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Objective To evaluate the efficacy of lamotrigine for treatment of short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing (SUNCT) syndrome.Data Sources: Literature was accessed through MEDLINE (1950-June 2010) using the terms lamotrigine, triazines, SUNCT, and trigeminal autonomic cephalgia.Study Selection And Data Extraction: All articles in English and studies conducted in humans were identified and evaluated.Data Synthesis: SUNCT syndrome can be an extremely challenging headache type to manage and has been considered refractory to pharmacotherapy. Many anticonvulsants have been evaluated as promising SUNCT treatments, with lamotrigine specifically reported as an effective first-line treatment option. There is a lack of randomized placebo-controlled clinical trials evaluating lamotrigine in SUNCT syndrome therapy; however, 2 observational studies, 3 case series, and 5 case reports were reviewed. Lamotrigine appears to decrease the frequency and severity of SUNCT attacks, leading to complete resolution in some patients. A decrease in symptoms was achieved with doses ranging from 25 to 600 mg/day. In some cases, there was initial response to low doses, but dosage titrations were often necessary when symptoms returned several days after being managed at the same dose. Lamotrigine should be initiated at 25 mg/day and gradually titrated, guided by response and adverse effects. The risk of Stevens-Johnson syndrome, a dose-related adverse effect, can be minimized with gradual titration.Conclusions: According to case reports and observational studies, lamotrigine therapy has resulted in decreased frequency or resolution of SUNCT syndrome attacks. Randomized, controlled trials are necessary to confirm the efficacy of lamotrigine for this indication.

Purpose To objectively evaluate various tertiary resources using a set of predetermined criteria to assess which provide the most complete, current, and accurate herbal–drug interaction information.Methods A search of the primary literature was conducted to gather evidence related to herbal–drug interactions. Based on the information found, six specific interactions were selected for review: St. John's wort–cyclosporine, St. John's wort–sertraline, coenzyme Q10–warfarin, ginseng–digoxin, danshen–warfarin, and kava kava–alprazolam. Thirteen resources commonly used in our drug information center were selected for evaluation: three drug interaction texts, three computer databases, and seven herbal texts. Criteria were developed to objectively evaluate the accuracy, completeness, and currentness of interaction information provided by each resource. Resources were ranked using an interaction content score, a referencing score, and an overall resource score (a sum of the interaction score and referencing scores).Results Interaction content scores and overall resource scores were highest for drug interaction texts and databases, whereas herbal texts generally earned lower scores. Interaction data found within the three Micromedex databases sometimes varied. Only three of the evaluated resources contained all six interactions.Conclusion Pharmacists should be familiar with the content and limitations of available resources for herbal–drug interactions. Based on the variability noted, it is recommended that providers use more than one of the more comprehensive resources described in this review. An evaluation of resources for herbal–drug interactions should be performed periodically as they are updated.