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Dilantin vs Lamictal
Introduction
For patients suffering from epilepsy or certain types of seizure disorders, specific drugs that affect the balance between excitation and inhibition in the brain can help manage and reduce the frequency of seizures. Dilantin (Phenytoin) and Lamictal (Lamotrigine) are two such medications often prescribed for these conditions. Both influence electrical activity in neurons but through different mechanisms.
Dilantin works by stabilizing neuronal membranes throughout the central nervous system, thereby reducing seizures by decreasing influxes of sodium ions during action potentials. On the other hand, Lamictal primarily inhibits voltage-sensitive sodium channels which dampen neuron firing, but also acts on calcium channels to a lesser extent.
Both have anti-epileptic effects in patients with seizure disorders; however, they each come with their own set of side-effects and interactions that need to be taken into consideration when choosing appropriate treatment.
Dilantin vs Lamictal Side By Side
| Attribute | Dilantin | Lamictal |
|---|---|---|
| Brand Name | Dilantin | Lamictal |
| Contraindications | Worsening of seizure disorders, certain medications like oral contraceptives, blood thinners, certain antibiotics and antifungals, Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). | Worsening of seizure disorders, severe skin reactions like Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). |
| Cost | Brand-name: Around $600 for 60 tablets of 100 mg. Generic: Between $0.15 and $0.45 per day. | Brand-name: Around $230 for 30 tablets of 25 mg. Generic: As low as about $0.17 per day. |
| Generic Name | Phenytoin | Lamotrigine |
| Most Serious Side Effect | Liver problems, low blood cell counts, signs of an allergic reaction. | Severe skin reactions including rash, serious immune system reaction involving multiple organs. |
| Severe Drug Interactions | Oral contraceptives, blood thinners, certain antibiotics and antifungals. | Not specified in the provided text, but similar caution as with other antiepileptic drugs regarding potential interactions. |
| Typical Dose | 100–600 mg/day, with a general effective dose of 300 mg/day. | Starting at 25 mg/day, up to 100 mg/day divided into two doses, with a maximum of 400 mg/day. |
What is Dilantin?
Phenytoin (the generic name for Dilantin) was one of the first drugs developed to control seizures in patients with epilepsy, which marked a significant advancement over the initial antiepileptic drugs. Phenytoin was first approved by the FDA in 1938. Dilantin works by slowing down impulses in the brain that cause seizures. It is prescribed for controlling various types of epileptic convulsions and seizures. However, it does not cure epilepsy and only helps to keep symptoms under control.
On the other hand, Lamotrigine (Lamictal) is a newer medication used primarily for treating certain types of seizures but has also been found effective as a mood stabilizer in bipolar disorder management. Lamictal slows down electrical activity within neurons, thus reducing seizure frequency and intensity while also regulating mood swings seen in bipolar disorder.
While both medications have valid uses, they differ significantly in their side effects profile. Dilantin may cause problems such as gum disease or bone density loss upon long-term use whereas Lamictal could potentially lead to skin rash which can be severe at times.
What conditions is Dilantin approved to treat?
Dilantin and Lamictal are both approved for the treatment of various types of seizures:
- Dilantin is primarily used to control generalized tonic-clonic (grand mal) seizures, complex partial (psychomotor, temporal lobe) seizures, and prevention of seizures during or following neurosurgery.
- Lamictal is indicated for the treatment of certain types of epileptic conditions such as primary generalized tonic-clonic seizures, partial-onset seizures, Lennox-Gastaut syndrome in pediatric patients as young as 2 years old. It's also used for maintenance treatment in bipolar disorder to delay the occurrence of mood episodes.
How does Dilantin help with these illnesses?
Dilantin, also known as phenytoin, aids in controlling seizures by reducing the electrical conductivity in neurons of the brain. It does this by stabilizing sodium channels when they are in an inactive state, therefore decreasing neuron excitability and preventing rapid, uncontrollable firing associated with seizures. Sodium is a key player in nerve conduction and any disruption to its normal flow can affect neuronal activity significantly. People with epilepsy often have abnormally high neural activities which lead to seizures. By decreasing such abnormal electrical activity, Dilantin helps prevent or control seizures.
On the other hand, Lamictal or lamotrigine works similarly but acts on different channels—sodium and calcium channels—to stabilize mood and reduce seizure occurrence. Like Dilantin it also decreases excessive electrical brain activity; however, it has additional effects on serotonin levels thereby having further benefits for depression management especially for individuals with bipolar disorder.
What is Lamictal?
