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Lamictal

Lamictal
Lamictal is indicated for partial and generalized seizures, including tonic-clonic and Lennox-Gastaut-associated bipolar disorders in adults over 18 years of age with predominantly depressive phases.

Brand: Lamotrigine

Availability: In Stock
Average Delivery Time: 9 Days
Exp. Date: November 2023
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Lamictal 200 mg
120 pills - 200 mg
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$351.93 $2.93 $147.87 Add to cart
90 pills - 200 mg
+ 8 free Viagra 100 mg, 5% discount for future orders
$275.91 $3.07 $98.94 Add to cart
60 pills - 200 mg
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$201.93 $3.37 $47.97 Add to cart
30 pills - 200 mg
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$124.95 $4.17 No Add to cart
Lamictal 100 mg
270 pills - 100 mg
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$349.15 $1.29 $229.64 Add to cart
180 pills - 100 mg
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$242.99 $1.35 $142.87 Add to cart
120 pills - 100 mg
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$171.99 $1.43 $85.25 Add to cart
90 pills - 100 mg
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$135.79 $1.51 $57.14 Add to cart
60 pills - 100 mg
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$100.29 $1.67 $28.33 Add to cart
30 pills - 100 mg $64.31 $2.14 No Add to cart
Lamictal 50 mg
270 pills - 50 mg
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$328.85 $1.22 $213.22 Add to cart
180 pills - 50 mg
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$229.91 $1.28 $131.47 Add to cart
120 pills - 50 mg
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$161.19 $1.34 $79.73 Add to cart
90 pills - 50 mg
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$128.67 $1.43 $52.02 Add to cart
60 pills - 50 mg $95.75 $1.60 $24.71 Add to cart
30 pills - 50 mg $60.23 $2.01 No Add to cart
Lamictal 25 mg
360 pills - 25 mg
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$339.99 $0.94 $235.17 Add to cart
180 pills - 25 mg
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$181.93 $1.01 $105.65 Add to cart
120 pills - 25 mg
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$127.99 $1.07 $63.73 Add to cart
90 pills - 25 mg
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$101.91 $1.13 $41.88 Add to cart
60 pills - 25 mg $74.99 $1.25 $20.87 Add to cart
30 pills - 25 mg $47.93 $1.60 No Add to cart

Product description

Pharmacological action of the drug Lamictal

Buy Lamictal in Canada

Pharmacological action - anticonvulsant.

Blocks voltage-gated sodium channels, stabilizes neuronal membranes and inhibits the release of glutamic acid, which plays a key role in the onset of epileptic seizures.

Pharmacokinetics

Lamotrigine is rapidly and completely absorbed from the intestine. Cmax in plasma is achieved approximately 2.5 hours after oral administration. Tmax increases slightly after a meal, but absorption remains unchanged.

Pharmacokinetics is linear when taken at a dose of up to 450 mg.

The degree of binding of lamotrigine to plasma proteins is about 55%. The volume of distribution is 0.92-1.22 l / kg.

The enzyme glucuronyltransferase is involved in the metabolism of lamotrigine. Lamotrigine does not affect the pharmacokinetics of other antiepileptic drugs.

In adults, Cl lamotrigine averages 39 ± 14 ml / min.

Lamotrigine is metabolized to glucuronides, which are excreted in the urine. Less than 10% of the drug is excreted in the urine unchanged, about 2% - with feces. Clearance and T1/2 are independent of dose.

Cl lamotrigine, calculated by body weight, is higher in children than in adults; it is highest in children under 5 years of age. In children, the T1/2 of lamotrigine is usually shorter than in adults.

The available data indicate that there are no significant differences in creatinine clearance in elderly patients compared with younger patients.

The mean Cl values ​​of lamotrigine for patients with chronic renal failure and patients on hemodialysis are 0.42 ml / min / kg (chronic renal failure), 0.33 ml / min / kg (between hemodialysis sessions) and 1.57 ml / min / kg (during hemodialysis). The average T1/2 is 42.9, respectively; 57.4 and 13 hours. During a 4-hour hemodialysis session, about 20% of lamotrigine is excreted from the body. Thus, in patients with impaired renal function, the initial dose of lamotrigine is calculated according to the standard antiepileptic drug regimen; for patients with a significant decrease in renal function, a reduction in the maintenance dose is recommended.

