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(anti-seizure medications) Summary of Anti-seizure medications Some of the more effective and commonly used medications for chronic pain are drugs that were developed to control other conditions. Anti-seizure (anticonvulsant) medications were developed primarily to reduce or control epileptic seizures, but they also help control stabbing or shooting pain from nerve damage. These drugs seem to work by quieting damaged nerves to slow or prevent uncontrolled pain signals. These medications can cause dizziness, drowsiness, nausea and lack of balance and coordination. But most people are bothered only minimally. More severe but less common side effects include blood and liver disorders. To reduce your risk of side effects, your doctor will likely start you off on a small amount of the drug and gradually increase the dose while monitoring you. The US FDA approved lamotrigine (Lamictal) for the treatment of epilepsy in 1994, and bipolar I disorder in 2003. Off-label uses include the treatment of peripheral neuropathy, trigeminal neuralgia, cluster headaches, migraines, and reducing neuropathic pain (Backonja, 2004; Jensen 2002; Pappagallo, 2003). Off-label psychiatric usage includes the treatment of bipolar II disorders, schizoaffective disorder, borderline personality disorder, post traumatic stress disorder, and as adjunctive therapy for "treatment-resistant" unipolar depression (Barbosa, Berk & Vorster, 2003).Lamotrigine prescribing information has a black box warning about life threatening skin reactions, including Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis. The manufacturer states that nearly all cases appear in the first 2 to 8 weeks of therapy and if medication is suddenly stopped then resumed at the normal dosage. Patients should seek medical attention for any unexpected skin rash as its presence is an indication of a deadly side effect of the drug. Cognitive side effects are common with doses over 50mg qid, per 2001-2003 Glaxo-sponsored Clinical Trials comparing quality of life between Topiramate and Lamotigine in healthy volunteers (unpublished). Common side effects include headaches, dizziness and insomnia. Other side effects may include acne and skin irritation, vivid dreams or nightmares, night sweats, body aches and cramps, fatigue, memory and cognitive problems, irritability, weight changes, hair loss, changes in libido, frequent urination, nausea, and other side effects. In very rare cases, Lamotrigine has been known to cause the development of a dangerous rash called Stevens-Johnson syndrome (or SJS). The rash is more common in children, so this medication is often reserved for adults. GlaxoSmithKline's trademarked brand of Lamotrigine, Lamictal, is manufactured in scored tablets (25 mg, 100 mg, 150 mg and 200 mg) and chewable dispersible tablets (2 mg, 5 mg and 25 mg). Five-week sample kits are also available; these include titration instructions and scored tablets (25 mg for patients taking valproate, 25 mg and 100 mg for patients not taking valproate). Lamotrigine is also available in un-scored tablet form. In 2005, Teva Pharmaceutical Industries Ltd. began selling generic Lamotrigine in the United States, but only in 5 mg and 25 mg chewable dispersible tablets. Lamotrigine is also available in generic form in the United Kingdom and Canada.
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