Lamotrigine is rapidly and completely absorbed from the intestines, almost without being first-pass metabolism of the first pass. Maximum plasma concentration is achieved in about 2.5 hours after oral dosing. The time to maximum concentration is slightly increased after a meal, but the degree of absorption is unchanged. The pharmacokinetics is linear with a single dose up to 450 mg trenbolone enanthate for sale (maximum dose investigated).There is considerable inter-individual fluctuations in the maximum concentration at steady state, however, with a few variations in each individual.
Distribution.Lamotrigine binds to plasma proteins for about 55%. It is unlikely that the drug release from the connection to the protein may lead to the development of toxic effects. The volume of distribution is 0,92-1,22 l / kg. Metabolism. The metabolism of lamotrigine participates enzyme uridine diphosphate-glucuronyl transferase (UDP-glucuronyl). Lamotrigine a small extent increases its own metabolism in a dose dependent manner. However, there is no evidence that lamotrigine affects the pharmacokinetics of other antiepileptic drugs and that between lamotrigine and other drugs metabolized by the cytochrome P450, possible interactions.Withdrawal. In healthy adults, lamotrigine clearance in a state of equilibrium concentrations averaged 39 ± 14 ml / min. lamotrigine is metabolized to glucuronide which the kidneys.
Less than 10% of the drug is trenbolone enanthate for sale excreted by the kidneys in an unmodified form, about 2% – the intestines. The clearance half-life, and do not depend on the dose. The half-life in healthy adults is on average from 24 hours to 35 hours. In patients with Gilbert’s syndrome observed decrease in clearance of the drug by 32% in comparison with the control group, which however remained within the normal range for the general population. On the half-life lamotrigine is greatly affected by jointly take drugs. The average half-life is reduced to approximately 14 hours, while the appointment of drugs that stimulate glucuronidation, such as carbamazepine and phenytoin and is increased to an average of 70 hours at a joint appointment with valproic acid.
Specific patient groups Children in children with clearance of lamotrigine per body weight higher than that of adults; it is highest in children under 5 years. In children, the half-life of lamotrigine is generally shorter than in adults. Its average value is approximately equal to 7 hours, while the appointment of drugs that stimulate glucuronidation, such as carbamazepine and phenytoin and is increased to an average of 45-50 hours, with a joint appointment with valproic acid (see. Sections “Dosage and administration”, “Interactions “). elderly patients no clinically significant differences in the clearance of lamotrigine in elderly patients trenbolone enanthate for sale compared to younger patients are not detected. patients with impaired kidney function If the kidney function the initial dose of lamotrigine is calculated in accordance with standard circuit-purpose antiepileptic drug.
Dose reduction may be required only when a significant decrease in kidney function. Patients with impaired liver function Starting, growing and maintenance doses should be reduced by approximately 50% in patients with moderate hepatic insufficiency (stage B according to Child-Pugh), and 75% – in patients with severe hepatic insufficiency (stage C according to Child-Pugh). Increasing the dose and the maintenance dose should be adjusted according to clinical response. Clinical efficacy in bipolar disorder patients Efficacy in preventing mood disorders in patients with bipolar disorder patients was demonstrated in two fundamental clinical studies. As a result, the combined analysis of the results, it was found that the duration of remission is defined as the time until the first occurrence of episodes of depression and mania episodes before the first / hypomania / mixed after stabilization, longer lamotrigine group compared with placebo. The duration of remission was more pronounced for depression.