Treatments

Lamotrigine

In this section:

Key points | Benefits and Harms | Comment

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Key points

  • For GRADE evaluation of interventions for Trigeminal neuralgia, see table.
  • We found insufficient evidence to judge the effectiveness of lamotrigine in people with trigeminal neuralgia.
  • Lamotrigine is often used in people who cannot tolerate carbamazepine, but the dose must be increased slowly to avoid rashes, thus making it unsuitable for acute use.
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Benefits and harms

Lamotrigine versus placebo:

We found one systematic review (search date 2011),[35] which identified one small double-blind crossover RCT comparing lamotrigine versus placebo in people receiving carbamazepine or phenytoin.[36]

Pain relief

Lamotrigine compared with placebo We don't know whether adding lamotrigine is more effective than adding placebo to current treatment at increasing the proportion of people improved (improvement not further defined) after 2 weeks of treatment (very low-quality evidence).

Ref (type)PopulationOutcome, InterventionsResults and statistical analysisEffect size (for ORs and RRs)Favours
Symptom improvement

[36]

RCT

Crossover design

14 people with refractory trigeminal neuralgia using either carbamazepine or phenytoin

In review [35]

Proportion of people improved, 2 weeks of treatment

10/13 (77%) with addition of lamotrigine

8/14 (57%) with addition of placebo

Other comment

Results after crossover

Significance not assessed

Psychological distress

No data from the following reference on this outcome.[36][35]

Ability to perform normal activities

No data from the following reference on this outcome.[36][35]

Adverse effects
Ref (type)PopulationOutcome, InterventionsResults and statistical analysisEffect size (for ORs and RRs)Favours
Adverse effects

[36]

RCT

Crossover design

14 people with refractory trigeminal neuralgia using either carbamazepine or phenytoin

In review [35]

Total number of people reporting adverse effects

7/13 (54%) with addition of lamotrigine

7/14 (50%) with addition of placebo

Other comment

Adverse effects with lamotrigine included dizziness, constipation, nausea, and drowsiness. Lamotrigine may also cause serious skin rash and allergic reactions, particularly if the dose is escalated rapidly; there were no reports of skin rash in the study

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Comment

As Clinical Evidence was unable to perform a second appraisal of results retrieved by the contributor's search, we may have missed studies that could affect our overall assessment of this intervention.

Clinical guide:

We found no good evidence assessing the benefits of lamotrigine. However, clinicians often use lamotrigine in people who cannot tolerate carbamazepine (e.g., because of allergy), or in addition to carbamazepine when the latter becomes less effective. The dose of lamotrigine must be escalated slowly in order to avoid rashes, and it is therefore not appropriate for acute management of trigeminal neuralgia. It is most effective when used for long-term control of moderate pain, such as in people with multiple sclerosis.[37]