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Lamictal vs Neurontin
Introduction
Patients dealing with epilepsy or bipolar disorder often require medications that influence the concentration of neurotransmitters in their brain to manage symptoms and stabilize mood fluctuations. Lamictal (Lamotrigine) and Neurontin (Gabapentin) are two such drugs commonly prescribed for these conditions. Both have effects on different neurotransmitters, yet are effective as mood stabilizers in patients with bipolar disorder or as anticonvulsants in those with epilepsy. Lamictal belongs to a class of medicines known as sodium channel blockers, which help reduce the release of excitatory neurotransmitters. On the other hand, Neurontin is primarily categorized as a GABA analogue; it works by mimicking the action of GABA - an inhibitory neurotransmitter, though its exact mechanism remains unclear.
Lamictal vs Neurontin Side By Side
| Attribute | Lamictal | Neurontin |
|---|---|---|
| Brand Name | Lamictal | Neurontin |
| Contraindications | May exacerbate depressive symptoms or trigger suicidal thoughts. Should not be taken with MAOIs. | May exacerbate depressive symptoms or trigger suicidal thoughts. Should not be taken with MAOIs. |
| Cost | Brand name: around $946 for 60 tablets of 100 mg. Generic: as low as $7 for a month supply. | Brand name: around $600 for 90 capsules of 300 mg. Generic: monthly supplies typically costing under $20. |
| Generic Name | Lamotrigine | Gabapentin |
| Most Serious Side Effect | A serious skin reaction that causes fever, sore throat, burning eyes, skin pain followed by a red or purple rash that spreads especially in the face or upper body causing blistering and peeling. | Severe skin reaction with symptoms such as fever, swollen glands accompanied by a red/purple skin rash that spreads causing blistering and peeling. |
| Severe Drug Interactions | MAOIs | MAOIs |
| Typical Dose | Starts from 25 mg/day, maintenance dose between 100–200 mg/day, maximum daily dose should not exceed 400mg. | Begins at 300 mg on the first day, up to 900 mg/day divided into three doses, maximum of 3600mg per day. |
What is Lamictal?
Lamotrigine (the generic name for Lamictal) was a significant advancement in the anticonvulsant class of drugs, similar to how fluoxetine represented a breakthrough in antidepressants. Approved by the FDA in 1994, Lamictal is used to delay mood episodes in adults with bipolar disorder and treat certain types of seizures (epilepsy). It works by restoring the balance of certain natural substances (glutamate) in the brain.
On other hand, Gabapentin (Neurontin's generic name), another drug from the anticonvulsant family, was approved earlier than Lamictal, in 1993. It works differently as it is specifically designed to mimic the body’s naturally occurring GABA neurotransmitter and decrease abnormal excitement in the brain.
While both medications are used for epilepsy treatment and nerve pain management, they have different areas of effectiveness. For instance, Neurontin has been found more effective for peripheral neuropathy or neuralgia pain while Lamictal is often preferred for its mood stabilizing properties. Both medications have side effects but those can vary based on individual health conditions.
What conditions is Lamictal approved to treat?
Lamictal is utilized for the treatment of several neurological and psychiatric conditions:
- Epilepsy, both as monotherapy and adjunctive therapy
- Maintenance treatment for Bipolar I disorder to delay the time to occurrence of mood episodes in patients treated for acute mood episodes with standard therapy
How does Lamictal help with these illnesses?
Lamictal helps to manage seizures and bipolar disorder by decreasing the release of glutamate in the brain. It does this by blocking sodium channels, preventing excessive electrical activity, thus reducing excitability in the brain. Glutamate is a neurotransmitter - a chemical that acts as a messenger in the brain and throughout the body. It plays an important role in learning, memory, neuroplasticity (the ability of neural networks to grow and reorganize), and regulation of synaptic plasticity among other things. Overactivity or excessive amounts can lead to harmful consequences like seizures or mood swings seen in bipolar disorder. Therefore by decreasing glutamate levels, Lamictal reduces seizure frequency and stabilizes mood swings associated with bipolar disorders.
