PsychRounds: The Psychiatry Podcast Mood Stabilizers: Lamotrigine (Lamictal)
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Jul 17, 2024 Discover the fascinating journey of lamotrigine, originally an anti-epileptic medication, and its surprising mood-stabilizing effects. Learn how it became a key player in treating bipolar disorder, especially for maintenance therapy. Hear about the importance of a slow titration schedule and the potential risks of serious rashes. Explore its favorable side-effect profile compared to lithium and the unique challenges in patients with genetic risk factors. Plus, insights on its off-label uses for conditions like unipolar depression and borderline personality disorder.
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Follow The Slow Titration Schedule
- Follow the strict titration: 25 mg weeks 1–2, 50 mg weeks 3–4, 100 mg week 5, 200 mg week 6.
- Target 100–200 mg/day for efficacy and only go up to 400 mg/day if clinically justified.
Prevent SJS By Slowing Titration
- Avoid rapid initiation to reduce Stevens–Johnson syndrome (SJS) risk; slow titration lowers risk from ~1/100 to ~1/3,000.
- Treat any ambiguous rash seriously and consider stopping the drug rather than risk SJS.
How To Tell Benign Rash From SJS
- Distinguish benign rash from SJS by checking distribution, mucosal involvement, systemic signs, and patient pain.
- If unclear, stop lamotrigine and evaluate because SJS presents with fever, leukocytosis, mucosal lesions, and pain.