Restarting Lamotrigine after abrupt Discontinuation.

(Q.1): Patient is stable on Lamotrigine but suddenly stopped it due to rash. Lamotrigine can be restarted (without need for titration) within how many days of lamotrigine discontinuation?

If a patient has discontinued lamotrigine for a period of more than 5 half-lives, it is recommended that initial dosing recommendations and guidelines be followed.

What is the mean half life of lamotrigine in healthy volunteers (single and multiple doses) receiving lamotrigine monotherapy?

  • 22.8 – 37.4 hr

Based on this information, 5 half-life = 114 – 187 hr (4.7 – 7.7 days).

Hence, patient can restart lamotrigine (without need for titration) within 4 days of medication discontinuation.

(Q.2): Patient is stable on Lamotrigine and Depakote but suddenly stopped lamotrigine due to rash. Lamotrigine can be restarted (without need for titration) within how many days of lamotrigine discontinuation?

Depakote increases the half-life of lamotrigine to mean values of:

  • 48.3 to 59 hours.

Based on this information, 5 half-life = 241.5 – 295 hr (10 – 12 days).

Hence, patient on depakote can restart lamotrigine (without need for titration) within 10 days of medication discontinuation.

References: 

  • Lamotrigine package insert.
  • Clin Pharmacokinet. 1993 Dec;25(6):433-43.

Academy members will have access to the following chapter:

Restarting Lamotrigine after abrupt Discontinuation

INTERESTED IN LEARNING MORE?

JOIN PSYCHIATRY EDUCATION FORUM ACADEMY MEMBERSHIP

This is a closed membership for medical professionals only.

  • 30+ Courses/Sections: Each chapter within these sections is of direct clinical relevance for your daily practice. 
  • Journal Club: we will post the most recently published psychiatry articles relevant to your daily clinical practice.
  • Coffee Club: contain short discussions with clinical experts in the field of psychiatry.
  • Essentials of Inpatient Psychiatry Book: All chapters from this book are included in the academy sections. 
  • Discussion Forum & Community: Connect with other medical professionals and discuss your difficult-to-treat clinical cases.
  • Conference Discounts: Academy members get discounted access at our conferences. 
  • Goal: is to have all important clinically relevant topics in one place for ease of access.
 

SUBSCRIBE TO OUR EMAIL NEWSLETTER:

Related Articles