LAMICTAL

*Monotherapy of seizures:* Adult & Children above 12 yrs: Initially 25 mg once daily for 14 days, increased to 50 mg once daily for further 14 days, then increased by max 100 mg every 7-14 days; usual maintenance 100-200 mg/day in 2 divided doses (up to 500 mg/day). *Adjunctive therapy of seizures with valproate:* Adult & Children above 12 yrs: Initially 25 mg on alternate days for 14 days then 25 mg once daily for further 14 days, thereafter increased by max 50 mg every 7-14 days; usual maintenance, 100-200 mg/day in 2 divided doses. Children 2-12 yrs: initially 150 mcg/kg once daily for 14 days (those weighing less than 13 kg may receive 2 mg on alternate days for first 14 days) then 300 mcg/kg once daily for further 14 days, thereafter increased by max of 300 mcg/ kg every 7-14 days; usual maintenance 1-5 mg/kg daily in 1-2 divided doses, max 200mg/day. *Adjunctive therapy of seizures with enzyme inducing drugs and without valproate:* Adult & Children above 12 yrs: Initially 50 mg once daily for 14 days then 50 mg twice daily for further 14 days, thereafter increased by max 100 mg every 7-14 days; usual maintenance 200-400 mg/day in 2 divided doses (up to 700 mg/ day). Children 2-12 yrs: initially 300 mcg/kg twice daily for 14 days, then 600 mcg/kg twice daily for further 14 days, thereafter increased by max 1.2 mg/kg every 7-14 days; usual maintenance 5-15 mg/kg daily in 1-2 divided doses, max 400 mg/day. *Adjunctive therapy of seizures without enzyme inducing drugs and without valproate:* Adult & Children above 12 yrs: Initially 25 mg once daily for 14 days, increased to 50 mg once daily for further 14 days, then increased by max 100 mg every 7-14 days; usual maintenance 100-200mg/day in 2 divided doses. Children 2-12 yrs: initially 300 mcg/kg, daily in 1-2 divided doses for 14 days, then 600 mcg/kg daily in 1-2 divided doses for further 14 days, thereafter increased by max 600 mcg/kg every 7-14 days; usual maintenance 1-10 mg/kg daily in 1-2 divided doses; max 200 mg daily. *Monotherapy or adjunctive therapy of bipolar disorder without enzyme inducing drugs without valproate:* Adult: Initially 25 mg once daily for 14 days, then 50 mg daily in 1-2 divided doses for further 14 days, then 100 mg daily in 1-2 divided doses for further 7 days: usual maintenance 200 mg/day in 2 divided doses; max 400 mg/day. *Adjunctive therapy of bipolar disorder with valproate:* Adult & Children above 12 yrs: Initially 25 mg on alternate days for 14 days, then 25 mg once daily for further 14 days, then 50 mg daily in 2 divided doses for further 7 days; usual maintenance 100 mg daily in 1-2 divided doses: max 200 mg daily. *Adjunctive therapy of bipolar disorder with enzyme inducing drugs without valproate:* Adult& Children above 12 yrs: Initially 50 mg once daily for 14 days, then 50 mg twice daily for further 14 days, then 100 mg twice daily for further 7 days, then 150 mg twice daily for further 7 days; usual maintenance 200 mg twice daily. *Monotherapy of typical absence seizures:* Children 2-12 yrs: Initially 300 mcg/kg daily in 1-2 divided doses for 14 days, then 600 mcg/kg daily in 1-2 divided doses for further 14 days, thereafter increased by max 600 mcg/kg every 7-14 days; usual maintenance 1-10 mg/kg daily in 1-2 divided doses (up to 15 mg/kg daily has been required).

Significant hepatic impairment.

Myoclonic seizures (may be exacerbated), Parkinsons disease (may be exacerbated). Monitor hepatic, renal & clotting parameters in patients who develop rash, fever, flu, drowsiness or worsening of seizure control. Withdraw gradually over 2 weeks.

Phenytoin, carbamazepine, phenobarbitone, primidone, sodium valproate.

Aggression, agitation, arthralgia, ataxia, back pain, blurred vision, diarrhoea, diplopia, dizziness, drowsiness, dry mouth, headache, insomnia, nausea, nystagmus, rash, tremor, vomiting, aseptic meningitis, suicidal ideation, skin reactions including Stevens-Johnson syndrome and toxic epidermal necrolysis. Rare: Hallucination, conjunctivitis, anaemia, blood disorders, confusion, exacerbation of Parkinsons disease, hepatic failure, hypersensitivity syndrome, leucopenia, lupus erythematosus-like reactions, movement disorders, pancytopenia, thrombocytopenia, unsteadiness