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Lamictal vs Vimpat
Introduction
For patients with epilepsy or other seizure-inducing conditions, certain drugs that alter the activity of neurotransmitters in the brain can help to manage symptoms and reduce occurrence of seizures. Lamictal and Vimpat are two such drugs commonly prescribed for these conditions. While both aim to achieve a similar outcome, they work in different ways within the body's biochemistry. Lamictal, generically known as lamotrigine, belongs to a class of antiepileptic medications called sodium channel blockers which inhibit voltage-sensitive sodium channels, stabilizing neuronal membranes and subsequently reducing seizure activity. On the other hand, Vimpat (lacosamide), is primarily considered an enhancer of slow inactivation of sodium channels - it selectively enhances this process without affecting normal neuron excitability. Both contribute significantly towards maintaining stable neurological function.
Lamictal vs Vimpat Side By Side
| Attribute | Lamictal | Vimpat |
|---|---|---|
| Brand Name | Lamictal | Vimpat |
| Contraindications | Worsening symptoms of depression, suicidal ideation. Should not be taken with Sodium Oxybate. | Worsening symptoms of depression, suicidal ideation. Should not be taken with Sodium Oxybate. |
| Cost | For brand-name, around $950 for 60 tablets (100mg). For generic lamotrigine, starts from about $8-$15 for thirty tablets. | For brand-name, around $1,300 for 60 tablets (200mg). For generic lacosamide, starts from roughly $230-$380 for thirty tablets. |
| Generic Name | Lamotrigine | Lacosamide |
| Most Serious Side Effect | Severe skin reaction – fever, sore throat, swelling in your face or tongue; burning in your eyes; skin pain followed by a red or purple skin rash that spreads and causes blistering and peeling. | Signs of an allergic reaction: hives; difficulty breathing or swallowing; swelling of your face, lips, tongue, or throat. |
| Severe Drug Interactions | Sodium Oxybate | Sodium Oxybate |
| Typical Dose | Starts from 25 mg/day, maximum recommended dose is 400 mg/day. | Begins at 50 mg twice daily, can be increased to a total of 400 mg/day. |
What is Lamictal?
Lamotrigine (the generic name for Lamictal) is a major development in the class of antiepileptic drugs, often utilized as a mood stabilizer in adults. It gained FDA approval in 1994 and has since been prescribed to patients suffering from epilepsy or bipolar disorder. The function of Lamictal involves decreasing abnormal excitement present within the brain, thus effectively controlling seizures and treating acute depressive episodes linked with bipolar disorder.
In comparison, Lacosamide (known by its brand name Vimpat), approved later by the FDA in 2008, is another valuable addition to antiepileptic medications specifically aimed at partial-onset seizure treatment. Its mechanism works differently by slowly increasing the electrical activity in damaged nerves rather than decreasing overall excitement like Lamotrigine.
Both medications are important advancements; however, their effectiveness varies depending on individual patient needs and medical histories. For instance, while Lamictal can be used as an effective mood stabilizer besides controlling seizures making it more suitable for those with concurrent bipolar disorders, Vimpat might be preferred due to its specific targeting of localized nerve damage associated with partial-onset seizures.
What conditions is Lamictal approved to treat?
Lamictal and Vimpat are approved for the treatment of different variations of epileptic seizures:
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Lamictal is used in the management of Epilepsy, both as monotherapy or adjunctive therapy for partial seizures, primary generalized tonic-clonic seizures, and seizure associated with Lennox-Gastaut syndrome. It's also used to delay mood episodes in adults with bipolar disorder.
-
Vimpat on the other hand is primarily used as an add-on medication to treat partial-onset seizures in people 4 years old and older or primary generalized tonic-clonic seizures in people 4 years old and older. It's also used to treat seizures associated with Lennox-Gastaut syndrome in individuals 2 years old and above.
How does Lamictal help with these illnesses?
Lamictal helps to manage seizures and bipolar disorder by decreasing excessive electrical activity in the brain. It does this through inhibition of voltage-sensitive sodium channels, which are crucial for neuron signaling, helping to stabilize the neuronal membrane and making it less likely for neurons to fire excessively or at inappropriate times. Excessive or abnormal neuronal firing is associated with conditions like epilepsy and mood disorders such as bipolar disorder. As these neurons also play an important role in cognition, mood stability, alertness among other things; excess activity can lead to seizure episodes or mood instability seen in patients with bipolar disorder. Therefore, by reducing this excessive electrical activity, Lamictal can limit the frequency of seizures and help patients better manage their condition while stabilizing their moods.