The average Cl values ​​of lamotrigine in patients with mild, moderate and severe liver dysfunction (stages A, B and C according to Child-Pugh) are 0.31; 0.24 and 0.1 ml / min / kg, respectively. Initial, escalating and maintenance doses should be reduced by about 50% in patients with moderate hepatic impairment (stage B) and by 75% in severe (stage C). The initial and increasing doses should be adjusted depending on the clinical effect.

Indications for Lamictal®

Lamictal for the treatment of bipolar disorder

Partial and generalized seizures, including tonic-clonic and associated with Lennox-Gastaut syndrome (in adults and children), bipolar disorders in adults over 18 years of age with predominantly depressive phases.

Dosing and Administration of the drug Lamictal

Inside. Epilepsy: adults and children over 12 years of age who did not receive sodium valproate, an initial dose of 25 mg once a day for 2 weeks, then 50 mg once a day for 2 weeks, then the dose is increased by 50-100 mg every 1 –2 weeks until the optimal therapeutic effect is achieved. The maintenance dose is 100-200 mg / day in 1 or 2 doses (some patients require a dose of 500 mg / day).

For patients receiving sodium valproate, the initial dose is 25 mg every other day for 2 weeks, then 25 mg daily for the next 2 weeks, after which the dose is increased by a maximum of 25–50 mg / day every 1–2 weeks until the optimal therapeutic effect. The maintenance dose is 100-200 mg / day in 1 or 2 doses.

For patients taking antiepileptic drugs that induce liver enzymes in combination with or without other antiepileptic drugs (with the exception of sodium valproate), the initial dose is 50 mg once a day for 2 weeks, then - 100 mg / day in 2 divided doses within 2 weeks. The dose is then increased by a maximum of 100 mg every 1–2 weeks until the optimal therapeutic effect is achieved. The maintenance dose to achieve the optimal therapeutic effect is 200-400 mg / day in 2 divided doses. Some patients may need a dose of 700 mg / day to achieve the desired effect.

Children from 2 to 12 years old, receiving sodium valproate in combination with other antiepileptic drugs or without them, the initial dose is 0.15 mg / kg once a day for 2 weeks; then - 0.3 mg / kg once a day for 2 weeks. Then the dose is increased by 0.3 mg / kg every 1–2 weeks until an optimal therapeutic effect is achieved. The maintenance dose is 1–5 mg / kg / day in 1 or 2 doses. The maximum daily dose is 200 mg.

For patients taking antiepileptic drugs that induce liver enzymes, in combination with or without other antiepileptic drugs (with the exception of sodium valproate), the initial dose is 0.6 mg / kg / day in 2 divided doses for 2 weeks, then 1 , 2 mg / kg / day in 2 divided doses for 2 weeks. Then the dose is increased by a maximum of 1.2 mg / kg every 1–2 weeks until the optimal therapeutic effect is achieved. The average maintenance dose to achieve the optimal therapeutic effect is 5-15 mg / kg / day in 2 divided doses. The maximum daily dose is 400 mg. To achieve optimal effect in children, it is necessary to systematically monitor body weight in order to adjust doses in accordance with changes in the child's body weight.

Bipolar disorders (in order to prevent the development of a depressive episode). Inside, chewing, dissolving in a small amount of water or swallowing whole with water.

Adults over 18 years of age taking Lamictal in combination with antiepileptic drugs, liver enzyme inhibitors (including sodium valproate), 25 mg every other day for 2 weeks, then 25 mg daily for 2 weeks, then 50 mg / day in 1 or 2 doses for 1 week; stabilizing dose - 100 mg / day in 1 or 2 doses (varies depending on the clinical effect). The maximum dose is 200 mg / day.

Lamictal therapy in combination with antiepileptic drugs that induce liver enzymes (carbamazepine, phenobarbital), without sodium valproate, the initial dose is 50 mg 1 time per day for 2 weeks, then 100 mg / day in 2 doses for 2 weeks. The dose is increased by 5 weeks to 200 mg / day in 2 divided doses and up to 300 mg / day by 6 weeks. To achieve the optimal therapeutic effect - 400 mg / day in 2 divided doses, starting from 7 weeks.

