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Lamictal vs Keppra
Introduction
For patients with epilepsy or other types of seizure disorders, certain drugs that regulate the transmission of signals in the brain can help in reducing the frequency and severity of seizures. Lamictal (lamotrigine) and Keppra (levetiracetam) are two such anti-epileptic drugs commonly prescribed to manage seizures. They each impact different aspects of neuronal activity but both aim to decrease abnormal electrical activity in the brain which triggers seizures. Lamictal is known as a sodium channel blocker, working by delaying electrical activity between neurons thereby preventing seizure onset. Keppra on the other hand works differently; its exact mechanism isn't fully understood but it's thought to influence synaptic neurotransmitter release possibly through binding to SV2A, a glycoprotein found in nerve cells, ultimately helping mitigate seizures.
Lamictal vs Keppra Side By Side
| Attribute | Lamictal | Keppra |
|---|---|---|
| Brand Name | Lamictal | Keppra |
| Contraindications | Should not be taken with or immediately after stopping valproic acid. Risk of severe skin rashes including Stevens-Johnson syndrome. | Abrupt discontinuation could lead to withdrawal seizures. Not specified interactions but caution advised. |
| Cost | For brand name: around $700 for 60 tablets of 100 mg. For generic: between $7 and $20 for 30 tablets of 100mg. | For brand name: about $840 for 60 tablets of 500 mg. For generic: costs range from approximately $.45-$6 per day based on typical dosages. |
| Generic Name | Lamotrigine | Levetiracetam |
| Most Serious Side Effect | Severe skin rash that could be life-threatening. | Changes in mood or behavior including anxiety, depression, and suicidal thoughts. |
| Severe Drug Interactions | Valproic acid can lead to severe skin rashes. | Not specifically mentioned, but generally has fewer drug interactions due to not significantly inducing or inhibiting drug metabolism enzymes. |
| Typical Dose | Starts from 25 mg/day, gradually increasing to a maintenance dose between 100-200 mg/day. | Typically initiated at 500 mg twice daily, can be increased to 1000 mg twice daily. |
What is Lamictal?
Lamotrigine (the generic name for Lamictal) is a mood stabilizer used in the treatment of epilepsy and bipolar disorder. It was first approved by the FDA in 1994. Lamictal works by decreasing abnormal electrical activity in the brain, effectively reducing seizure frequency and improving mood swings. It's prescribed for various forms of epilepsy, including partial seizures and generalized seizures of Lennox-Gastaut syndrome, as well as maintenance treatment of bipolar I disorder to delay the time to occurrence of mood episodes.
On the other hand, Levetiracetam (the generic name for Keppra) is an antiepileptic drug that was approved by the FDA in 1999. Like Lamictal it reduces abnormal excitation in the brain but through a different mechanism: it influences calcium channels and inhibits nerve impulse transmission pathways which aids to prevent seizure activity.
Both drugs have been shown effective at controlling seizures with relatively mild side effects; however, they each have unique potential side effects due to their different mechanisms inside our body. While both medications can cause dizziness or tiredness among others, Lamictal has a rare risk causing severe rash that could be life-threatening whereas Keppra might lead occasionally to changes affecting mood or behavior.
What conditions is Lamictal approved to treat?
Lamictal is approved for the treatment of several neurological conditions:
- Epilepsy: As an adjunctive therapy in patients aged two years and older, or monotherapy in adults and pediatric patients aged 16 years and older with partial seizures or primary generalized tonic-clonic seizures
- Conversion to monotherapy in adults (aged 16 years and older) with partial seizures who are receiving treatment with a single enzyme-inducing antiepileptic drug
- Bipolar disorder: For maintenance treatment of bipolar I disorder to delay the time to occurrence of mood episodes (depression, mania, hypomania, mixed episodes) in adult patients treated for acute mood episodes.
How does Lamictal help with these illnesses?
Lamictal, also known as lamotrigine, works to manage epilepsy by decreasing the release of glutamate in the brain. Glutamate is a neurotransmitter that stimulates nerve cells and plays a key role in causing seizures. Lamictal inhibits sodium channels which results in stabilization of neuronal membranes, preventing the release of glutamate and subsequently reducing excitation. Thus, it helps prevent or reduce the frequency of epileptic seizures.
