Lamotrigine: treatment of epilepsy in the elderly.

OBJECTIVE: To review the pharmacology, pharmacokinetics, clinical use, and potential adverse effects of lamotrigine in elderly patients with epilepsy. DATA SOURCES: English-language literature regarding humans was searched from January 1990 through January 2003 using PubMed and the terms "lamotrigine," "epilepsy," and "elderly." STUDY SELECTION: Studies of epilepsy treatment with lamotrigine in elderly patients, review articles, pharmacokinetic and pharmacodynamic studies, and clinical studies/reports regarding adverse effects of lamotrigine were evaluated. Two studies specifically dealing with lamotrigine treatment of epilepsy in the elderly were reviewed in detail. DATA EXTRACTION: Data from identified publications were included. Relevant data from other patient populations were evaluated and used to develop recommendations. DATA SYNTHESIS: The pharmacokinetic and pharmacologic profiles of lamotrigine were evaluated to assess this drug's utility for treatment of epilepsy in the elderly. Safety, efficacy, and frequency of common side effects such as sedation and cognitive interference were assessed and compared with those of other antiepileptic drugs. Risk factors for less common, serious adverse effects such as skin rash and hypersensitivity were evaluated. Specific risks to elderly patients related to these adverse effects were assessed. Potential interactions between lamotrigine and other drugs likely to be used in elderly patients with seizure disorders were evaluated. CONCLUSION: Lamotrigine is an effective antiepileptic drug in the elderly. It has a favorable side effect profile when accepted dosage recommendations are followed. Elderly patients do not appear to be at increased risk for lamotrigine-induced skin rashes and hypersensitivity reactions. Cotherapy with valproate may increase the likelihood of skin rash. Combined treatment with lamotrigine and carbamazepine may increase central nervous system (CNS) adverse effects. Interactions between lamotrigine and other drugs are uncommon. Additional evaluations of long-term outcomes in elderly patients treated for epilepsy with lamotrigine will clarify the place of this drug in therapy.