Therapy with Lamictal and drugs with an unknown nature of interaction (lithium drugs, bupropion). Monotherapy with Lamictal: the initial dose is 25 mg / day for 2 weeks, then 50 mg / day in 1 or 2 doses for 2 weeks. The dose should be increased to 100 mg / day for 5 weeks. To achieve the optimal therapeutic effect, a dose of 200 mg / day is required in 1 or 2 doses.

Once the daily maintenance stabilizing dose has been reached, other psychotropic drugs may be discontinued.

Lamictal therapy after discontinuation of antiepileptic drugs, inhibitors of liver enzymes (including sodium valproate): after discontinuation of sodium valproate, the stabilizing dose is doubled, not exceeding 100 mg / week. For example, the stabilizing dose of 100 mg / day is increased in the first week to 200 mg / day, in the second, third week and further, the dose is maintained at 200 mg / day in 2 divided doses. If necessary, the dose can be increased to 400 mg / day.

Lamictal therapy after discontinuation of antiepileptic drugs that induce liver enzymes (carbamazepine), depending on the initial maintenance dose: the dose of Lamictal is gradually reduced over 3 weeks.

Lamictal therapy after the withdrawal of psychotropic drugs or other antiepileptic drugs, the nature of the interaction of which with lamotrigine is unknown (lithium preparations, bupropion): the same maintenance dose remains.

The addition of antiepileptic drugs, inhibitors of hepatic enzymes (sodium valproate), depending on the initial dose of lamotrigine: with a stabilizing dose of 200 mg / day, in the first week - reduce it to 100 mg / day, in the second, third week and further - keep 100 mg / day At a dose of 300 mg / day, in the first week, reduce to 150 mg / day and then keep unchanged, at a dose of 400 mg / day, in the first week, reduce to 200 mg / day and then keep unchanged.

The addition of antiepileptic drugs that induce liver enzymes (carbamazepine) in patients who do not receive sodium valproate, depending on the initial dose of lamotrigine: at a dose of 200 mg / day, keep it unchanged in the first week, in the second - increase it to 300 mg / day, in the third and further - increase to 400 mg / day.

At a dose of 150 mg / day in the first week, keep it unchanged, in the second - increase to 225 mg / day, in the third and further - increase to 300 mg / day. At a dose of 100 mg / day, in the first week, keep it unchanged, in the second - increase to 150 mg / day, in the third and further - increase to 200 mg / day.

The addition of other psychotropic or antiepileptic drugs, the nature of the interaction of which with lamotrigine is unknown: maintain a maintenance dose of 200 mg / day in 2 divided doses (from 100 to 400 mg).

In patients with impaired liver function, the initial, increasing and maintenance doses should be reduced by ~ 50 and 75% in patients with moderate (stage B) and severe (stage C) liver failure, respectively. In the future, they should be adjusted depending on the clinical effect. In case of impaired renal function, a reduction in the maintenance dose is recommended. Patients over 65 years of age do not need to change the dosage regimen. There are no dosage recommendations for children under 18 years of age.

Overdose

Symptoms: dizziness, headache, drowsiness, vomiting, nystagmus, ataxia, impaired consciousness, coma.

Treatment: gastric lavage, detoxification therapy.

Precautions

Unless the patient's condition requires urgent discontinuation of the drug (for example, when skin rashes appear), the dose of Lamiktal should be reduced gradually over 2 weeks.

During the period of treatment, it is necessary to refrain from engaging in potentially hazardous activities that require increased concentration of attention and speed of psychomotor reactions.

Special instructions

There is evidence of the development of skin rashes, which were usually observed during the first 8 weeks after starting treatment with lamotrigine. In most cases, skin rashes were mild and went away on their own, but at the same time, serious cases were sometimes noted that required hospitalization of the patient and withdrawal of Lamictal (for example, Stevens-Johnson syndrome and toxic epidermal necrolysis). Rash (mild forms) is usually a manifestation of hypersensitivity syndrome and is a dose-independent effect, while Lyell's and Stevens-Johnson syndrome are always dose-dependent.