On the other hand, Keppra (levetiracetam) is another medication used for managing epilepsy but with a different mechanism. It binds to synaptic vesicle protein SV2A found in neurons and modulates intracellular calcium levels thereby affecting neurotransmitter release from these vesicles. By doing so, it can help control seizure activity and stabilize mood among individuals who experience both seizures and mood instability due to their condition.
Choosing between these two medications will depend on individual patient characteristics including specific type of seizure disorder they have, potential side effects tolerance level as well as response to previous antiepileptic drugs.
What is Keppra?
Keppra, known generically as levetiracetam, is an anticonvulsant medication used primarily in the management of epilepsy. It functions by decreasing excessive electrical activity in the brain. Unlike Lamictal (lamotrigine), Keppra does not inhibit voltage-sensitive sodium channels; instead, it binds to a synaptic vesicle protein, SV2A, which likely contributes to its mechanism of action.
This unique mechanism means that the side-effect profile for Keppra can be different from other anti-epileptic drugs like Lamictal. Common side effects may include drowsiness and weakness, but it's less likely to cause severe skin reactions - a risk associated with Lamictal use.
First approved by the FDA in 1999, this medication comes as immediate-release tablets or oral solution and extended-release tablets taken once daily. The efficacy of Keppra has made it a valuable option for patients who do not respond well or are intolerant to other typical antiepileptic drugs such as Lamictal.
What conditions is Keppra approved to treat?
Keppra is a medication that has been approved for the management of:
- Epilepsy, particularly in controlling seizures. It's used as an adjunctive therapy in the treatment of myoclonic seizures in adults and adolescents 12 years of age and older.
- Primary generalized tonic-clonic seizures in adults and children 6 years of age and older with epilepsy.
- Partial onset seizures in adults and children 1 month of age and older with epilepsy.
How does Keppra help with these illnesses?
Levetiracetam, commonly known as Keppra, is a medication that works by affecting the transmission of nerve signals in the brain. It plays an essential role in many neurological processes such as cognition, memory retention and coordination. Just like neurotransmitters play vital roles in mood disorders like depression, abnormal neuronal signaling can lead to seizures. Keppra functions by restoring the balance of neural activity, thereby reducing the occurrence of epileptic seizures. Its action on synaptic vesicle protein SV2A may also contribute to its efficacy as an antiepileptic drug. Since it does not significantly induce or inhibit enzymes responsible for drug metabolism, it has fewer drug interactions compared to other antiepileptics (such as Lamictal), making it a safer option for patients on multiple medications or those who have not responded well to traditional seizure medications.
How effective are both Lamictal and Keppra?
Both lamotrigine (Lamictal) and levetiracetam (Keppra) have proven efficacy in the treatment of epilepsy, with both achieving FDA approval within a few years of each other. They work by different mechanisms - lamotrigine by inhibiting voltage-sensitive sodium channels which suppresses release of glutamate, and levetiracetam through binding to synaptic vesicle proteins thereby affecting neurotransmitter release. Their effectiveness was studied directly in several clinical trials; both drugs demonstrated similar abilities to control seizures and exhibited similar safety profiles.
A 2004 review on lamotrigine indicated that it is effective from the initiation of therapy for reducing seizure frequency in individuals with partial-onset seizures, also showing promise for generalized seizures. Lamotrigine is well-tolerated across various population groups including children and seniors. It has become one of the most widely-used antiepileptic drugs worldwide due to its broad spectrum coverage against multiple types of epileptic conditions.
In contrast, a meta-analysis conducted in 2016 confirmed that levetiracetam demonstrates significant effectiveness compared to placebo in controlling focal onset seizures as well as generalized tonic-clonic seizures. Despite this, it's typically considered as an add-on or second-line therapy after first-line treatments like carbamazepine or valproate fail or aren't tolerated. Levetiracetam has been extensively studied when co-prescribed alongside these first line therapies but data supporting its use as a monotherapy remains somewhat less robust than that for lamotrigine.
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At what dose is Lamictal typically prescribed?
