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Valproic Acid vs Lamictal
Introduction
For patients with epilepsy or bipolar disorder, certain drugs that impact the function of neurotransmitters in the brain can help stabilize mood swings and control seizures. Valproic Acid (Depakote) and Lamictal are two such drugs frequently prescribed for these conditions. They each work on different aspects of brain chemistry but both have shown effectiveness in managing symptoms of these disorders. Valproic Acid is classified as a broad spectrum anticonvulsant, it increases levels of gamma-aminobutyric acid (GABA), an inhibitory neurotransmitter in the brain which helps reduce seizure activity and has mood-stabilizing effects. On the other hand, Lamictal works by decreasing abnormal electrical activity in the brain; while its exact mechanism is unknown, it's thought to inhibit sodium channels thus stabilizing neuronal membranes.
Valproic Acid vs Lamictal Side By Side
| Attribute | Depakote | Lamictal |
|---|---|---|
| Brand Name | Depakote | Lamictal |
| Contraindications | Intensify symptoms of depression, increase in suicidal thoughts or behaviors. Should not be taken with certain medications without doctor's advice due to harmful drug interactions. | Intensify symptoms of depression, increase in suicidal thoughts or behaviors. Should not be taken with certain medications without doctor's advice due to harmful drug interactions. |
| Cost | Brand name: around $400 for 60 tablets of 500 mg. Generic: between $0.25 and $0.90 per day. | Brand name: about $450 for 30 tablets of 100 mg. Generic: approximately $.50 to $2 per day depending on dosage. |
| Generic Name | Valproic Acid | Lamotrigine |
| Most Serious Side Effect | Life-threatening skin rash, vision changes, cardiovascular alterations, low platelet levels, severe nervous system reaction. | Potentially life-threatening skin rash, changes in mental health, vision problems, increased frequency of convulsions, cardiac issues. |
| Severe Drug Interactions | Rifampin, carbamazepine, phenytoin and others. | Rifampin, carbamazepine, phenytoin and others. |
| Typical Dose | Oral dosages usually start at 10-15 mg/kg/day, typically falls within the range of 1000–2000 mg/day. | Initiated at 25 mg/day for the first two weeks, then increased to 50 mg/day. Maximum of 200-400 mg/day. |
What is Valproic Acid?
Valproic Acid (also known as Depakote) was one of the first anticonvulsants used to treat bipolar disorder and epilepsy. It received its FDA approval in 1978. Valproic acid works by increasing levels of gamma-aminobutyric acid (GABA), thereby reducing the frequency of abnormal electrical discharges in the brain that cause seizures, effectively maintaining it for longer durations than usual. It is prescribed extensively for managing various forms of epilepsy and bipolar disorder. On the other hand, Lamotrigine (the generic name for Lamictal), another anticonvulsant approved by FDA later in 1994, acts on voltage-gated sodium channels in neurons. This action stabilizes neuronal membranes, inhibits neurotransmitter release and reduces seizure activity without influencing normal neurotransmission as much as valproic acid does. Consequently, Lamictal tends to have fewer side effects than valproic acid which has a broader effect on brain chemistry.
What conditions is Valproic Acid approved to treat?
Valproic Acid is approved for the treatment of several neuropsychological disorders:
- Epilepsy, particularly in treating various types of seizures
- Bipolar disorder, including manic episodes and maintenance treatment to prevent relapse
- Migraines prevention (however, it's not used to relieve an active migraine headache)
How does Valproic Acid help with these illnesses?
Valproic acid works to manage epilepsy and bipolar disorder by increasing the amount of gamma-aminobutyric acid (GABA) in the brain. It does this by blocking its degradation, allowing GABA levels to be maintained at a higher level for extended periods. This is important because GABA is a neurotransmitter that helps to slow down activity in the nervous system, providing a calming effect which can help control seizures, mood episodes, and prevent migraine headaches. Like serotonin in depression management, individuals with these conditions often have relatively lower levels of GABA. Therefore, by boosting GABA availability through valproic acid use, patients can manage their condition more effectively and stabilize their mood or decrease seizure frequency.