What is Neurontin?
Neurontin is a brand name for gabapentin, an anticonvulsant medication that was first approved by the FDA in 1993. Neurontin increases levels of gamma-aminobutyric acid (GABA) in the brain by reducing its absorption. GABA is a neurotransmitter that inhibits nerve transmission in the brain, and it's thought to affect our moods. Unlike Lamictal, Neurontin does not inhibit voltage-dependent sodium channels. This unique action makes its side-effect profile different from other antiepileptic drugs such as Lamictal. In particular, it does not cause skin rash or impact liver function - common side effects associated with Lamictal usage. Moreover, Neurontin can also be used off-label to treat neuropathic pain and restless leg syndrome which sets it apart from many typical antiepileptic drugs like Lamictal.
What conditions is Neurontin approved to treat?
Neurontin, also known as gabapentin, is an anti-epileptic medication approved by the FDA for treating:
- Seizures: It's used as a monotherapy or adjunctive therapy in patients over 3 years of age with partial seizures.
- Postherpetic Neuralgia (PHN): Neurontin is additionally utilized to manage the nerve pain following a shingles attack in adults.
How does Neurontin help with these illnesses?
Neurontin, also known as gabapentin, is a drug that mimics the structure of neurotransmitters in the brain and affects their release. It acts on gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter that slows down brain activity to induce relaxation and reduce nerve pain. Neurontin increases the synthesis of GABA, thus enhancing its calming effect on the nervous system. This medication is primarily used for treating seizures and neuropathic pain but it's also sometimes prescribed for certain anxiety disorders or insomnia due to its sedative properties. Unlike Lamictal which targets glutamate production (a different pathway implicated in seizure activity), Neurontin does not affect this pathway significantly, making it a useful alternative when patients do not respond well to drugs like Lamictal or can be combined with them for enhanced therapeutic effect.
How effective are both Lamictal and Neurontin?
Both lamotrigine (Lamictal) and gabapentin (Neurontin) have long-standing records as effective treatments for certain types of epilepsy, and they were initially approved by the FDA within a span of three years. These medications work differently; Lamictal is a sodium channel blocker while Neurontin primarily interacts with voltage-gated calcium channels. Therefore, they may be prescribed under different circumstances to manage seizures.
The effectiveness of lamotrigine and gabapentin in controlling epilepsy was directly studied in multiple clinical trials throughout their history. In general, these drugs demonstrate similar efficacy in managing symptoms of specific kinds of epilepsy, showcasing promising safety profiles as well. Studies comparing both drugs didn't show significant differences between patients receiving either medication regarding seizure control.
A 2009 review article indicated that lamotrigine is an effective drug for partial-onset seizures and generalized seizures starting from the first week of treatment without significant side effects compared to other antiepileptic drugs. It's also reported that Lamictal has become one of the most widely prescribed antiepileptic medications worldwide due to its broad spectrum activity against diverse seizure types along with its good tolerability profile even in elderly populations.
An analysis published in 2016 highlighted that gabapentin seems more effective than placebo at treating neuropathic pain - another common use case aside from epileptic disorders - presenting similar efficacy levels to other commonly used options for this condition but often considered after initial-line treatments fail or are not suitable due to contraindications or adverse reactions. Notably, research involving co-prescription alongside primary anti-epileptics shows less robust confirmation on standalone efficacy when compared with lamotrigine data.
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At what dose is Lamictal typically prescribed?
Oral dosages of Lamictal for epilepsy generally start from 25 mg/day and can increase to a maintenance dose between 100–200 mg/day. However, the dosage may be adjusted based on individual responses. Children and adolescents' starting dosage is determined by weight, typically beginning at 0.3 mg/kg/day. If there's no sufficient response or in cases of severe seizures, the dosage can be increased after a few weeks under medical supervision. The maximum daily dose should not exceed 400mg in any case.
At what dose is Neurontin typically prescribed?
