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Lamotrigine: dosing tips and prescribing pearls.

Brands * Lamictal

Generic not available

Class

Anticonvulsant, mood stabilizer, voltage-sensitive sodium channel antagonist

Dosing Tips and Prescribing Pearls

** Lamotrigine is a first-line treatment for bipolar maintenance and bipolar depression

** May be more effective at treating depression than mania, but may prevent both depressive and manic relapses

** Valproate inhibits lamotrigine metabolism, so when used together, lamotrigine dose should be reduced by half

** Lamotrigine use may be reduced due to exaggerated fears of skin rashes or limited understanding of how to manage skin rashes

** Rashes occur in 5-10% of placebo-treated bipolar patients

** Rashes occurring within 5 days of after 8-12 weeks of treatment are rarely drug-related

** If benign rash develops, reduce dose or stop dosage increase, prescribe antihistamine and/or topical corticosteroid for pruritus, and monitor patient closely

** If rash worsens or new symptoms emerge, stop lamotrigine treatment

** Some patients with benign rash can be rechallenged with 5-12 mg/day, with very slow titration if benefits outweigh the risks, patient is reliable and is informed of risks, patient is closely monitored, and patient is told to stop lamotrigine and contact the physician at first sign of hypersensitivity

** Risk of severe rash is less than one percent and has been declining

** Risk of serious rash is not unique to lamotrigine but also exists for carbamazepine, oxcarbazepine, zonisamide, valproic acid, phenytoin, and phenobarbital

** If serious rash develops, stop lamotrigine, monitor and investigate organ involvement, and consider hospitalization

** Risk may be greater with higher doses, faster titration, concomitant valproate, in epilepsy patients, and/or in children under 12 years of age

Adapted from Stahl SM Essential Psychopharmacology: The Prescriber's Guide.

Cambridge: Cambridge University Press: 2005. Reproduced by permission of Cambridge University Press. To order, go to: http://us.cambridge.org/titles/catalogue.asp?isbn=0521011698
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Title Annotation:Tips and Pearls
Publication:Clinical Psychiatry News
Geographic Code:1USA
Date:Jun 1, 2005
Words:290
Previous Article:Soothing the anxious patient: calculated combinations.
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