What is Vimpat?
Vimpat is a brand name for the drug lacosamide, which is an anticonvulsant medication used to treat epilepsy. It works by enhancing slow inactivation of voltage-gated sodium channels and interacting with collapsing response mediator protein-2 (CRMP-2), thus reducing neuron excitability. Vimpat was first approved by the FDA in 2008, making it relatively new compared to other anti-epileptic drugs. Unlike Lamictal, its mechanism doesn't involve inhibiting voltage-dependent sodium channels directly or increasing the synthesis or release of GABA. This different mode of action means that Vimpat's side-effect profile may vary from those typically seen with older antiepileptics like Lamictal; for instance, it may cause less severe mood changes and skin rashes but might have slightly higher risks for dizziness and headache. The unique effects of lacosamide on neuronal hyperexcitability can be beneficial especially in patients who do not respond well to “typical” antiepileptic drugs such as Lamictal.
What conditions is Vimpat approved to treat?
Vimpat is approved for the treatment of partial-onset seizures in patients with epilepsy. It can be used as a stand-alone medication or as an adjunctive therapy alongside other antiepileptic drugs. Some key uses of Vimpat are:
- Partial Onset Seizures (POS) in adults and children 4 years old and above
- Primary Generalized Tonic-Clonic Seizures (PGTCS) in adults and adolescents from 12 years old onwards
How does Vimpat help with these illnesses?
Vimpat, or lacosamide, is an antiepileptic medication utilized for the management of partial-onset seizures. It operates by enhancing the slow inactivation of voltage-gated sodium channels within the brain, thereby reducing abnormal electrical activity and minimizing seizure occurrences. This action makes it a useful addition to treatment regimens when patients do not respond adequately to other conventional antiepileptic drugs like Lamictal. Despite sharing similar therapeutic goals with Lamictal, Vimpat's unique impact on sodium channels offers a distinct mechanism of action that could prove beneficial for certain individuals experiencing epilepsy. The selection between these medications should be individualized based on each patient’s specific needs and responses to therapy.
How effective are both Lamictal and Vimpat?
Both lamotrigine (Lamictal) and lacosamide (Vimpat) have established histories of success in treating patients with certain types of epilepsy, and they were approved by the FDA approximately a decade apart. Since they act on different targets within the nervous system, they may be prescribed under different circumstances. The effectiveness of lamotrigine and lacosamide in controlling seizures was directly studied in several clinical trials; both drugs exhibited similar efficacy for managing symptoms as well as promising safety profiles.
A 2004 review showed that lamotrigine is effective in controlling partial-onset seizures from the first week of treatment, has a favorable side effect profile compared to other antiepileptic drugs such as carbamazepine or phenytoin, and is well-tolerated even long term. Lamotrigine also appears to have mood-stabilizing properties which makes it an important therapeutic option for people with bipolar disorder.
On the other hand, a 2016 meta-analysis indicated that lacosamide seems to be more effective than placebo at reducing seizure frequency but had comparable efficacy when matched against other common antiepileptic medications. Lacosamide's unique mechanism allows it to work alongside traditional sodium channel blockers effectively without significantly increasing adverse effects making it optimal for patients who need additional seizure control beyond what their current regimen provides them.
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At what dose is Lamictal typically prescribed?
Oral dosages of Lamictal start from 25 mg/day, and it's typically used for treating bipolar disorder in adults. On the other hand, Vimpat is usually given at a starting dose of 50 mg twice daily for controlling seizures in adults with epilepsy. For children and adolescents under the age of 18, these medications should only be started under medical supervision. With either medication, dosage may be adjusted over several weeks based on response and tolerability. The maximum recommended dose for Lamictal is 400 mg/day while that for Vimpat should not exceed 300 mg twice daily.
At what dose is Vimpat typically prescribed?
Vimpat treatment typically begins at a dose of 50 mg twice daily. The dosage can then be increased to 100 mg taken twice daily, spaced approximately 12 hours apart. If necessary and under the supervision of a healthcare professional, the maximum dose can be escalated to a total of 400 mg/day divided into two doses of 200 mg each, with an interval of around 12 hours in between them. This higher dose may be considered if there is no adequate response to Vimpat at a total daily dosage of 200mg after sufficient time has passed for assessment.