Lamictal, the brand name for lamotrigine, is an anticonvulsant medication that acts on voltage-sensitive sodium channels to stabilize neuronal membranes and inhibit glutamate release. This action inhibits seizure activity and mood instability in conditions like epilepsy and bipolar disorder. FDA approved Lamictal in 1994. Unlike Dilantin (phenytoin), another antiepileptic drug which also works by blocking sodium channels, Lamictal does not require regular blood monitoring due to its more predictable pharmacokinetics. Unique from other medications in its class, Lamictal's side-effect profile is generally well-tolerated; it doesn't commonly cause sedation or weight gain - frequent complaints with other similar drugs such as Dilantin. The efficacy of lamotrigine in managing seizures and stabilizing moods can be particularly beneficial for patients who do not respond adequately or tolerate "typical" antiepileptic or mood-stabilizing drugs such as phenytoin.
What conditions is Lamictal approved to treat?
Lamictal is a prescription medication that's widely used for the management of:
- Epilepsy: It helps to prevent and control seizures in both adults and children.
- Bipolar disorder: Specifically, it's used to delay mood episodes such as depression, mania or hypomania in adults with bipolar disorder.
How does Lamictal help with these illnesses?
Lamictal, similar to Dilantin, is used in the treatment of epilepsy and bipolar disorder. It works by stabilizing electrical activity in the brain and modifying the release of excitatory neurotransmitters which are involved in nerve signalling. This can prevent seizures and delay mood episodes in patients with bipolar disorder. Lamictal affects both sodium channels and calcium channels, whereas Dilantin primarily acts on sodium channels. Furthermore, because its mechanism allows it to impact a broader range of neurotransmitters such as glutamate and aspartate, Lamictal may also be prescribed when a patient does not respond well to other antiepileptic drugs like Dilantin or could be combined with them for additive effects.
How effective are both Dilantin and Lamictal?
Both phenytoin (Dilantin) and lamotrigine (Lamictal) have established histories of success in treating seizure disorders. They were approved by the FDA several decades apart, with Dilantin gaining approval in 1953 and Lamictal in 1994. The two drugs act on different cellular targets: Dilantin reduces sodium influx into neurons to inhibit repetitive firing, while Lamictal blocks voltage-gated sodium channels as well as calcium channels.
The effectiveness of both antiepileptic drugs has been studied extensively; however, a direct comparison shows varying results depending on the type of epilepsy treated. A randomized controlled trial conducted in 2007 found that Lamictal is more effective than Dilantin for controlling seizures among patients with localization-related epilepsy but not for those with generalized or unclassified epilepsy.
A systematic review published by the Cochrane Collaboration summarized studies comparing these two medications' efficacy and tolerability among adults with newly diagnosed epilepsy. It suggested that people taking Lamictal are less likely to stop medication due to side effects compared to those using Dilantin which may suggest better overall tolerance.
Nonetheless, it's important to note that individual response varies greatly, prompting clinicians often opt for patient-specific treatment strategies rather than one-size-fits-all approaches when managing seizure disorders. As such, choice between these medications is typically based on factors like specific diagnosis, comorbidities, potential drug-drug interactions and other personal considerations such as pregnancy planning or bone health.
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At what dose is Dilantin typically prescribed?
Oral dosages of Dilantin typically range from 100–600 mg/day, though studies suggest that a daily dosage of 300 mg is generally effective for most patients with seizure disorders. Children and adolescents may be started on a lower dose tailored to their weight (5mg/kg/day). The dosage can be adjusted after a few weeks if there is no response. The maximum dosage should not exceed 600 mg/day in any case.
In contrast, Lamictal oral dosages range between 25-400 mg/day for adults depending on the condition being treated and the presence of other concurrent anti-seizure medications. In children, the starting dose can be as low as 0.15mg/kg and increased slowly over several weeks to minimize side effects. It's important to keep in mind that abrupt discontinuation or rapid increase of Lamictal doses can lead to serious health implications including severe rash or an increase in seizures.
At what dose is Lamictal typically prescribed?
Lamictal treatment is typically initiated at a dosage of 25 mg/day. The dose can then be progressively increased weekly, up to 100 mg/day divided into two doses, spaced 12 hours apart. If necessary, the maximum dose can reach up to 400 mg/day divided into two doses of 200 mg and spaced out every 12 hours. This may be considered if there is no response or inadequate control over seizures at lower dosages after a few weeks. However, any increase in dosage should always be done under careful medical supervision due to the risk of serious skin reactions.
What are the most common side effects for Dilantin?