What is Lamictal?
Lamictal is a brand name for lamotrigine, an anticonvulsant medication primarily used in the treatment of epilepsy and bipolar disorder. It works by stabilizing electrical activity in the brain to prevent seizures and mood episodes. Lamotrigine was first approved by the FDA in 1994 and has since become a mainstay of treatment for these conditions.
As lamotrigine is not a typical mood stabilizer, it does not function through sodium channel blocking like valproic acid. This different mode of action means that its side effect profile is also distinct from that of other mood stabilizers, especially valproic acid; it does not typically cause weight gain or sedation (common side effects with valproic acid). However, serious skin reactions are possible with lamotrigine (though rare), which necessitates careful monitoring during initial titration.
The modulation of glutamate and GABA activity provided by lamotrigine can be advantageous in managing both manic and depressive phases of bipolar disorder, particularly for patients who may not have responded optimally to traditional mood stabilizers such as valproic acid.
What conditions is Lamictal approved to treat?
Lamictal is approved by the FDA for a range of conditions, including:
- Maintenance treatment of Bipolar I Disorder to delay the time to occurrence of mood episodes in patients treated for acute mood episodes with standard therapy.
- Adjunctive therapy for primary generalized tonic-clonic seizures and partial-onset seizures with or without secondary generalization in adults and pediatric patients aged 2 years and older.
- Conversion to monotherapy in adults (≥16 years) with partial-onset seizures who are receiving treatment with a single enzyme-inducing antiepileptic drug.
How does Lamictal help with these illnesses?
Lamictal, also known as lamotrigine, is a medication primarily used for the treatment of epilepsy and bipolar disorder. It's unique in its function compared to other mood stabilizers because it doesn't just block sodium channels in the brain like valproic acid does; Lamictal actually works by delaying their recovery time which inhibits repetitive neuron firing. This method has proven highly effective for many patients dealing with seizures or episodes of mania from bipolar disorder. Its action on glutamate (an excitatory neurotransmitter) may also play a role in Lamictal's efficacy as an antiepileptic and mood stabilizer. Unlike valproic acid, Lamictal tends to have fewer side effects making it more tolerable for long-term use or when combined with other medications as part of a comprehensive treatment plan.
How effective are both Valproic Acid and Lamictal?
Both valproic acid and lamotrigine (Lamictal) have established histories of success in treating patients with bipolar disorder, epilepsy, and other seizure disorders. Valproic acid was approved by the FDA in 1978 while lamotrigine received approval in 1994. Because they act on different neurotransmitters and ion channels, they may be prescribed under differing circumstances. The effectiveness of valproic acid and lamotrigine has been compared directly in several double-blind clinical trials; both drugs exhibit similar efficacy managing symptoms of bipolar disorder as well as promising safety profiles.
A review published in 2003 comparing these two medications concluded that while both are effective for treating acute manic episodes associated with bipolar disorder, Lamictal might show superiority when it comes to delaying/managing depressive episodes within this condition. That being said, the same study found that the overall side effect profile is relatively favorable for both drugs but did note some differences: Lamictal tends to cause fewer adverse cognitive effects than valproic acid which can lead to sedation or dizziness.
Further research indicated that Lamictal seems comparably effective against placebo when used as a maintenance treatment for Bipolar I Disorder, showing particular efficacy at preventing or delaying the onset of depressive episodes rather than mania/hypomania ones. Nonetheless, it's typically considered only after first-line treatments such as lithium have failed or weren't tolerated well by patients due to their side-effects profile.
Valproic Acid also provides robust evidence supporting its use for rapid cycling bipolar disorder and mixed states where depression coexists with hypomania/mania - areas where few other mood stabilizers demonstrate consistent benefits. It remains a preferred option among clinicians dealing particularly with these complex presentations due to its wider therapeutic index allowing more flexible dosing adjustments depending on individual patient needs.
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At what dose is Valproic Acid typically prescribed?
