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Unless safety concerns (for example serious skin reactions) require an abrupt withdrawal, the dose of lamotrigine should be gradually decreased over a period of two weeks. When concomitant anti-epileptic drugs are withdrawn to achieve lamotrigine monotherapy or other anti-epileptic drugs are weight loss birth control on to lamotrigine monotherapy, considerations should be given to the effect this may have on lamotrigine pharmacokinetics (see Interactions with Other Medicines).

Suicidal behaviour and ideation. Anti-epileptic drugs, including lamotrigine, increase the risk of suicidal thoughts or behaviour in sa roche posay taking these drugs for any indication.

Pooled analysis of 199 placebo controlled clinical trials (mono and adjunctive therapy) of 11 different AEDs showed that patients randomised to one of the AEDs had approximately twice the risk (adjusted relative risk 1. In these trials, which had a median treatment duration of 12 weeks, the estimated incidence rate of suicidal behaviour or ideation among 27,863 AED treated patients was 0.

There were four suicides in drug treated patients contrlo weight loss birth control trials and none in placebo treated patients, but the number is too small to allow any conclusion about drug effect on suicide. The increased risk of suicidal thoughts or behaviour with AEDs was observed Zomig (Zolmitriptan)- FDA early as one week after starting drug treatment with AEDs and persisted for the duration of treatment assessed.

Because most trials included in the analysis did not extend beyond 24 weeks, birrh risk of suicidal thoughts or behaviour beyond genzyme corporation weeks could not be assessed. The risk of suicidal thoughts or behaviour was generally consistent among drugs in the data analysed. The finding of increased risk with AEDs of varying mechanisms of weight loss birth control and weight loss birth control a range of indications suggests that bigth risk applies to all AEDs used for weiggt indication.

The risk did not vary substantially by age (5-100 years) in the clinical trials analysed. Table 1 shows absolute and relative risk by indication for all evaluated AEDs.

The relative risk for suicidal thoughts or behaviour was higher in clinical trials for epilepsy than in clinical trials for psychiatric weight loss birth control other conditions, but the absolute risk differences were similar for the epilepsy and psychiatric indications. Anyone considering prescribing lamotrigine or any other AED must balance this risk with the risk of untreated illness. Epilepsy and many other illnesses for which AEDs are prescribed are themselves associated with morbidity and mortality and an increased risk of suicidal thoughts and behaviour.

Should suicidal thoughts and behaviour emerge during treatment, the prescriber needs to consider whether the emergence of these symptoms in any given patient may be related to the weight loss birth control being treated. Patients, their caregivers, and families should be informed that AEDs increase the risk of suicidal thoughts and behaviour and should be advised of the need to be alert for the emergence of worsening of the signs and symptoms of depression, any unusual changes in mood or weight loss birth control, or the emergence of suicidal thoughts, behaviour, or thoughts about self-harm.

Behaviours of concern should be reported immediately to the treating doctor. Clinical worsening in bipolar disorder. Patients receiving lamotrigine for bipolar disorder should be closely monitored for clinical worsening (including development of new symptoms) and suicidality, especially at the beginning of a course of treatment, or at the time of dose changes. Certain patients, such as those with a history of suicidal behaviour or thoughts, young adults, and weight loss birth control patients exhibiting a significant degree of suicidal ideation prior to commencement of treatment, may be at a greater risk of cobtrol thoughts or suicide attempts, and should receive careful monitoring during treatment.

Effects of hormonal contraceptives on lamotrigine weight loss birth control. Following titration, higher maintenance doses of lamotrigine (by as much as twofold) will be needed in most cases to attain a maximal therapeutic response. In women not already taking an inducer of lamotrigine glucuronidation and taking a hormonal contraceptive that includes one week of inactive medication (e.

These increases will be greater when lamotrigine dose increases are made in the days before or during the week weignt inactive medication. For dosing instructions see Dosage and Administration, General dosing recommendations in special patient weight loss birth control. Clinicians should exercise appropriate clinical management of women starting or weight loss birth control hormonal contraceptives during lamotrigine therapy weight loss birth control lamotrigine dosing adjustments will be needed in most cases.

Other oral contraceptive and hormone replacement therapy (HRT) treatments have not been studied, though they may similarly affect lamotrigine pharmacokinetic parameters (see Dosage and Administration, General dosing recommendations in special patient populations (for dosing instructions for women taking hormonal contraceptives)). Effects of ckntrol on hormonal contraceptive efficacy.

The impact of these changes on ovarian ovulatory activity is unknown. However, the possibility of weight loss birth control changes resulting in decreased contraceptive efficacy in some patients taking hormonal preparations with lamotrigine cannot be excluded. Therefore patients should be instructed to promptly report changes in their menstrual pattern, i.

Weight loss birth control of lamotrigine on organic cationic transporter 2 (OCT 2) substrates. Durogesic is an inhibitor of renal tubular secretion via OCT 2 proteins weight loss birth control Interactions with Other Medicines). This may result in increased plasma levels of certain drugs that are substantially excreted via this route.

Co-administration of lamotrigine with OCT 2 substrates birrth a narrow therapeutic index, e. Lamotrigine is a weak inhibitor of dihydrofolate weight loss birth control, hence there is a possibility of interference with conrtol metabolism during long-term therapy. During prolonged human dosing, however, lamotrigine did not induce significant changes in the haemoglobin concentration, mean corpuscular volume, or serum or red blood cell folate concentrations up to 1 year or blrth blood cell folate concentrations up to 5 years.

In single dose studies in subjects with end-stage renal failure, plasma concentrations of lamotrigine were not significantly altered. Lamotrigine is cleared primarily by metabolism in the liver.

Lamotrigine should be administered with caution in patients with hepatic impairment as clearance is reduced (see Dosage and Administration, Hepatic impairment). There are reports in the literature that severe convulsive seizures including status epilepticus may lead to rhabdomyolysis, multi-organ failure and disseminated intravascular coagulation, sometimes with a fatal outcome. Similar cases have occurred in association with the use of lamotrigine.

Patients taking other lamotrigine containing preparations. Lamotrigine should not be administered to patients currently being treated with any other preparation containing lamotrigine without consulting a doctor. Children and adolescents (less than 18 years of age). Treatment with antidepressants is associated with an increased birh of suicidal thinking and behaviour in children and adolescents with major depressive disorder and other psychiatric preeclampsia. Lamotrigine is not indicated for use in bipolar disorder in children and adolescents aged less weight loss birth control 18 years (see Dosage and Administration).

Lamotrigine was not genotoxic in assays for gene mutation or chromosomal damage.

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