Oral dosages of Lamictal for adults typically start from 25 mg/day, gradually increasing to a maintenance dose between 100-200 mg/day. For children and adolescents, the starting dosage depends on their weight and whether they are taking other medications. The dosage can be increased after a few weeks if there is no adequate response. On the other hand, Keppra's oral dosages range from 500–1500 mg twice daily for adults and adolescents over 12 years old suffering from epilepsy. Dosage adjustments in both cases should only be done under medical supervision with the maximum dose not exceeding 400mg/day for Lamictal and 3000mg twice daily for Keppra.
At what dose is Keppra typically prescribed?
Keppra treatment is typically initiated at a dosage of 500 mg twice daily. The dose can be increased to 1000 mg twice daily, depending on the response and tolerance of the patient. This increase should not occur earlier than one week after starting therapy. Maximum dose for adults is generally limited to 3000 mg per day divided into two doses, if there's no satisfactory response or adverse effects become problematic with lower doses. For children, dosing varies based on weight and should be determined by a healthcare professional.
What are the most common side effects for Lamictal?
Common side effects of Lamictal can include:
- Dizziness, tremors
- Headache
- Insomnia or sleepiness (somnolence)
- Nausea, vomiting, upset stomach (dyspepsia), and diarrhea
- Back pain
- Fever, flu-like symptoms
- Nasopharyngitis (inflammation of the nose and throat)
- Dry mouth
- Blurred or double vision
- Rash
Whereas Keppra might cause:
-Drowsiness/somnolence, weakness/asthenia -Nervousness/anxiety -Loss of appetite(anorexia) -Irritability/mood swings -Dizziness/headache/tremor -Cough/nasopharyngitis/sinusitis, -Diarrhea/nausea/vomiting/indigestion(dyspepsia)
It's important to note that each individual may react differently to these medications, so it is essential to monitor any changes closely and consult your doctor.
Are there any potential serious side effects for Lamictal?
Lamictal and Keppra, both used in the treatment of seizures, can sometimes lead to serious side effects. In rare cases with Lamictal:
- One should be vigilant about increased thoughts of suicide or self-harm.
- Allergic reactions such as hives, difficulty breathing and swelling on the face or throat are infrequent but need immediate medical attention.
- Eye problems like blurred vision, tunnel vision, eye pain or swelling should not be overlooked.
Keppra also has its own share of potential issues:
- It may cause changes in mood or behavior including anxiety, depression and even suicidal thoughts.
- Some people may experience severe muscle weakness leading to loss of coordination which could potentially result in a fall.
- Rarely it might lead to inflammation affecting organs including the liver and kidneys. Symptoms include fever, rash and abnormal blood tests indicating organ dysfunction.
Both drugs have been associated with causing low sodium levels (hyponatremia) in some patients resulting in symptoms like headache, confusion slurred speech etc.
It is important that any new symptoms experienced after starting these medications are reported promptly for correct management by healthcare professionals.
What are the most common side effects for Keppra?
Keppra, while highly effective for managing seizures, does come with its own set of potential side effects. These may include:
- Sleepiness or drowsiness
- Dizziness or weakness
- Infection
- Nasal congestion
- Decreased appetite
- Irritability and aggressive behavior
- Mood swings and other changes in behavior
- Problems with muscle coordination (ataxia) Although these side effects can be concerning, most patients find that they taper off over time as their bodies grow accustomed to the medication. As always, it's important to discuss any concerns you have about potential side effects with your healthcare provider before starting new medications.
Are there any potential serious side effects for Keppra?
While Keppra is generally well-tolerated and effective in managing seizures, it's crucial to be aware of potential side effects. These may include:
- Signs of a serious rash or allergic reaction: hives, fever, swollen glands, mouth sores, itching, joint pain, difficulty breathing or swallowing
- Extreme mood swings or changes in behavior – such as hostility or irritability
- Hallucinations (seeing or hearing things that are not there)
- Changes in mental health - including suicidal thoughts
- Symptoms related to coordination and movement like unsteady walking
- Unusual tiredness If any of these symptoms arise while using Keppra, seek immediate medical attention.
Contraindications for Lamictal and Keppra?
Both Lamictal and Keppra, similar to most other antiepileptic drugs, may increase the risk of suicidal thoughts or behavior in some individuals. If you notice any mood changes, worsening depression, or an increase in suicidal ideation or behavior while on these medications, please seek immediate medical assistance.