Due to the risk of developing a rash, it is impossible to exceed the initial dose and to violate the dose escalation regimen.

Lamictal is a weak inhibitor of dihydrofolate reductase and therefore may interfere with folate metabolism during long-term therapy. However, even with prolonged use, lamotrigine did not cause significant changes in hemoglobin content, average blood cell volume, serum folate concentration (when taken up to 1 year) or erythrocytes (when taken up to 5 years).

At the end stage of renal failure, the accumulation of the lamotrigine metabolite - glucuronide is possible, therefore, lamotrigine is prescribed with caution in patients with renal failure.

Patients who are receiving any other drug containing lamotrigine should not take Lamictal without consulting their doctor.

If the estimated daily dose is 1-2 mg, it is allowed to take Lamiktal at a dose of 2 mg every other day for the first 2 weeks. If the calculated dose is less than 1 mg, Lamictal should not be taken.

In pediatric practice, drug monotherapy is not recommended as the initial method of treatment in patients with a primary diagnosis. After achieving an anticonvulsant effect with the help of combination therapy, antiepileptic drugs simultaneously used with Lamictal

can be discontinued, and patients can continue treatment with Lamictal as monotherapy.

It is possible that children aged 2 to 6 years will need a maintenance dose at the upper end of the recommended dose range.

General dosing recommendations for epilepsy

With any change in therapy, both with the withdrawal of the antiepileptic drug, which was prescribed in conjunction with lamotrigine, and, conversely, with the addition of other antiepileptic drugs to combination therapy, including lamotrigine, it is necessary to take into account the possibility of changing the pharmacokinetics of lamotrigine.

Contraindications

Hypersensitivity.

Precautions should be taken in renal failure.

Use during pregnancy and lactation

Since lamotrigine is a weak inhibitor of dihydrofolate reductase,

there is at least a theoretical risk of developing birth defects in the fetus when taking the drug during pregnancy.

There are insufficient data to assess the safety of lamotrigine in pregnancy.

Currently, information on the use of lamotrigine in lactation is incomplete.

Lamotrigine is determined in breast milk at concentrations of 40-60% of its plasma concentration. In some breastfed babies, the plasma concentration of lamotrigine reaches therapeutic levels.

Side effects

Adverse reactions identified in clinical trials in patients with epilepsy or bipolar disorder were divided into separate sections, specific to the indications for use. Additional adverse reactions identified in the course of post-registration observation for both indications for use are included in the subsection "Post-registration observation". When considering the general safety profile of Lamictal® , the information contained in all three sections should be consulted.

The adverse reactions presented below are listed in accordance with the damage to organs and organ systems and the frequency of occurrence. The frequency of occurrence is determined as follows: very often (≥1 / 10), often (≥1 / 100, <1/10), infrequently (≥1 / 1000, <1/100), rarely (≥1 / 10,000, < 1/1000), very rarely (<1/10 000, including isolated cases). Frequency categories were formed on the basis of clinical studies of the drug and post-marketing follow-up.

Frequency of occurrence of adverse reactions

Epilepsy

The following adverse reactions have been identified in clinical trials in patients with epilepsy and in determining the overall safety profile of Lamictal® should be considered in conjunction with adverse reactions identified in clinical trials in patients with bipolar disorder and post-marketing use of the drug.

On the part of the skin and subcutaneous fat: very often - skin rash; rarely - Stevens-Johnson syndrome, very rarely - toxic epidermal necrolysis.

In additional double-blind clinical studies in adult skin rash occurred in 10% of patients or less, taking the drug Lamictal®,and 5% of patients receiving placebo. In 2% of the patients the occurrence of skin rash caused the abolition of the drug Lamictal®.The rash, mainly maculopapular in nature, usually appears within the first 8 weeks from the start of therapy and disappears after the drug Lamictaldiscontinued® is.

There have been reports of rare cases of severe, potentially life-threatening skin rash, including Stevens-Johnson syndrome and toxic epidermal necrolysis (Lyell's syndrome). Although symptoms reversed in most cases when the drug was discontinued, some patients remained permanently scarred and, in rare cases, drug-related deaths were reported.

