Background:
Lamotrigine is a phenyltriazine medication that has been approved by the
United States Food and Drug Administration as monotherapy and as an adjunctive agent for the
treatment of seizure disorder. It was later approved by the FDA for the treatment of bipolar disorder.
Lamotrigine is generally well tolerated by patients, but some serious symptoms can occur during
treatment. These severe side effects include rashes and multi-organ failure. Lamotrigine has also
been associated with the development of mental status changes, frequently when used concurrently
with other medications that may impact the metabolism of lamotrigine.
Objective:
To present the case of a 65-year-old man being treated with lamotrigine and valproic acid
who developed mental status changes after the addition of sertraline to his medication regimen,
and to compare this case to existing cases reported in the literature.
Discussion:
Our case adds to the existing literature by demonstrating that patients may experience
adverse medication effects despite lamotrigine levels that are normally considered to be in the therapeutic
range, highlighting the importance of clinical correlation when obtaining medication levels.
Conclusion:
Clinicians should use caution interpreting lamotrigine levels when working up delirium,
as normal levels may not rule out the development of lamotrigine toxicity.
:
Ramelteon is a melatonin receptor agonist that is approved for the treatment of
insomnia. It is widely used due to its relatively benign side effect profile and lack of dependence
or withdrawal. Due to its tolerability, clinicians have attempted to utilize ramelteon
to normalize the sleep/wake patterns in patients with delirium as a safer alternative
to antipsychotics or other medications. We present the case of a 75-year-old man with
long-standing dementia who was hospitalized due to mental status changes, agitation, and
sleep disturbance. After addressing possible underlying causes with minimal improvement,
the team initiated treatment with ramelteon (8mg nightly) which resulted in rapid
improvement of symptoms. Uses and mechanisms of action of ramelteon will be reviewed,
as well as current pharmacologic treatments of delirium. Prior research studies
and case reports regarding the use of ramelteon in the treatment of delirium will be discussed
and suggestions made regarding possible areas of future study.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.