What are the most common side effects for Lamictal?
Common side effects of Lamictal can include:
- Headache
- Dizziness or drowsiness
- Blurred or double vision
- Tremors (unintentional trembling or shaking)
- Sleep problems (insomnia)
- Nausea, vomiting, stomach pain
- Dry mouth
- Changes in menstrual periods
- Back pain.
On the other hand, Vimpat might cause:
- Dizziness and headache
- Double vision
- Nausea and vomiting
- Tiredness/fatigue
- Problems with balance or muscle coordination (ataxia)
- Tremors (shakiness)
- Memory problems.
Both medicines may also cause more severe reactions like rash indicating a possible serious reaction. Therefore, if you experience any unusual symptoms while taking either drug, it is important to contact your healthcare provider immediately.
Are there any potential serious side effects for Lamictal?
While both Lamictal and Vimpat are used to control seizures, they do have potential side effects that require immediate medical attention.
For Lamictal, these include:
- Thoughts about suicide or self-harm
- Signs of a severe allergic reaction such as hives; difficulty breathing; swelling in your face, lips, tongue or throat
- A severe skin reaction – fever, sore throat, swelling in your face or tongue; burning sensation in the eyes; skin pain accompanied by a red/purple rash that spreads (especially on the face and upper body) causing blistering and peeling
Vimpat also has its own serious side effects which can include:
- Similar suicidal thoughts or actions
- Unusual changes in mood or behavior
- Feeling short of breath even with mild exertion; feeling like you might pass out
- Rapid heartbeats
- Easy bruising
- Symptoms associated with low sodium levels - headache, confusion, slurred speech, severe weakness
Both medications may cause neurological reactions such as stiff muscles high fever sweating fast uneven heartbeats tremors loss of coordination nausea vomiting diarrhea.
If you experience any of these symptoms while taking either medication stop using it immediately and seek emergency medical help.
What are the most common side effects for Vimpat?
While considering Vimpat as a medication, it's essential to be aware of the potential side effects. They can include:
- Dizziness or spinning sensation
- Headache
- Blurred/double vision
- Nausea and vomiting
- Fatigue, weakness or lack of energy
- Problems with balance or coordination
- Tremors
- Memory problems This drug might also cause irregular heart rhythms which may manifest as a rapid heartbeat. It's less common but possible for patients to experience weight loss, confusion, agitation or hostility while on this medication. In some rare instances, an individual could have increased urination and skin rashes due to Vimpat. If you notice any severe symptoms such as mood changes/anxiety/nervousness or muscle/joint pain, consult your healthcare provider immediately.
Are there any potential serious side effects for Vimpat?
While Vimpat is typically well-tolerated, it is important to recognize that serious side effects can occur. These may include:
- Signs of an allergic reaction: hives; difficulty breathing or swallowing; swelling of your face, lips, tongue, or throat
- Unusual changes in mood or behavior such as new or worsening depression, anxiety, aggression, panic attacks
- Increased risk of suicidal thoughts or actions
- A change in seizure pattern (more frequent seizures)
- Dizziness and problems with balance and coordination
- Fainting spells caused by a slow heart rate
- Severe skin reactions including Stevens-Johnson syndrome characterized by fever sore mouth/throat with red/purple skin rash that blisters and peels
If you notice any severe symptoms while using Vimpat immediately contact medical professionals.
Contraindications for Lamictal and Vimpat?
Both Lamictal and Vimpat, along with most other anticonvulsant medications, may worsen symptoms of depression in some people. If you notice your depression worsening, or an increase in suicidal ideation, thoughts, or behavior while taking these drugs, please seek immediate medical attention.
Neither Lamictal nor Vimpat should be taken if you are taking certain specific drug classes such as Sodium Oxybate (used for sleep disorders) due to a risk of severe drowsiness and breathing problems. Always inform your physician about all the medications you are currently taking; they can then monitor potential interactions and adjust the dosages accordingly. It's also essential to consider that both these drugs need time to leave your system completely - typically around 5-6 days for Lamictal and 30 hours for Vimpat - so any new medication regimen needs to take this into account to prevent harmful interactions.
How much do Lamictal and Vimpat cost?
For the brand-name versions:
- The price of 60 tablets of Lamictal (100mg) averages around $950, which works out to $16–31/day when taken at a dosage range between 50 mg and 400 mg per day.
- The price for Vimpat is higher, with an average cost of $1,300 for 60 tablets (200mg), working out to more than $20/day even on its lower dosage recommendation.
