Comparative Pharmacology
Head-to-head clinical analysis: LAMICTAL CD versus VALPROIC ACID.
Peer-Reviewed Evidence
Head-to-head clinical analysis: LAMICTAL CD versus VALPROIC ACID.
LAMICTAL CD vs VALPROIC ACID
Comparing the clinical profiles, pharmacokinetic behaviors, and safety indices of these two therapeutic agents.
Lamotrigine is a phenyltriazine anticonvulsant that stabilizes neuronal membranes by blocking voltage-sensitive sodium channels and inhibiting the presynaptic release of excitatory neurotransmitters such as glutamate and aspartate.
Increases GABA concentration in the brain by inhibiting GABA transaminase and succinic semialdehyde dehydrogenase; also blocks voltage-gated sodium channels and T-type calcium channels.
Lamotrigine extended-release (LAMICTAL CD) for epilepsy: initial 50 mg orally once daily for 2 weeks, then 100 mg once daily for 2 weeks, then 200 mg once daily for 2 weeks, then 300 mg once daily for 2 weeks, then 400 mg once daily thereafter. For bipolar disorder: initial 25 mg once daily for 2 weeks, then 50 mg once daily for 2 weeks, then 100 mg once daily for 2 weeks, then 200 mg once daily thereafter.
Initial: 10-15 mg/kg/day orally (divided 2-3 times), increase by 5-10 mg/kg/week; maintenance: 30-60 mg/kg/day. IV infusion: same oral dose, rate ≤20 mg/min.
None Documented
None Documented
Clinical Note
moderateValproic acid + Fluticasone propionate
"The risk or severity of adverse effects can be increased when Valproic acid is combined with Fluticasone propionate."
Clinical Note
moderateValproic acid + Sulfisoxazole
"The metabolism of Sulfisoxazole can be decreased when combined with Valproic acid."
Clinical Note
moderateValproic acid + Cyclosporine
"The metabolism of Cyclosporine can be decreased when combined with Valproic acid."
Clinical Note
moderateValproic acid + Fluconazole
Terminal elimination half-life in adults is approximately 25.4 hours (range 14-50 hours) in healthy volunteers; reduced to 14.5 hours (range 12-20) with enzyme-inducing antiepileptics (e.g., carbamazepine, phenytoin), increased to 59 hours (range 30-90) with valproate, and prolonged in renal impairment.
Terminal elimination half-life is 9–16 hours in adults; shorter in children (6–9 hours) and longer in neonates (20–30 hours), elderly, or hepatic impairment (up to 18 hours).
Lamotrigine is primarily eliminated by hepatic metabolism, with approximately 94% of the dose excreted in urine as glucuronide conjugates (10% as unchanged drug) and 2% in feces.
Primarily hepatic metabolism (>95%), with less than 3% excreted unchanged in urine. Minor fecal excretion (~5%).
Category C
Category D/X
Anticonvulsant
Anticonvulsant
"The metabolism of Fluconazole can be decreased when combined with Valproic acid."