#1: Make sure that blood clozapine levels are in the therapeutic range and the patient is taking the maximum tolerable doses of clozapine over at least 18-24 weeks.
#2: Inform the patient and the caregiver about possible dermatological side effects, including Stevens-Johnson syndrome, and how to monitor the skin.
#3: The initial dosage of lamotrigine should be as low as possible (12.5-25 mg by mouth, at bedtime) and increased VERY slowly, on average 25 mg/week to clinical response. You may consider increasing to a maximum of 300 mg/day.
#4: There has been 1 case of lamotrigine associated agranulocytosis reported, but one should be aware of such theoretical possibility.
#5: Try to keep patients on only the clozapine plus lamotrigine combination and avoid any concomitant medications (including nonpsychotropic medications).
#6: Upon achieving a clinically satisfactory response, the patient can be maintained on this combination indefinitely.
Source: J Psychiatry Neurosci. 2001 March; 26(2): 168.
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Dr. Harvinder Singh, M.D. (Admin)
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