The overall risk of rash is closely associated with high initial doses of drug Lamictal® and exceeding the recommended doses for its application; with the concomitant use of valproic acid.

There have also been reports of the development of a rash within the hypersensitivity syndrome associated with various systemic manifestations (see Immune system disorders *).

From the hematopoietic system: very rarely - hematological disorders (including neutropenia, leukopenia, anemia, thrombocytopenia, pancytopenia, aplastic anemia, agranulocytosis), lymphadenopathy. Hematologic disorders and lymphadenopathy may or may not be associated with hypersensitivity syndrome (seeDisorders Immune System*).

From the immune system: very rarely - hypersensitivity syndrome * (including symptoms such as fever, lymphadenopathy, facial edema, abnormalities in the blood and liver function, disseminated intravascular coagulation syndrome, multiple organ failure).

* There have also been reports of the development of a rash associated with hypersensitivity syndrome associated with various systemic manifestations, including fever, lymphadenopathy, facial edema, and abnormalities of blood and liver function. The syndrome occurs with varying degrees of clinical severity and can, in rare cases, lead to the development of disseminated intravascular coagulation and multiple organ failure. It is important to note that early manifestations of hypersensitivity (i.e., fever, lymphadenopathy) may be present even in the absence of overt signs of rash. With the development of such symptoms, the patient should be immediately examined by a doctor and, unless another reason for the development of symptoms is established, Lamictal® should be canceled.

From the side of the psyche: often - aggressiveness, irritability; very rarely - tics, hallucinations, confusion.

From the nervous system: very often - headache; often - drowsiness, insomnia, dizziness, tremors; infrequently - ataxia; rarely - nystagmus.

From the side of the organ of vision: infrequently - diplopia, blurred vision.

From the digestive system: often - nausea, vomiting, diarrhea; very rarely - increased activity of hepatic enzymes, impaired liver function, liver failure. Liver dysfunctions usually develop in combination with hypersensitivity reactions, but in isolated cases, they were noted in the absence of obvious signs of hypersensitivity.

From the musculoskeletal system: very rarely - lupus-like syndrome.

Others: often - fatigue.

Bipolar affective disorder

following adverse reactions have been identified during clinical trials in patients with bipolar disorder and the determination of the overall safety profile of the drug Lamictal® should be considered in conjunction with the adverse reactions identified in clinical studies in patients with epilepsy and post-marketing surveillance.

On the part of the skin and subcutaneous fat: very often - skin rash; rarely - Stevens-Johnson syndrome. When evaluating all studies (controlled and uncontrolled) on the drug Lamictal® in patients with bipolar disorder, skin rash occurred in 12% of all patients receiving Lamictal®, while skin rash in controlled clinical trials in patients with bipolar disorder occurred in 8% patients receiving Lamictal®,and 6% of patients receiving placebo.

From the nervous system: very often - headache; often - agitation, drowsiness, dizziness.

From the musculoskeletal system: often - arthralgia.

Others: often - pain, back pain.

Post-marketing surveillance

This section includes adverse reactions identified during post-marketing surveillance for both indications for use. When determining the general safety profile of Lamictal®, these adverse reactions should be considered in conjunction with adverse reactions identified in clinical studies in patients with epilepsy and bipolar disorder.

On the part of the skin and subcutaneous fat: rarely - alopecia.

Mental disorders: very rarely - nightmares.

From the nervous system: very often - drowsiness, ataxia, headache, dizziness; often - nystagmus, tremor, insomnia; rarely - aseptic meningitis; very rarely - agitation, gait instability, movement disorders, worsening symptoms of Parkinson's disease, extrapyramidal disorders, choreoathetosis. There are reports that the drug Lamictal® may worsen the symptoms of parkinsonism in patients with Parkinson's disease and, in isolated cases, cause extrapyramidal symptoms of choreoathetosis in patients without previous disorders.

Fromthe side of the organ of vision: very often - diplopia, blurred vision; rarely - conjunctivitis.

From the digestive system: very often - nausea, vomiting; often diarrhea.

Only with epilepsy

From the nervous system: very rarely - an increase in the frequency of seizures.