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Lamotrigine 💊
Related Subjects: |Status Epilepticus (Epilepsy) |Coma management |Lorazepam |Phenytoin |Levetiracetam |Epilepsy - General Management |First Seizure |Epilepsy in Pregnancy |Febrile seizures
⚠️ Caution: Stop immediately if rash, anaemia, bruising, fever, lymphadenopathy, or sore throat develop → urgent medical review. 👉 Starting low and titrating slowly reduces the risk of severe rash (e.g. Stevens–Johnson Syndrome, TEN).
📖 About
- Check BNF entry here for up-to-date dosing and monitoring guidance.
- Mechanism: stabilises neuronal membranes by inhibiting voltage-sensitive sodium channels and indirectly decreases glutamate release.
- Favourable cognitive profile compared with some other antiepileptics.
🧾 Indications
- Partial seizures.
- Primary generalised tonic–clonic seizures.
- Juvenile myoclonic epilepsy.
- Secondary generalised seizures.
- Mood stabiliser (esp. in bipolar disorder, depressive relapse prevention).
💊 Dose (Adults)
- Weeks 1–2: 25 mg PO on alternate days.
- Weeks 3–4: 25–50 mg daily.
- Titration: Increase by 25–50 mg every 1–2 weeks as tolerated.
- Maintenance: ~200 mg/day (range 100–500 mg/day in divided doses).
- ⚠️ Interactions matter: halve dose if taking valproate; increase dose more rapidly if on enzyme inducers (e.g. carbamazepine, phenytoin).
🔄 Interactions
- ↑ Carbamazepine levels (may cause toxicity).
- Valproate ↑ lamotrigine levels → higher rash risk.
- Enzyme inducers (phenytoin, carbamazepine, rifampicin) ↓ lamotrigine levels.
- Always adjust dose depending on co-prescribed AEDs.
💥 Side Effects
- Skin rash (within first 8 weeks) – may progress to Stevens–Johnson Syndrome or TEN → stop immediately.
- Drowsiness, dizziness, diplopia, headache, insomnia.
- Psychiatric: agitation, anxiety, confusion, hallucinations.
- Haematological: bone marrow suppression → ↓ Hb, WCC, platelets.
- Hepatotoxicity (rare).
🧪 Monitoring
- FBC, U&E, LFTs, and clotting at baseline and if symptoms develop.
- Monitor for rash closely during first 2 months.
- Caution in hepatic impairment (dose reduction needed).
📚 References
- BNF – Lamotrigine
- NICE CG137: Epilepsies in children, young people and adults
- NICE CG185: Bipolar disorder
| The content on this website is provided for educational and informational purposes only to support exam preparation (e.g., MLA, MRCP, USMLE) and learning. This is NOT medical advice, diagnosis, treatment, or professional guidance. It does not replace consultation with a qualified healthcare professional, official guidelines (e.g., NICE, GMC, BNF), or supervised clinical practice. Always verify information with current, authoritative sources. Makindo and its contributors accept no liability for any reliance on this content, including errors, omissions, or any resulting harm, loss, or consequences. By using this site, you agree to these terms. |
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