Oral dosages of Valproic Acid for treating seizures in adults usually start at 10-15 mg/kg/day, with the dose gradually increased until a therapeutic effect is achieved. This typically falls within the range of 1000–2000 mg/day. For children and adolescents, the starting dosage might be lower, according to their weight and age. Similarly, Lamictal dosages usually begin at a low level (25 mg/day) and are slowly escalated based on patient response, sometimes reaching up to 400 mg/day in divided doses for adults with epilepsy. As always, any increase or adjustment should only be done under medical supervision. The maximum daily dose that should not be exceeded for Valproic Acid is generally believed to be around 60mg/kg/day while for Lamictal it's typically capped at 400mg per day.
At what dose is Lamictal typically prescribed?
Treatment with Lamictal is usually initiated at a dosage of 25 mg/day for the first two weeks. This dose can then be increased to 50 mg/day, divided into two doses and taken 12 hours apart. If there is no satisfactory response after several weeks, the dose may be further escalated to a maximum of 200-400 mg/day, depending on whether it's used alone or in combination with other drugs, and divided into two doses spaced out evenly throughout the day. It's important that any increase in dosage should be done under careful medical supervision due to risk of severe rash associated with rapid titration.
What are the most common side effects for Valproic Acid?
Common side effects of Valproic Acid may include:
- Nausea, vomiting, or indigestion
- Diarrhea or constipation
- Drowsiness or sleepiness
- Tremor (unintentional trembling or shaking)
- Hair loss
- Weight changes
- Changes in menstrual cycle
- Dry mouth
Whereas common side effects of Lamictal can encompass:
- Headache
- Dizziness
- Rash
- Sleep problems (insomnia)
- Nausea, vomiting, stomach pain;
- Tired feeling;
- Fever, sore throat;
- Runny nose.
Please note that these lists are not exhaustive and other side effects may occur. Always consult your healthcare provider to ensure the information applies to your personal circumstances.
Are there any potential serious side effects for Valproic Acid?
While Valproic Acid is generally well-tolerated, it can cause certain serious adverse reactions in some patients. The following are potential side effects:
- Suicidal thoughts or behavior
- Signs of allergic reaction such as hives, difficulty breathing, swelling of your face or throat
- Life-threatening skin rash: fever, sore throat, burning eyes, skin pain; red or purple skin rash with blistering and peeling
- Vision changes: blurred vision, tunnel vision, eye pain/swelling/seeing halos around lights
- Cardiovascular alterations: fast/pounding heartbeats; fluttering in the chest; shortness of breath; sudden dizziness (like you might pass out)
- Low platelet levels leading to easy bleeding and bruising
- Severe nervous system reaction - rigid muscles; high fever; sweating confusion fast uneven heartbeats tremors feeling like you might pass out. If any symptoms akin to these arise during treatment with Valproic Acid alert medical professional immediately for further guidance.
What are the most common side effects for Lamictal?
Lamictal, like many other medications, comes with a list of potential side effects that may include:
- Headache or dizziness
- Sleep problems (insomnia)
- Tremors
- Rash, in rare cases this could lead to serious and potentially fatal skin conditions
- Nausea, vomiting
- Stomach pain or upset stomach
- Blurred vision
- Dry mouth Anxiety or nervousness.
It's important to remember that not everyone who takes Lamictal will experience these side effects and they're generally mild and manageable for most people. However, anyone experiencing severe reactions should seek immediate medical attention.
Are there any potential serious side effects for Lamictal?
While Lamictal is generally well-tolerated, it's important to be aware of potential serious side effects. Some signs that might indicate a severe reaction include:
- An allergic reaction or potentially life-threatening skin rash: This may present as hives, fever, swollen glands, mouth sores, itching and peeling skin.
- Changes in mental health: Unusual thoughts about suicide, sudden changes in mood or behavior including depression or anxiety can occur.
- Vision problems such as blurred vision or abnormal eye movements
- Seizures: Increased frequency of convulsions or new types of seizures
- Cardiac issues: Irregular heart rhythms
- Symptoms suggesting multiorgan dysfunction like persistent nausea/vomiting/abdominal pain; jaundice(yellowing eyes/skin); dark urine; swelling hands/ankles/feet.