Common side effects of Dilantin can include:
- Nervousness
- Insomnia or somnolence (sleepiness/drowsiness)
- Ataxia (a lack of muscle control during voluntary movements)
- Involuntary eye movement
- Slurred speech, confusion, dizziness
- Nausea, vomiting
- Constipation
- Abnormal growth of hair on the body
- Gingival hyperplasia (overgrowth of the gums)
On the other hand, Lamictal might cause:
- Dizziness or drowsiness
- Headache
- Double vision
- Tremor
- Rash (serious skin reaction is a potential risk)
- Nausea and vomiting.
Both drugs have unique side effect profiles and should be chosen based on individual patient needs under medical supervision.
Are there any potential serious side effects for Dilantin?
While both Dilantin and Lamictal are used in the treatment of seizures, they do have potential side effects which users should be aware of.
For Dilantin, these can include:
- Unusual mood changes or thoughts about self-harm
- Signs of an allergic reaction such as hives; difficulty breathing; swelling in your face, lips or throat
- Vision problems like blurred vision, double vision or involuntary eye movements
- Rapid heartbeat, chest fluttering, shortness of breath and feeling faint
- Low blood cell counts - fever, swollen glands, painful mouth sores (indicating a weak immune system)
- Liver problems - loss of appetite leading to severe weight loss and yellowing eyes/skin (jaundice)
Meanwhile for Lamictal:
- Increased suicidal thoughts or actions
- Severe skin reactions including rash that might lead to hospitalization if not addressed promptly. This could cause blistering peeling skin accompanied by high fever.
- Eye changes like double vision or blurriness. -Increased heart rate -Low sodium levels in the body causing symptoms such as headache confusion slurred speech severe weakness vomiting loss coordination unsteady feelings. -Severe nervous system reaction where you might feel very stiff muscles high fever sweating confusion fast uneven heartbeats tremors feeling-like-you-might-pass-out sensation.
Overall it is essential that any adverse reactions are reported to your healthcare provider immediately.
What are the most common side effects for Lamictal?
Lamictal, like Dilantin, is used to control seizures in people with epilepsy. However, the side effects can differ. Some of the potential side effects of Lamictal include:
- Headache or dizziness
- Sleep problems (insomnia)
- Nausea, vomiting, stomach pain
- Dry mouth and sore throat
- Blurred vision
- Tiredness or fatigue
- Rash (note: a severe rash may be a sign of a serious reaction requiring immediate medical attention)
- Anxiety and nervousness -Tremors -Unusual weight loss or gain.
It's crucial that patients discuss all potential side effects with their healthcare provider before starting new medication.
Are there any potential serious side effects for Lamictal?
While Lamictal is generally well-tolerated, it's important to be aware of potential side effects, including:
- Signs of allergic reactions: skin rash (which could be severe and potentially life-threatening), fever, swollen glands that last for a long time
- Serious immune system reaction involving multiple organs such as the liver or kidney. Symptoms may include fever, rash, fatigue, loss of appetite, yellowing of your skin or the whites of your eyes (jaundice), dark urine coloration
- Mood changes or new depression symptoms: thoughts about suicide or dying; attempts to commit suicide; worsening depression; any unusual changes in mood or behavior
- Visual disturbances like double vision or blurred vision
- Unexpected muscle pain and weakness
- Uncontrollable eye movements
If you experience any of these symptoms while taking Lamictal, contact your healthcare provider right away.
Contraindications for Dilantin and Lamictal?
Both Dilantin and Lamictal, along with most other anticonvulsant medications, may worsen symptoms of seizure disorders in some people. If you notice your seizures worsening or an increase in frequency or severity, please seek immediate medical attention.
Neither Dilantin nor Lamictal should be taken if you are taking certain other medication such as oral contraceptives, blood thinners, or certain antibiotics and antifungals. Always tell your physician which medications you are taking; these will require a period of careful monitoring to prevent dangerous interactions with Dilantin and Lamictal.
Furthermore, both drugs can have severe effects on the skin causing conditions like Stevens-Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). If signs of a rash appear while using either drug inform your doctor immediately.
Remember that abrupt discontinuation of these types of medication can lead to adverse effects including increased seizures. Therefore it's crucial not to stop using them without consulting your healthcare provider first.
How much do Dilantin and Lamictal cost?
For the brand-name versions of these drugs:
- The price of 60 tablets of Dilantin (100 mg) averages around $600, which works out to approximately $10–20 per day, depending on your dose.
- The price for 30 tablets of Lamictal (25 mg) averages at about $230, working out to roughly $7.67 per day.