Neurontin, also known as Gabapentin, treatment typically begins at a dosage of 300 mg on the first day. The dose can then be increased to 600 mg/day on the second day, divided into two doses spaced about 12 hours apart. From the third day onwards, the daily dosage may be further increased to 900 mg and divided into three doses of 300 mg each with approximately an interval of 8 hours between each dose. If necessary, based on individual patient response and tolerability, your physician may decide to increase your dosage up to a maximum of 3600mg per day split into three separate doses which should not exceed more than1200mg in any single dose.
What are the most common side effects for Lamictal?
Common side effects of Lamictal and Neurontin can vary. For Lamictal, they may include:
- Dizziness
- Headache
- Double vision or blurred vision
- Nausea and vomiting
- Insomnia (difficulty sleeping)
- Lack of coordination (loss of balance)
- Rash
- Dry mouth
- Somnolence (sleepiness/drowsiness)
In contrast, the common side effects for Neurontin are somewhat different:
- Dizziness and drowsiness
- Unsteadiness or loss of coordination
- Memory problems or forgetfulness
- Tremors (unintentional trembling or shaking)
- Swelling in your hands and feet
- Dry mouth
- Anxiety
Always consult with a medical professional if you experience any unusual symptoms while taking these medications.
Are there any potential serious side effects for Lamictal?
Like any medication, Lamictal and Neurontin can cause side effects. While most of these are mild to moderate, some may be more severe:
- Any signs of suicidal thoughts or self-harm
- Signs of an allergic reaction such as hives; difficulty breathing; swelling in your face, lips, tongue, or throat.
- A serious skin reaction that causes fever, sore throat, burning eyes, skin pain followed by a red or purple rash that spreads especially in the face or upper body causing blistering and peeling.
- Changes in vision including blurred vision; eye pain or swelling; seeing halos around lights.
- Heart problems including fast heartbeats - fluttering in your chest - shortness of breath - sudden dizziness (like you might pass out).
- Low sodium levels which might result in headache confusion slurred speech severe weakness vomiting loss of coordination feeling unsteady -Severe nervous system reactions like very stiff muscles high fever sweating confusion fast heartbeats trembling feeling like you might pass out.
If taking either Lamictal or Neurontin and experiencing any symptoms similar to those listed above it's important to seek immediate medical attention.
What are the most common side effects for Neurontin?
Potential side effects of Neurontin (Gabapentin) may include:
- Dizziness, drowsiness
- Dry mouth, sore throat
- Blurred vision
- Nausea, vomiting, stomach pain or upset stomach
- Sleep problems (insomnia)
- Uncontrolled eye movements (nystagmus)
- Headache
- Weight gain rather than weight loss
- Swelling in your hands or feet While these side effects can be common when taking Neurontin, they are not usually severe. If any of these symptoms persist or worsen over time, it is advised to consult with a healthcare professional promptly.
Are there any potential serious side effects for Neurontin?
While Neurontin is generally well-tolerated, there are potential side effects to be aware of. Serious reactions may include:
- An allergic reaction that includes symptoms such as hives, difficulty in breathing or swallowing, swelling of the face or throat
- New or worsened depression and suicidal thoughts especially in younger people within the first few months of treatment
- Severe skin reaction with symptoms such as fever, swollen glands accompanied by a red/purple skin rash that spreads causing blistering and peeling
- Unusual shifts in mood or behavior
- Blurred vision and/or changes to eye movement
- Rapid heart rate; chest pain
- Signs indicating a seizure (convulsions)
If you experience any severe side effects while using Neurontin, it’s important to seek immediate medical attention.
Contraindications for Lamictal and Neurontin?
Just like Wellbutrin and Prozac, both Lamictal and Neurontin - which are used to treat epilepsy and certain types of nerve pain - may exacerbate depressive symptoms or trigger suicidal thoughts in some individuals. If you notice your depression worsening, or if you experience an increase in suicidal ideation, thoughts or behaviors while taking either medication, please seek immediate medical attention.