If any of these symptoms are experienced while taking Lamictal, medical attention should be sought immediately.
Contraindications for Valproic Acid and Lamictal?
Both valproic acid and Lamictal, along with many other antiepileptic drugs, may intensify symptoms of depression in some individuals. If you notice your condition worsening or an increase in suicidal thoughts or behaviors, please seek immediate medical attention.
Neither valproic acid nor Lamictal should be taken if you are using certain medications without doctor's advice as they can lead to harmful drug interactions. This includes medications such as rifampin, carbamazepine, phenytoin and others. Always inform your physician about the current medications that you are taking; some medicines might require a period of time to clear from the body before starting treatment with either Valproic Acid or Lamictal to avoid dangerous interactions.
How much do Valproic Acid and Lamictal cost?
For the brand name versions of these drugs:
- The price for 60 tablets of Depakote (valproic acid, 500 mg) averages around $400, which works out to approximately $13-$26/day depending on your dose.
- The price for a pack of 30 tablets of Lamictal (lamotrigine, 100 mg) is about $450, working out to roughly $15/day.
Thus, if you are in the higher dosage range for valproic acid (i.e., 1 g/day or higher), then brand-name Lamictal could be less expensive on a per-day treatment basis. It's important to note that cost should not be the primary consideration while determining which drug is right for you.
When considering generic versions:
- Valproic Acid (500mg tablets) come in packs ranging from as low as 10 up to hundreds with approximate costs varying between $0.25 and $0.90 per day based on dosages between 250mg and above.
- Lamotrigine comes in packs starting from as low as ten up to hundreds with prices varying from approximately $.50 cents a day all the way up to an average of about two dollars per day depending upon one’s prescribed dosage amount.
Popularity of Valproic Acid and Lamictal
Valproic acid, also available under brand names like Depakote, was estimated to have been prescribed to about 3.9 million people in the US in 2020. Valproic acid accounted for just over 25% of antiepileptic drug prescriptions in the US. However, it is not only used as an anticonvulsant but also as a mood stabilizer and hence its presence among psychiatric medications cannot be ignored.
Lamotrigine, commonly known by the brand name Lamictal, was prescribed to approximately 5 million people in the USA during the same period. In terms of usage within specific classes of drugs, lamotrigine accounts for nearly 30% of "other" antiepileptic drug prescriptions (those not classified into broad categories such as barbiturates or benzodiazepines), showcasing its widespread use beyond epileptic disorders including bipolar disorder treatment where it's considered first line therapy. The prevalence of both valproic acid and lamotrigine has remained relatively steady over recent years with slight fluctuations based on new research findings and changes in clinical guidelines.
Conclusion
Both Valproic Acid (Depakote) and Lamictal (lamotrigine) have a long history of use in managing epilepsy, bipolar disorder and, less commonly, for off-label uses such as migraine prophylaxis. Both drugs have been supported by numerous clinical studies proving their effectiveness over placebo treatments. In some cases, these medications may be combined to enhance efficacy or manage treatment-resistant conditions; however, this is subject to careful consideration by a physician due to the potential for interactions between them.
Valproic acid acts primarily through increasing GABA levels and suppressing repetitive neuronal firing while lamotrigine works mainly through inhibiting voltage-sensitive sodium channels leading to stabilization of presynaptic neuronal membranes. Therefore they are often prescribed under different circumstances - valproic acid is usually considered an initial option whereas lamotrigine might be preferred when avoiding specific side effects associated with valproate like weight gain or teratogenicity.
Both drugs are available as generics saving considerable costs especially for those who must pay out-of-pocket. An adjustment period might be needed meaning that therapeutic benefits may not become apparent immediately after starting treatment.
In terms of side effects profile, both medicines are generally well-tolerated but differ slightly: valproic acid can cause gastrointestinal disturbances and weight gain more frequently than lamotrigine which has been linked with skin rashes including the rare but serious Stevens-Johnson syndrome. Patients should always monitor any new symptoms or mood changes particularly at the beginning of therapy or during dosage adjustments and contact their doctor promptly if worsening symptoms or concerns arise.
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Refrences
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