If you are in a higher dosage range for Dilantin (i.e., 300 mg/day or higher), then brand-name Lamictal is less expensive on a per-day treatment basis. However, please note that cost should not be the only consideration when determining which medication is right for you.
As with most medications, generic versions offer significant savings:
- Generic phenytoin (equivalent to Dilantin) costs between $0.15 and $0.45 per day based on dosages ranging from 100mg/day up to more typical doses of 300mg/day.
- Generic lamotrigine (equivalent to Lamictal) can cost as low as about $0.17 per day if purchased in larger quantities upfront and does not exceed roughly $.50/day even at higher doses.
Popularity of Dilantin and Lamictal
Phenytoin, sold under the brand name Dilantin among others, is an anti-seizure medication that was estimated to have been prescribed to about 2 million people in the US during 2020. Phenytoin accounted for approximately 5% of all antiepileptic drug prescriptions in the country. Although it has been around since the early 20th century and its use has gradually decreased with time due to newer medications becoming available.
Lamotrigine, commonly known as Lamictal, was prescribed to nearly 8 million people in America during 2020. In comparison to phenytoin, lamotrigine accounts for a larger portion of antiepileptic prescriptions - close to 15%. Furthermore, this medication also serves as a mood stabilizer in bipolar disorder treatment which contributes significantly towards its higher prescription numbers. Over the past decade or so, there's been a steady increase in lamotrigine usage owing largely due to its broader spectrum of application and less severe side effect profile compared with drugs like phenytoin.
Conclusion
Both Dilantin (phenytoin) and Lamictal (lamotrigine) have a long history of use in managing epilepsy, with substantial clinical research demonstrating their effectiveness over placebo treatments. Sometimes, these drugs may be used together to manage difficult or refractory cases of epilepsy but this should only be done under direct supervision by a healthcare professional due to the potential for drug interactions.
Dilantin and Lamictal work in different ways - Dilantin works primarily by blocking sodium channels thereby stabilizing neuronal membranes and reducing seizure activity, while Lamictal also blocks sodium channels but has additional effects on calcium channels. This results in them being suitable for treating different types of seizures.
In terms of primary treatment options, both drugs are considered first-line therapy for certain types of seizures. However, Lamictal is often preferred due to its broader spectrum of efficacy and better side effect profile.
Both medications are available as generics which can save patients money especially those who pay out-of-pocket. It's worth noting that some people may require time to adjust when starting either medication so improvements might not be immediately noticeable.
The side effect profiles for the two drugs are generally similar with common issues including dizziness, headache and nausea. However, it’s important to note that serious skin reactions are more frequently associated with Lamictal than Dilantin. For both medications though, regular follow-ups with your doctor are advised during treatment initiation or dose changes because there could be worsening symptoms that need immediate medical attention.
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Refrences
- Choi, H., & Morrell, M. J. (2003, February). Review of lamotrigine and its clinical applications in epilepsy. Expert Opinion on Pharmacotherapy. Informa Healthcare.http://doi.org/10.1517/14656566.4.2.243
- Malik, S., Arif, H., & Hirsch, L. J. (2006, November). Lamotrigine and its applications in the treatment of epilepsy and other neurological and psychiatric disorders. Expert Review of Neurotherapeutics. Informa UK Limited.http://doi.org/10.1586/14737175.6.11.1609
- Bhagwagar, Z., & Goodwin, G. M. (2005, July). Lamotrigine in the treatment of bipolar disorder. Expert Opinion on Pharmacotherapy. Informa Healthcare.http://doi.org/10.1517/14656566.6.8.1401
- Goldsmith, D. R., Wagstaff, A. J., Ibbotson, T., & Perry, C. M. (2003). Lamotrigine. Drugs. Springer Science and Business Media LLC.http://doi.org/10.2165/00003495-200363190-00009
- Trevathan, E., Kerls, S. P., Hammer, A. E., Vuong, A., & Messenheimer, J. A. (2006, August 1). Lamotrigine Adjunctive Therapy Among Children and Adolescents With Primary Generalized Tonic-Clonic Seizures. Pediatrics. American Academy of Pediatrics (AAP).http://doi.org/10.1542/peds.2006-0148
- Baumann, R. J., Fakhoury, T. A., Kustra, R. P., Vuong, A., Hammer, A. E., & Messenheimer, J. A. (2007, August 28). Conversion to lamotrigine monotherapy from valproate monotherapy in older adolescent patients with epilepsy. Current Medical Research and Opinion. Informa Healthcare.http://doi.org/10.1185/030079907x226320