Neither Lamictal nor Neurontin should be taken if you are currently on certain other medications such as MAOIs (monoamine oxidase inhibitors) due to the risk of serious drug interactions. Always inform your healthcare provider about any medications that you're taking; for example, it's important to know that MAOIs will require a period of about 5 weeks to clear from the system before starting treatment with either Lamictal or Neurontin to avoid potentially dangerous interactions.
How much do Lamictal and Neurontin cost?
For the brand name versions of these drugs:
- The price of 60 tablets of Lamictal (100 mg) averages around $946, which works out to $15.77/day at the lower dosage range and can go up to over $30/day for higher doses.
- The price of 90 capsules of Neurontin (300 mg) averages about $600, working out to approximately $6.67/day.
Thus, if you are in the higher dosage range for Lamictal (i.e., 200 mg/day or higher), then brand-name Neurontin 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.
For the generic versions, costs are significantly lower:
-
Generic lamotrigine (Lamictal's active ingredient) ranges from as low as $7 for a month supply at some pharmacies - around only about 20 cents per day even at common therapeutic dosages like 200mg daily.
-
Gabapentin (Neurontin’s active ingredient) shows similar dramatic savings when comparing brand vs generic - with monthly supplies typically costing under $20 without insurance coverage – so often less than a dollar per day even at typical doses like 900mg daily.
Remember that prices may vary by pharmacy and region, so check your local prices carefully!
Popularity of Lamictal and Neurontin
Lamotrigine, commonly known by the brand name Lamictal, was estimated to have been prescribed to about 3.5 million people in the US in 2020. Lamotrigine accounted for just over 10% of anticonvulsant prescriptions in the US. As a mood stabilizer and an antiepileptic drug, lamotrigine is used primarily for treating epilepsy and bipolar disorder.
On the other hand, Gabapentin including brand versions such as Neurontin was prescribed to about 8 million people in the USA in 2020. In terms of overall anticonvulsant prescriptions, gabapentin accounts for around 22%. It has versatile uses such as relief from nerve pain and helping control seizures in adults with epilepsy.
The prevalence of both drugs has seen a steady increase over time due to their reliable efficacy profiles and expanded applications beyond seizure disorders—lamotrigine also being used as a mood stabilizer while gabapentin employed often for neuropathic pain management.
Conclusion
Both Lamictal (lamotrigine) and Neurontin (gabapentin) have well-established records of usage in patients with epilepsy, and are supported by numerous clinical trials indicating that they are more effective than placebo treatments. In some cases, the drugs may be used together under careful physician supervision as both can lead to increased central nervous system depression when combined.
Due to their different mechanisms of action, with Lamictal acting primarily on sodium channels stabilizing neuronal membranes and inhibiting glutamate release, while Neurontin works primarily by binding to calcium channels reducing neurotransmitter release; they tend to be prescribed under different circumstances. Lamictal is considered a first-line treatment for certain types of seizures and bipolar disorder whereas Neurontin would usually be considered as an adjuvant therapy (addition) or in patients suffering from neuropathic pain.
Both drugs are available in generic form which represents significant cost savings especially for patients who must pay out of pocket. Both Lamictal and Neurontin may require a titration period meaning that full effects may not be noticeable right away.
The side effect profile is similar between the two drugs, both being generally well-tolerated but there can be differences such as rash being more common with lamotrigine whilst somnolence tends to occur more frequently with gabapentin. For both medications, it's important that patients closely monitor their condition especially when starting treatment or adjusting doses. If they notice worsening symptoms or new onset symptoms like mood changes or suicidal thoughts then immediate medical help should be sought.
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Refrences
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- Prica, C., Hascoet, M., & Bourin, M. (2008, August). Antidepressant-like effect of lamotrigine is reversed by veratrine: A possible role of sodium channels in bipolar depression. Behavioural Brain Research. Elsevier BV.http://doi.org/10.1016/j.bbr.2008.03.007
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