Thus, if you are in the higher dosage range for Lamictal (i.e., 300 mg/day or higher), then brand-name Vimpat could be more expensive on a per-day treatment basis. However, cost should not be your primary consideration in determining which drug is right for you; efficacy and side effects also play significant roles.
For generic versions - lamotrigine (Lamictal) and lacosamide (Vimpat):
- A pack size of thirty lamotrigine tablets starts from as low as about $8-$15 making it approximately $0.25-$0.50 per day depending upon the dose.
- Lacosamide has a much higher comparative price starting from roughly $230-$380 for thirty tablets resulting in about $7.5-$13 per day again depending upon the prescribed daily dose.
As always remember that while generics tend to be less costly they are usually just as effective as their brand name counterparts.
Popularity of Lamictal and Vimpat
Lamotrigine, available under the brand name Lamictal among others, was estimated to have been prescribed to around 6.2 million people in the US in 2020. Lamotrigine accounted for just over 15% of antiepileptic drug prescriptions in the US. However, it has a unique profile as a mood stabilizer that can be beneficial for those with bipolar disorder and is also used off-label for depression treatment. Since its introduction in the late 90s, lamotrigine's popularity has seen steady growth.
On the other hand, Lacosamide (brand name Vimpat) is a newer medication introduced after lamotrigine and was used by approximately two million patients across America in 2020. It accounts for nearly six percent of all antiepileptic prescriptions within that year. Unlike lamotrigine which has broader use cases including bipolar disorder management, lacosamide is strictly marketed as an add-on therapy for partial-onset seizures due to epilepsy. Over time we have observed an increase in Vimpat prescription rates likely due to its effectiveness and tolerability.
Conclusion
Both Lamictal (lamotrigine) and Vimpat (lacosamide) are antiepileptic drugs with long-standing records of usage in patients with epilepsy. They both have been found to be more effective than placebo treatments through clinical studies and meta-analysis. However, their applications can vary depending on the patient's specific condition due to their different mechanisms of action. Lamictal primarily works by blocking voltage-sensitive sodium channels, which help reduce the release of glutamate in the brain - a neurotransmitter that triggers seizures when excessive amounts are present.
Vimpat operates by enhancing slow inactivation of sodium channels, contributing to stabilization of hyper-excitable neuronal membranes and inhibition of repetitive neuronal firing.
Lamictal is often considered a first-line treatment option for certain types of seizures such as absence seizures or generalized tonic-clonic seizures among others. On the other hand, Vimpat is usually utilized as an additional therapy for partial-onset seizures or primary generalized tonic-clonic seizures when first-line therapies aren't successful.
Generic versions exist for both medications offering significant cost savings especially if one has to pay out-of-pocket expenses. Both may require an adjustment period where effects might not be immediately noticeable upon starting treatment.
Side effect profiles between these two drugs show similarities but also differences: side effects like dizziness, headache, nausea happen frequently with both; however rash appears more commonly with Lamictal while balance disorder occurs more often with Vimpat. Patients must monitor themselves closely when initiating treatment and seek prompt medical attention if they notice intensification in the frequency or severity of their seizure episodes.
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Refrences
- Scott, L. J. (2015, November 25). Lacosamide: A Review in Focal Seizures in Patients with Epilepsy. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-015-0514-7
- Wilson, S. M., & Khanna, R. (2014, June 20). Specific Binding of Lacosamide to Collapsin Response Mediator Protein 2 (CRMP2) and Direct Impairment of its Canonical Function: Implications for the Therapeutic Potential of Lacosamide. Molecular Neurobiology. Springer Science and Business Media LLC.http://doi.org/10.1007/s12035-014-8775-9
- Hoy, S. M. (2013, November 8). Lacosamide: A Review of Its Use as Adjunctive Therapy in the Management of Partial-Onset Seizures. CNS Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40263-013-0123-5
- Beydoun, A., D’Souza, J., Hebert, D., & Doty, P. (2009, January). Lacosamide: pharmacology, mechanisms of action and pooled efficacy and safety data in partial-onset seizures. Expert Review of Neurotherapeutics. Informa UK Limited.http://doi.org/10.1586/14737175.9.1.33
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- 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
- 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
- Hoy, S. M. (2018, May). Lacosamide: A Review in Focal-Onset Seizures in Patients with Epilepsy. CNS Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40263-018-0523-7