the ordinary? (For example, sadness, anger, nervousness, too much or too little energy)
Do you find that you have problems with coordination? (For example, you feel dizzy or unsteady)
Do any of the above symptoms you described or other problems you may be experiencing interfere with your daily activities or life goals? (For example, it has affected your job performance, schoolwork, or your relationships with family or friends)

Factors about the AED:
Is titration required? If so, are there titration kits available to simplify the process?
How much does it cost?
Are there significant drug interactions?
Is routine blood monitoring required?
Are alternative formulations available for patients who can't swallow regular pills?
Have your patients complete a Treatment Satisfaction Questionnaire and review the results with them.
Provide your patients with the events calendar , a useful tool for keeping track of seizures and side effects they may experience.
Please see tolerability data specific to LAMICTAL.
Safety and effectiveness of LAMICTAL have not been established 1) as initial monotherapy, 2) for conversion to monotherapy from AEDs other than carbamazepine, phenytoin, phenobarbital, primidone, or valproate, or 3) for simultaneous conversion to monotherapy from 2 or more concomitant AEDs
Important Safety Information

•   Serious rashes requiring hospitalization and discontinuation of treatment have been reported in association with the use of LAMICTAL, some of which have included Stevens-Johnson syndrome
  
-   Epilepsy clinical trials: The incidence of these rashes is approximately 0.8% (8/1000) in pediatric patients (age <16 years) receiving LAMICTAL as adjunctive therapy and 0.3% (3/1000) in adults on adjunctive therapy. In a prospectively followed cohort of 1983 pediatric patients taking adjunctive LAMICTAL, there was 1 rash-related death
•   In worldwide postmarketing experience, rare cases of toxic epidermal necrolysis and/or rash-related death have been reported in adult and pediatric patients, but their numbers are too few to permit a precise estimate of the rate
•   Hypersensitivity reactions, some fatal or life-threatening, have occurred in association with the use of LAMICTAL. It is important to note that early manifestations of hypersensitivity (eg, fever, lymphadenopathy) may be present even though a rash is not evident. If such signs or symptoms are present, the patients should be evaluated immediately. LAMICTAL should be discontinued if an alternative etiology cannot be established
•   Prior to initiation of treatment with LAMICTAL, the patient should be instructed that a rash or other signs or symptoms of hypersensitivity (eg, fever, lymphadenopathy) may herald a serious medical event and that the patient should report any such occurrence to a physician immediately
•   To avoid an increased risk of rash, the recommended initial dose and subsequent dose escalations of LAMICTAL should not be exceeded
•   LAMICTAL should ordinarily be discontinued at the first sign of rash, unless the rash is clearly not drug-related


Complete Prescribing Information for LAMICTAL® (lamotrigine) Tablets



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