Neither Lamictal nor Keppra should be taken if you are using or have recently stopped using valproic acid (a type of seizure medication). Always inform your physician about any current or past medications; Valproic acid can interact with Lamictal leading to severe skin rashes including Stevens-Johnson syndrome which can be life-threatening. On the other hand, abrupt discontinuation of either Lamictal or Keppra could lead to withdrawal seizures so it is important not to stop them without consulting your doctor first.
How much do Lamictal and Keppra cost?
For the brand name versions of these drugs:
- The price for 60 tablets of Lamictal (100 mg) averages around $700, which works out to approximately $23–46/day, depending on your dose.
- The price for 60 tablets of Keppra (500 mg) averages about $840, working out to roughly $28/day.
Thus, if you are in the higher dosage range for Lamictal (i.e., 200 mg/day or higher), then brand-name Keppra is less expensive on a per-day treatment basis. Please note that cost should not be a primary consideration in determining which of these drugs is right for you.
When it comes to generic versions:
- Generic Lamotrigine (the active ingredient in Lamictal) costs significantly less than its branded counterpart. For example, a supply of 30 tablets at 100mg each may be priced between $7 and $20 ($0.23 - $0.67 per day).
- Levetiracetam's pricing varies as well but tends to be lower than branded Keppra with costs ranging from approximately $.15-$2 per tablet based on strength; this translates into daily prices ranging from about $.45-$6 when taking typical dosages of 1g up to potentially even higher amounts like 4g daily.
Popularity of Lamictal and Keppra
Lamotrigine, also known by its brand name Lamictal, is a widely-used anticonvulsant and mood stabilizer. In 2020, approximately 3.8 million prescriptions were filled for lamotrigine in the United States alone. It accounts for about 17% of all anticonvulsant prescriptions. Notably used for patients with epilepsy and bipolar disorder, the use of lamotrigine has been generally increasing over time due to its effectiveness in managing seizures and mood swings.
Levetiracetam or Keppra, another commonly prescribed anticonvulsant medication primarily used to treat epilepsy, had roughly 5 million prescriptions filled in the USA during the same year. This made it account for around 22% of all antiepileptic drug (AED) prescriptions within that period. The prevalence of levetiracetam has also seen an upward trend as healthcare providers continue to see positive results from using this medication to manage epileptic conditions.
Conclusion
Both Lamictal (lamotrigine) and Keppra (levetiracetam) have established records of usage in patients with epilepsy, and are supported by numerous clinical studies indicating their effectiveness over placebo treatments. In some cases, the drugs may be combined for enhanced efficacy, but this is subject to careful consideration by a physician due to potential interactions. Due to their different mechanisms of action -- Lamictal stabilising neuronal membranes through sodium channel inhibition while Keppra binds to synaptic vesicle proteins – they tend to be prescribed under different circumstances.
Lamictal can also serve as a mood stabiliser in bipolar disorder whereas Keppra does not have this indication. Both drugs are available in generic form which represents significant cost savings especially for those paying out-of-pocket.
The side effect profile differs between the two; both are generally well-tolerated but with different sets of common side effects - dizziness, headache and upset stomach for Lamictal; fatigue, drowsiness and weakness for Keppra. For both drugs, patients must closely monitor any changes or worsening conditions when starting treatment or changing doses and should seek medical help if severe reactions occur.
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Refrences
- Contreras-García, I. J., Cárdenas-Rodríguez, N., Romo-Mancillas, A., Bandala, C., Zamudio, S. R., Gómez-Manzo, S., … Pichardo-Macías, L. A. (2022, April 13). Levetiracetam Mechanisms of Action: From Molecules to Systems. Pharmaceuticals. MDPI AG.http://doi.org/10.3390/ph15040475
- 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
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- Leon, A. C., Solomon, D. A., Li, C., Fiedorowicz, J. G., Coryell, W. H., Endicott, J., & Keller, M. B. (2012, March). Antiepileptic Drugs for Bipolar Disorder and the Risk of Suicidal Behavior: A 30-Year Observational Study. American Journal of Psychiatry. American Psychiatric Association Publishing.http://doi.org/10.1176/appi.ajp.2011.11060948
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