Lamotrigine Vs. Lexapro: Drug Comparison

Lamotrigine is the active ingredient in the brand-name medication Lamictal^®. The information below is about brand name Lamictal. According to the FDA, “Generic medicines use the same active ingredients as brand-name medicines and work the same way, so they have the same risks and benefits as the brand-name medicines.”

Lamictal (lamotrigine) is an anticonvulsant medication used to treat epilepsy and bipolar disorder by stabilizing electrical activity in the brain and reducing the release of certain neurotransmitters involved in seizures and mood regulation. Its FDA-approved indications include the treatment of partial seizures, generalized seizures, and the maintenance of mood stability in bipolar disorder. Lamictal is available in tablets, chewable tablets, and orally disintegrating tablets. Common side effects include dizziness, headache, blurred vision, and nausea. It carries a boxed warning for the risk of serious skin rashes, including Stevens-Johnson syndrome, which requires immediate medical attention.

Lexapro^® (escitalopram) is a selective serotonin reuptake inhibitor (SSRI) used to treat anxiety and depression by increasing available serotonin levels in the brain, which helps improve mood and reduce anxiety. Its FDA-approved indications include the treatment of major depressive disorder (MDD) and generalized anxiety disorder (GAD) in adults and adolescents. Off-label uses may include treating panic disorder, obsessive-compulsive disorder (OCD), and social anxiety disorder. Lexapro is available in tablet and oral solution forms, taken once daily. Common side effects include nausea, insomnia, and sexual dysfunction, and it carries a boxed warning for an increased risk of suicidal thoughts and behaviors in children, adolescents, and young adults, particularly during the initial stages of treatment.

Anticonvulsant

Selective serotonin reuptake inhibitor (SSRI)

Lamictal (lamotrigine) is indicated for:

• Epilepsy—adjunctive therapy in patients aged 2 years and older:

  • Partial-onset seizures

  • Primary generalized tonic-clonic seizures

  • Generalized seizures of Lennox-Gastaut syndrome

• Epilepsy—monotherapy in patients aged 16 years and older: Conversion to monotherapy in patients with partial-onset seizures who are receiving treatment with carbamazepine, phenytoin, phenobarbital, primidone, or valproate as the single antiepileptic drug

• Bipolar disorder: 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

Lexapro (escitalopram) is indicated for the:

• Treatment of major depressive disorder (MDD) in adults and pediatric patients 12 years of age and older

• Treatment of generalized anxiety disorder (GAD) in adults and pediatric patients 7 years and older

• Typically taken orally with dosing based on concomitant medications, indication, and patient age

• Comes in 25 mg, 100 mg, 150 mg, and 200 mg tablets; 2 mg, 5 mg, and 25 mg tablets for oral suspension; and 25 mg, 50 mg, 100 mg, and 200 mg orally disintegrating tablets

• Typically taken orally once daily

• Comes in 5 mg, 10 mg (scored), and 20 mg (scored) tablets

Epilepsy: Most common adverse reactions (incidence ≥10%) in adults were:

• Dizziness

• Headache

• Double vision

• Poor muscle control

• Nausea

• Blurred vision

• Sleepiness

• Inflammation of the nasal passages

• Inflammation of the throat

• Rash

• Additional adverse reactions (incidence ≥10%) reported in children included:

  • Vomiting

  • Infection

  • Fever

  • Accidental injury

  • Diarrhea

  • Abdominal pain

  • Tremor

Bipolar disorder: Most common adverse reactions (incidence >5%) in adults were:

• Nausea

• Insomnia

• Sleepiness

• Back pain

• Fatigue

• Rash

• Inflammation of the nasal passages

• Abdominal pain

• Dry mouth

Most commonly observed adverse reactions (incidence ≥ 5% and at least twice the incidence of placebo patients) are:

• Insomnia

• Ejaculation disorder (primarily ejaculatory delay),

• Nausea

• Sweating increased

• Fatigue and sleepiness

• Decreased libido

• Inability to orgasm

• Hypersensitivity to the drug or its ingredients

• Drug interactions: valproate, carbamazepine, phenytoin, phenobarbital, primidone, rifampin, estrogen-containing oral contraceptives, protease inhibitors lopinavir/ritonavir and atazanavir/lopinavir, organic cationic transporter 2 substrates

• Do not use MAOIs intended to treat psychiatric disorders with Lexapro or within 14 days of stopping treatment with Lexapro. Do not use Lexapro within 14 days of stopping an MAOI intended to treat psychiatric disorders. In addition, do not start Lexapro in a patient who is being treated with linezolid or intravenous methylene blue

• Concomitant use of pimozide

• Known hypersensitivity to escitalopram or citalopram or any of the inactive ingredients

• Drug interactions: SSRIs, SNRIs, tryptophan, drugs that affect hemostasis (NSAIDs, aspirin, warfarin)

• Life-threatening serious rash and/or rash-related death

• Hemophagocytic lymphohistiocytosis

• Fatal or life-threatening hypersensitivity reaction

• Cardiac rhythm and conduction abnormalities

• Blood dyscrasias (e.g., neutropenia, thrombocytopenia, pancytopenia)

• Suicidal behavior and ideation

• Aseptic meningitis

• Medication errors due to product name confusion

• Pregnancy: Based on animal data may cause fetal harm

• Serotonin syndrome

• Discontinuation syndrome

• Seizures

• Activation of mania/hypomania

• Low blood sodium: Can occur in association with syndrome of inappropriate antidiuretic hormone secretion

• Increased risk of bleeding

• Interference with cognitive and motor performance

• Angle closure glaucoma

• Use in patients with concomitant illness

• Sexual dysfunction

• Pregnancy: SSRI use, particularly later in pregnancy, may increase the risk for persistent pulmonary hypertension and symptoms of poor adaptation (respiratory distress, temperature instability, feeding difficulties, hypotonia, tremor, irritability) in the neonate

WARNING: SERIOUS SKIN RASHES

Cases of life-threatening serious rashes, including Stevens-Johnson syndrome and toxic epidermal necrolysis, and/or rash-related death have been caused by lamotrigine. The rate of serious rash is greater in pediatric patients than in adults. Additional factors that may increase the risk of rash include:

• Coadministration with valproate

• Exceeding recommended initial dose of Lamictal

• Exceeding recommended dose escalation for Lamictal

Benign rashes are also caused by lamotrigine; however, it is not possible to predict which rashes will prove to be serious or life threatening. Lamictal should be discontinued at the first sign of rash, unless the rash is clearly not drug related.

WARNING: SUICIDAL THOUGHTS AND BEHAVIORS

Increased risk of suicidal thoughts and behavior in pediatric and young adult patients taking antidepressants. Closely monitor all antidepressant-treated patients for clinical worsening and emergence of suicidal thoughts and behaviors. Lexapro is not approved for use in pediatric patients less than 7 years of age.

*This information is from the label for brand name Lamictal^®. See the Full Prescribing Information for more complete information. Lamotrigine, the active ingredient in Lamictal, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient lamotrigine.

*This information is from the label for brand name Lexapro^®. See the Full Prescribing Information for more complete information. Escitalopram, the active ingredient in Lexapro, may also be the active ingredient in other medications, and this information may not be accurate for all medications that include the active ingredient escitalopram.